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12040 SW 119TH AVENUE-1 12040 SW 119TH AVENUE li o N :Ya , .-a o s� a L` I a w I 1 llvlI+ V City of Tigard INSPECTION REQUEST for INSPECTION TIME: PERMIT NO. DATE ; 41_x'1_%'--' DATE ISSUED :!-_1__ OW N E.RS NAME * -- r�' ADDRESS: CONTRACT() R : - ��- �-- - TEST '. Air O, Water Ill , Visual laboratory ❑ RESULT : Approved Ll-'-- Disapproved 0 Pending ❑ SKETCH.* INSPECTOR DATE OTE: Attach supplemental teat doto hereto IIS �vuQcc7-D ALL gt�.AC'�a i':�iUr`' T C I ... ,y �' j�iVJ ,�("' •r,.' .. Vy n rrLAPJNiNti, I P. �v. C t•.'f I CITYAUMiN ,.... 13Y pr,T?.•- y'� TI TI }7Y.... y- W �7 ? ty DATtL Q -- _-1 c DATL f I vr. NAWRAL - -- SA —�—..�. 71 BY -- '�~ �• r' nCD 73 rn a \ ...i I ri'l t 13` C U CL n' 0 (1) L.- c L 1 4/6 S �ti' . / y till i i i s a � 4 ► h .J D-110 A- Xlk •C .,J .d ' top J �- i -c _ �► U V6% f I i !a o •,�6 S, w /I 9G4�� Al li va Ilk Q�.6 0 Lj d W CITY OF TIGARD 12420 S. W. Main stmvt TIGARD. OREGON 97223 APPLICATION FOR BUILDING PERMIT Neo Construction Demolish ❑ Addition © Remodel ❑ Move ❑ ZONII,G R-7 DATE ISSUED 4-2� 73 _ BUILDING PERMIT DATE 2EC)✓I"ED BUILDING FEE $__ 2�pp_ No. , v A9 PLAN CHECK $__ 14.50 BY FS OTHER $ VALUATIOiv S 4,950 TOTAL $ liter^ RECEIPT No. 2YC2 TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION LOT M 3000 MAP M 1S1 34CD CENSUS TRACT W-19 JOB N Architect or Engineer— Address --Phone Owner Address Lolao_c_lIL_ Iia*--�-- — — ------- --- --Phone, Builder Walter Romans Audress166TO S.W. Vinoent St., Beaverton. QrejAa —_i„Phone-t"L.!U,,a BUILDING USE: Single Res. © Multi Res. ❑ Comm. ❑ industrial OCCUPANCY GROUP! No, of Stories- Total Height Area of Lot Type of Constructionfimmf V Floor Area B---.— 1 376 ?_ Set Backs: Front cL,`_ Back, 43t L.side_- -- R.Si.de_ _,(L Private Sewer Pipe Size Sewer__-_______ Selo is T� nk ❑ Water Service Pipe Size_ _ Storm Sewer ❑ Ditch ❑ Drywell ❑ Street and Curb Requirements Driveway Width_____ existing _No. of Parkinq Spaces____.___ SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING SPECIAL INFORMATION ADDRESS ASSIGNED _ FIELD CHECK hY" � ___ —DATEas 43 __-- PERMIT' APPROVED BY L.r14 A�1/� It is understood that all work will conform with applicable codes and ordinances of the State of Oreqon and the City of Tigard, Oreyon, and that the building will not be occupied until a Certificate of Occupancy has been issued by the City of Tigard Building Inspector. 5qna ure of :,�p�icant i I CITY OF TIGARD PROCESSING/TRANSMITTAL CHECK LIST JOB NAME: *TYPE: LOCATION: RECEIVED FROM: a&( RECIPIENT 0=1 _ , Date CHECK ITEMS RECEIVED CIRCLE ITEMS NEEDED ffFinal Plot/Site Plan /�4-'Floor ' Building Plan Construction Plan Preliminary Plat. Foundation Plan Sanitary Sewer Plan PlatPlan Storm Sewer Plan Landscape Plan LExterior Plan Street Level Plan Parking Plan Mechanical Plan Streetlight Plan Sign Detail Cabinet Detail `_� Area Drainage Plan �—/-; Aerial Photo Stair Detail ! / Water Utility Plan L! Location Map Truss Detail 7-� Gas Utility Plan Topography Map Fireplace Detail Phone Utility Plan Z/ Land Survey Building Specification Elect, Utility Plan L/ Building Elevations Street. Sign Detail LL Catch Basin Detail Co:t Estimatef4q $vc—"- � l �u / / Manhole Detail Specification E / Sidevalk Detail [Ll Material/Quantity List ��? Curb Detail Report/Legal Documents c� /�/ Driveitay Detail Deposit/Fee L/ Other: COMMENTS: ATTACHMENTS: Routed To (date Planning Dept. Public Works Building Dept. Other * Insert: L.I.D. Project; Subdv. Imprv. Project; Building Const. Project; Etc. PERMIT TO CONNECT Tigard Sanitary Disirict PERMrr N9 1077 UATf: --. PERMIT IS GIVEN TO - - OF TO CONNECT A TO THE SYSTEM OF TIGARD SANITARY DIbPRICT AT Tans 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 CONNECTION INSPECTED AND APPROVED Date -- _ ._ 8uperluteadent UEPMN Mill MiI'll Address_ 2ok/p Permit No. /(' Permit charge 20� Owner G_T�'a_tt��•,� ia. ��� Connection fee rf.J�+✓ Paid by b�1r l Type of Building Date connected—,-) Service :tate_ _ Inspection fee � Contractor_ _ Paid 'A Date C to-•-� �'�� Size of connection Assessment Paid 1 Ldr