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`BUTLDING PERMIT APPLICATION TiGARD DATE_ ,TA's►ABY � �_,19 ���"
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE ? J -
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATICGNS. OWNER PHONE
LOT N0. H) T.cron
OWNER '(r: nand Clark JOBADDRESS 1.1980 SriJ• 119th Ave. - _---
-- +-;,1ITECT
I.W. Firs11y4[rn iil�l=. Inc. 11U59 Sr'.. IiiwitRicm I�tA. ' NG!NEER 11mysan, 1* L
BUILDER — ADDRESS — - -)ES_GNER --- - - -
STRUCTURE _❑ NEW ❑ REMODEL [2 ADDITION Cl REPAIR _ ❑ RENENAL _ ❑ FIRE DAMAGE ❑ DEMOLITION
*OESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOWT 1 RELIG,IOUS_❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLABL1 FENCE
OCCUPANCY -It--3 _'LAND USE ZONE _.��_. .BLDG.TYPEA� 5u FIRE ZONE__ - PLAN CHECK BY !! HEAT__ ^^
Conutruet Fratily F,nm iddition to : ini?le Family 1Duollinge
See correction nbeot AttaCl,w-l.
Pym-vtC reg1d fur ;'oo,.' Stnvv_
SEWERPERMITq - ----
_OCC.LOAD _FLOOR LOAD 40 HEIGHT il. NO.STORIES _ 2AREA 210 NO.BEDROOMS VALUE 1 ,501
BUILDING DEPARTMENT SET BACKS FRONT REAR Flt LEFT SIDE 12 RIGHT SIDE
Permit 86.50• THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
REGULATIONS AND ALI APPLICABLE CODF-; AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check Fxl• WORK WILL BE DONE IN ACCORDANCE W1. 1 THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
3'irSU WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PFRMIT DOES NOT WAIVE
Sub-total RESTRICTIVE COVENANTS,CONTRACTOR A14D SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
3r��h LICENSE.SEPARATE PERMITS RFOUIRED FORSEWER PLUMJSIN
f{0fAND HE9 t �
State Tax
SDC-
Total
PDCM APOLICAN?OFR� OE
ANT
drrl'
By _ _ ger" ll♦'. /�'�� /� � Ir'''I
���AI Recelpt No. ADDRESS PHONE
Approved _ _ �-__` !•
i
I
DAIS INSR TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No. —
t
Rough-in - — -
-'�3 1 _ Fixture — _ -
Final
HEATING
Contractor
�
Permit No. 2 e9 -2255 /-
Gas or Oil
Rough-in
Final
SEWER —
^ � Final ---- —
DRIVEWAY
Final
Storm Drainage
--
(Rein Drain)Final
Sidewalk
Curb&Street Final
— - --_y-- ---� Aporoech _
BLnG. DEPT.FIN/`t. TEMPORhRY CERTIFICATE OCCUPANCY Final J
CERTIFICATE CCCUPANCYfff j
Landscnpint 1
Zoning Firal -
a+Ahi oh Q' r.r�ur,K •Z i� r
BUILDING PERMIT APPLICATION TIGARD
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THEVNORK HEREIN INDICATED BUILDER PHONE25-3-11 07
OH AS SHOV:N AND APPROVED IN THF ACCOM PANYING PLANS AND SPECIFICATIONS. OWNER PHONE
JUB ODRESS I I9Q S� 1119--Ave. _ LOT NO. �.e!���y�5
O'IVNEY._ _ i �IIiZ- -
1 ARCHITECTENGINEER
(�
BUILDER„I`u �T� � q, Ur jNC.ADCRESSllO 3 S AN 0 �DESIGNER C>r,QJ�fo //`C.
STRUCTURE ❑ NEW ❑ REMODEL ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE (] COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE_ G STORAGE ❑ SLAB❑ FENCE
OCCUPANCY . __LAND USE ZONE BLDG.TYPE __FIRE ZONE-_-"' PLAN CHECK BY � HEAT
--am - - ° ^gi n- ;0-�Itv �\)Ue 'itd -
SEWER PERMIT M /a/2S'V
OCC.LOAD ------FLOOR LOAD HEIGHT 'f NO.STORIES 1 AREA 2130 NO.BEDROOMS VA.lAf fto
VBUILDING DEPl,RTMENT SETBACKS FRONT •-^ REAR LEFT SIDE 14 RIGHT SIDE -�
P^rmlt 6.3-0 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTA'NED IN THE BUILDING CODE,70WNG
P REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCiS, AND IT IS IiEHE3Y AGREED THAT THE
SPI&n Check P�� .. WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
r �� - WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERPAIT DOES NOT WAIVE
e
0 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE.PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
;Stata Tax
SDC- '^ � -
Total i SO M
- - - _
PDCN APPLICA OR AGENT
By
Receipt No.
Approved ADDRESS ��= PHONE
SDC -
PDC - S # Cj
SCWER CONNECTION S /
SEWER INSPECTION S / ' II $�
SEWER SURCHARGE S Key'
11 .17 4)LO 14000
CITY OF T167A RD
WASHINGTON COUNTY,OREGON
BUILDING DEPARTMENT
PLAN CHECK APPLICATION Date N6-v ' 9�•2-
This is to certify that the following plans have been submitted
for plan check pursuant to the Oregor Structural Code and Fire
& Life Safety Code, 1979 Edition.
Owner ettj-mymx UAr
Job Address 110, f3o Sw 1I k 1 .
Lot No. 600, Leyvvl W5, fV6,. -
1�
Owner/ADplicant Address j1 g.0W I I q
t 1 o r i _ P h o n e N o. —11�0-2&
Description: P_ S rlx v o l 1 Cao Lr-),% GSR I <
°l r>z3 i P.H-Gem,2 6 C1 -�rj
elaya 6�J1c1 f3,na seh F;1 '
Cit3(:�of- Tigard, Building, Dept.
B Y
- --- 12420 S.W. MAIN P.O. BOX 23397 TIGARD, OREGON 97223 PH: 639-4171 ---- - --�
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CITY OF TIGARD— 12420 S.W.MAIN -- TIGARD,OREGON 97223
PIECEIPT
DATE:
AMOUNT- S-,5
_-_-_4)0LLARS
NAMEL: -CASH:
ADDRESS: _wj
�HE __
# OF
FOR: ACCT. 0 PERMITS SURCHARGE AMOUNT
SEWFR BILLINGS 40-364
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNFICTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV,CHARGE 25-366
PARK DEV CHARGE #1 30-367
PARK DEV.CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362
1�'CCG rtJf".1-� A,11
fj'_
TOTALSal
RECEIVED BY
PERMIT NUMBERS ASSIGNED:
Number Amount -Number Amount Number Amount
RECEIPT #1
256
F-JOIWM
PERMIT TO CONNECT
Tiga;.-d Sanitary Distric'L
PERMIT N9 1698 DATE - - - - -
PFRIIIIT IS GIVEN TO
i
OF --...--- .., — - -- — -- �.�---
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.... .............................TIGARD SANITARY DISTRICT
By
(•1)f+NE(l'I0N INSPECTFI) AND APPROVED
Date Superintendent
Address L q6� / / QT Permit No. f Q QP
_ Permit charge o�
Owner i7, � - Cf— Connection fee �h--co'
Paid by
Type of Building Date connected
Service Rate Inspection fee
Contractor_ Paid by �.dt Date
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Size of connection y, Assessment Paid
I _