13780 SW 114TH AVENUE 1.3780 SW 114TH AVENUE
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BU LDING PERMIT APPLICATION SOF VGARD DATE._A_11• � __. 19�—_
THE I)NDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED SU:LDERPHON �. _
OR AS SHOWN AND APPROVED IN THE ACCOMPAM'rING PLANS AND SPECIFICATIONS 7 �
WNERPHONE _M.2,
L07 NO.
O%IVNFR Jack LNntCC►I JOB ADDRESS 1,;780 `iU 114th HOME ADDRESS
ARCHITECT —
B'JILDER DWI) ADDRESS ENGINEER
- _ DESIGNER_ _
STRUCTURE ❑NEW ❑REMODEL - ❑ADDITION ❑PEPAIR _URENEWAL [IF IRE DAMAGE ❑DEMOLITION
RESIDENCE OCOMM ❑EDUCATIONAL. ❑GOV'T ❑RELIGIOUS❑PAT17 ❑CARPORT ❑GF9AGE ❑STORAGE❑SLAB []FENCE
t�
— — I
OBOND _—_ ❑MOVING 000NDITIONAL USE ❑DESIGN RE /IEW ❑COUNCIL APPROVED ❑SIGNS _
OCCUPANCY � LAND USE ZONE . _ BLDG.TYPE------FIRE ZOF E,L_ PLAN CHECK BY_L__—_ - HEAT
ba6a(nl.11-lt F_mL 'Iai — �a.tl per plen
Plumbifl(i 11 rlRit �;.:yuir(.,ra ---- ----� ------
OCC.LOAD FLOQR LQAD HEIGIjI _ NO,STOR 0- No.BEpgc)o 4S--_VALLIE-'OQ(I
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit `4,03
—` THIS PERMIT IS ISSUED SUBJFCT TO THE REGULATICINS CONTAINED IN THE BUILDING COOP, ZONING
Plan Check REGULATIONS AND ALL APFLICABLE CODES AND ORDINANCES AND IT IS HEREPY AGREES THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH 1 HE PLANS AND SPECIFICATIONS ANC IN COMPLvANI:E WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THE, PERMIT DOES NOT WAIVE
RESIRIC71VE COVFNANTS. CONTRACTOR AND SUB C.ONTRAC"FORS TO HA 1/E CURR(N-' CITY BUSINR
State Tat 1. 7u LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEk'•ING.
Total 41), 76
Y ._—
- �_...
Apoi.ICANT OR AGENT
Approved (�,�r,�il,I N..
AnDRFSS — BN23R€—
DAi E INSP. TYPE INSPECTION REMARKS PLUMBING DATE
�— -- - Contractor -
Permit No.
Rough-in
r — Fixture +—
Final_
-- --- HEATING
Contractor
Permit No.
Gas or Oil
Rou h in
_ Final
--- - -- _ SEWER
Final
DRIVEWAY
Final
—_— — -- — -- -_ Storrn Drainage-_
(Rain Drain) Final
Sidewalk
Curb&Street Final
-- -- -- ---...--._ A roach
BLDG DEPT. FINAI TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final —
Landscaping
Zoning Final
BIJII. E.M PLHMIT APPLICATION LOFY TIC ,",RD DATE_--_L�-.__�i_. tQ7 N2
-,,HE I,NDi HSIGNELQ HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED bUILDER PHONE
AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIF ICATIO"IS. OWNER PHONE
.L� LOT NO. ---
k - 'JOB ADDRESS f 3 7�� J L HOME ADDRESS —
'v ARCHITECT
J �/ � ENGINEER
_R —_� G- J ADDRESS __—_-- DESIGNER
;..'URE LJ%EW REMODEL ❑ADDITION ❑HEPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
.IFNCE ❑COMM ❑EDUCATIONAL OGOV'T 0RF.LlrI0US0PATI0 0CARPORT ❑GARAGE ❑STORAGEOSLAB ❑FENCE
'POND ❑MOVING _ ❑CONDITIONAL USE r❑DESIGN REVIEW []COUNCIL APPROVED OSIGNS
'.CUPANCY� �LAND USE ZONE` BLDG TYPE _._s�1.�FIRE ZONE PLAN CHECK BY..___JL-6,1,'-/—� HEAT—,Ale
----
(:. H€ISG_H_IT --_--- _.__M_,.TQB,E5----_Aft LA VALUE__
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
- THIS PERMIT IS ISSUED SUBJECT t0 THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL !'E DONE IN ACCORDANCE WITH THE PLANS AND SPEC$FICATIONS AND IN COMPLIANCE WITH
Sub total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVF COVENANTS. CONTRACTOR AND SUB CONTRACTORS FO HAVE CURRENT CITY BUSINESS
Bic Tax -- /�J LICENSE SEPARATE PF LIMITS RFOUIRED FOR SEWER, PLUMBING AND HEATING.
Total
APOI ICANT OP ROE NT
App'nved Receipt No.
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City of Tigard
INSPECTION REQUEST
i for
INSPECTION TIME PERMIT NO. :
DATE: _ i7 73,. DATE ISSUED:--,/-
OWNERS NAME
IADDRESS * _13���' dcs• rrs/�'` Com.•, - ----
I
CONTRACTOR ' _ - - -- - --- -----
ITEST. Air CJ , Water ❑ , Visual �(, Laboratory
RESULT. Approved Disapproved 0 Fending L7
SKETCH:
I
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INSPECTOR DATE
I NOTE: Attach supplemental tett dato hsrtt-
01
1
9
Address 13780 S.W. 114th Ave. Permit No. 4741
Permit charge
Owner Jack LENTSH Connection fee 425
Paid by Columbia Custom Homes
Type of building Residence Date connected 11-28-72
Service rate 3.00 per month Inspection fee 25.00
Contractor Culumbia Custom Homes Paid by same Date
Size of connection 4" Assessment Paid
j t
111,1111raw IKPF ml
I
City of Tigard
INSPECTION REQUEST
for
I
r-.
IINSPECTION TIME : _ PERMIT NO.: y7y�
I DATE: DATE ISSUED: -"
OWNERS NAME . —
I
ADDRESS ' —
CONTRACTOR :
DDRESS ' _CONTRACTOR : z< <<" -E-- - —
ITEST: Air U, Water ❑ , Visual 0 , Laboratory [I
RESULT: Approved D Disapproved O , Pending L]
I SKETCH:
I
I
I
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INSPECTOR DATE
[t OTE . Attoch supplementol test dato hereto]
I
.W,.mw
ffIN' � �XW_AW I-W- r WF
it lsauxd /O 3.�`�. __ CITY OF TIGA3n, ORZGK)N Permit No-
Cly 1&U
Aagdic,tiwr .Approved Bulldint Departmuit Coed of Instal3atk+tt—.-
4 1(04 -0""" J"""Aba gee for paresdt__„help_
.�
f
Applicant shall fill in cost of installation only,
street Sewer Permit
above this double line. ----__-.- _
Application u hereby made to raf4 Plumbing Pipes or Fixtures according to plana and specifications and
Install description as given below.
IAWSUOn of building--Numtx-T and Street
Lot — ----.__ Block Addition__ -- -- -
Nam,: and Address of Owner (� Q
Name and Address of Plumber-4
Building (Old or New)- Height in Stories.___.____ __ Occupied as--
SCHEDULE
s SCHEDULE OF WORK
"�•' NUMBER NUMBER
MTURES_ New Move I R'pl'ee P7RTURES _ New Move R'pl'ee
—�_„" _I I _ Fountains, Drinking
Water Closets- - -- --- —'
Both Shower Fountains, Yard-1
I
Bath Tub - Fountains, Soda_-_ _
Iw
Basins -_ I Hei Waier Toni_
Sinks, Ordinavll. t�i — -- `.inks, Bar _
Sinks. DishwashingI __ q:nks, Slo
�f
Automatic Dishwasher n___I __i �•.-
Drains,
Laundry Trays Il Drains, Ice Box
_._I`�` Urinals ._.
Drains. h:oor II_- _ -
Drains, Area -_ _ _._.___I____—I� —_--_- Catch Basins, Yard _i - ---
Agin Drains I' �QT�..—__ Catch-Basins, Garage
_ _
I i ;
/ I Catch-Basins, Sub Soil_._,__
Automatic Washer__ _ �. I_ .,•_-- -
Water Permit No.__. . _ _ Illdg. Permit No. �1 _�f� __ I `'
REMARKS: ctiJ
IMPORTAN i I—Plumbing shall not be Installed In any building, (aither new, altered,or repaired), except as shown or designated
on the corresponrMg building plans as filed with, or required by, the Building Department In accordance with the
provisionsof the Building Cade and Ordinance 61.19 ')f the City of Tigard.
I Agree to aftt�lr the plumbing system according to this description, plans and speritiratiom and the Plumbing Cotte of the
install city�o Tigard. /
t: , /
Plumbing Firm. �'~ - - 0� - - ---•------ - _ _ --- - - - _
Supervisor ie
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BUIIVER ' C�l�j� <2!�� �n �x � VALUE ��'J, D FEE //�` O DATEi .� j
LOCATION UwlVER
10._.8�## MAP # 5i :'VC' LOT TYPE �
PLUMBER P RMIT
SEWER PERMIT 7V -FEE � -r �S r Sv NECHAN CA rEHMI
DATE BY DATE
EXCAVATION FILL AIR CONDITIONING
_ FOOTINGS FOUNDATION IVERTILATION
FORMS SPRINKLER SYSTEM _
SLABS MASONRY FLUES
REINFORCING STEEL FIRE DOORS EXITS _
STRUCTURAL STEEL _ GARAGE FLOOR
_ PLUMBING R, I . D U VEWAY
ROOF/FLASHING ; �� SEWER
FRAMESTORM DRAIN
LATH/WALLBOARD PARKING
-_ HEATING FEN(.'O'EZ,SCREEN
WATER HEATER FINAL
CITY OF TIGARD
171!0 f. W. Main Nr.M
11GARD, ORNGON 17227
APPLICATION FOR BUILDING PERMIT
New Construction Demolish ❑ Addition, ❑ Remodel ❑ Move Q�
ZONING R-7 �_- DATE ISSUED 1-0'542 BUILDING PERMIT
S
DATE RECEIVED 9'27'72 BUILDING FEE
PLAN CHECK S yALUATION $ 30#000'
BY __- _H8 — OTHER $ 10.20 .—.
t
TOTAL $ 111.50 Y4ECE I PT NO.
_
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT / 26 MAP / SOC CENSUS TRACT _W JOB 1
_._ -_ - ----- --
Architect or Eng inee r �..l,..w+. cys� •••�•• _ ____..__-- ___-_
Phone
Address
owner_ ""I,...hi_ r-untno unman -
Phone _
Address _ -
Builder__
Phone
Address
BUILDING USE Single Res. l:1T Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP__ No. of Storie'1_ Total Fieight___Ifi_ Area of LotjUQQ*__
Type of Construction X1XX10d7000012XXM V Floor Area B _ 1� 4, _ 2- -_
Set Backs: Front 24 _ Back 52 L.Side 15 R.ride_-22.25
Private Sewer Pipe Size 4" SewerU*S.A. riprdseptic Tan►: ❑
Water Service Pipe Size4" Storm Sewer ® t)itch ❑ Drywell`]
Street and Curb Requirements_ jx st -------
Drivcway Width No. of Parking Spaces_ J-
SEPARATE PF:RMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED_— _ -@•N.
FIELD CHECK BY __ _ ___ ___ _,DATE.
PERMIT APPROVE[) 14Y .-
it
Y -It is understood that all work, will conform with applicable 1201!"s and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building till
not be occupied until a Certificate of Occupancy has,been issued by the City of
Tiqard Building Inspector.
natur 0 Appcint
YlN1FfEQ► SEWERAGE AC�iEl�i `Y . 4741
WASHINGTON COUNTY DATE
.u'
CITY
APPLICATION FOR SEWER CONNECTION PERMIT
a
OWNER:
---- ------- 1—-- ——_ ----- - -- — -----
OWNER'S ADDRESS: —_--- 9 &A&
STREET
BUILDING SITE. LOT-_.._ 26 — BLOCK �_____. ACClTION
TAX LOT NO. TYPE OF OCCUPANCY _ - MAUSUO
ADDRESS __ 12W S.M. 1VAh AV*
1 FIXTURE UNITS
DWELLING UNITS - --- -- _
SURCHARGE IF APPLICABLE _—_.__ 50.00iit ------
PERMIT FEE .. -_- -..---- INSPECTION FEE 15-99--_ TOTAL DEPOSITED _ •� __
1
(NEW) (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agenc�i.
J
APPLICANT
SEW R PERMIT
THIS PERMIT .AUTHORIZES CONNECTION TO THE SEWER SYSTEM
LINE SIZE -4--m INSTALLER _ Dish Moe
RECEIVED BY_ -
*1 _0
R ITS AOENTI
COMMENTS:This Application and permit expires in ninety (90) days. The amount paid will he forfeited
should expiration occur. `
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