10570 SW 121ST AVENUE 10570 SW 121ST AVENUE
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City of Tigard
INSPECTION! REQUEST
for
INSPECTION TIME : �GaG�� PERMIT NO. : --
DATE
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DATE ISSUED:. I—J -
0WNERS NAME : '�` ``� 4-�4z cr --
AD OR E S S
CONTRACTOR '-
Water
ONTRACTOR :_
TEST'. Air O, Water 4ieual it Laboratory ❑
RESULT: Apuraved Disapproved ❑ Pendon4
I SKETCH: �w� �� ��• � �/, ecj
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IOTE: A11eeh •upplsmonfal test data hereto]
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :
DATE : DATE ISSUED :__IL
OWNERS NAME
ADDRESS: _ �L
C0NTRACTOR --
TEST : Air 0, Watery , Visual tR Labt...votory p
4ESULT: Approved iJ , Disapprove Pending p
SKETCH:
INSPECTOR DATE
50TE: Attach supplemental test data bereto�
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City y of Tigard
INSPECTION REG? S U E �
for
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SPECTION TIME: PERMIT NO. :
DATE: J-11477 DATE ISSUED
V N E RS NAME : c� 49-� c.•
ADDRESS:
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ST : Air ❑, Water❑ , Visual p , Laboratory ❑
"SULT: Approved ❑ Disapproved C , Pending p
KETCH: 13c vc- H q c v s,,,...;, �.-F .�.� �•w. .p
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INSP TOR DATE I
[NOTE: Attach Supplaffiantal toot data boreta� I
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City of Tigard r
INSPECTION REQUEST
for
SPECTION TIME: PERMIT NO. :
DATE: s //x/27 DATE. ISSUED .__LL_
NNERS NAME . t t_ —
ADDRESS:AY,&r, 13 C' 4 li4" Uj•4 , ^ I
)N TRACTOR :
'EST : Air p, Woter_O ,, Visual -3 , Laboratory p
ESULT: Approved Er' ,"'Disapproved Disapproved C Pending n I
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NOTE: Attach supplemental rest data pererai
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FIRE PREVENTION BUREAU
OFF1,. OF FIRE MARSHAL Z
5 5 ��1 ,�
INSPECTION NOTICE
OWNER l' 1T --DATE
OCCUPANTf __OCCUPANCY , ,e [j!'�✓Fyp ,,�
LOCATION �
YOUR ATTENTION 19 CALLED TO THE FOLLOWING FIRE SAFETY DEFICIENCIESt
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FAILURE TO CORRECT THE ABOVE CONDITIONS WITHIN 0/A�.YS WILL. MAKE YbU,LtARLE T'b b19 SV'�"
SHOO D FIRE,
RESULT FROM SUCH CONDITIONS YOU MAY BE LIABLE FOR DMMAGE$ TO PERS $..pR,PROPtRTY ROVIS UNS O '
ORS 47D 100.
Y / y—., J
WASHINGTON COUNTY FIRE DISTRICT N1 .JE Ards AL
17880 S. W. BLANTON STREET f'4�
ALOHA, OREGON 97005 649857; PRESIENTEQ' ,
FORM 900 - 40
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BUILDING PERMIT APPLICATION " Y TIGARD 4-19DALE 4-� 19_77 +�
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE_
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHOPIE
n f LOT NO.—_
OWNER a9nc��e11 A C►d• JOB ADDRESS 105710
05 X10 SeLt• lest AyLiWOME ADF-RFSS
C ARCHITECT
DUILDER Groan Gunits Co, ENGINEER
ADDRESSDESIGNER
STRUCTURE tNEW O REMODEL^- OADDITION OREPAIR ❑RENEWAL OF IRE DAMAGE ❑DEMOLITION_
O RESIDENCE OCOMM ❑EDUCATIONAL OGOV'T ORELIGIOUS OPATIO OCAR PORT ❑GARAGE O STORAGE OSLAB OFENCE
OBOND OMOVING OCONDITIONAL USE ODESIGN REVIEW ❑COUNCIL APPROVED - ❑SIGNS
OCCUPANCY LAND USE ZONE _BLDG.TYPE'_ FIRE ZONE. PLAN CHECK BY_ HEAT
const. a 4U x 10 f t commercf al •Wimm"rj - oog per olene dry s ,]uly a, ;.Q7:,
Oy Rolla Be d^ughen .E• Protection fence to be in place boforo pool is
P6rnt t raquirr d f,ar pool h �u11M—
uCS�l.OAD Fl,9S)6_L�QBI- -- - HEIGHT! NQ SLTSZBIF.�.----_—AHEA_ NO.BF12QM: VALUE 6500
BUT' G DEPARTMENT SETBACKS FRONT-par PISMEAR LEFT SIDE RIGHT SIDE
Permit 40.00
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDINU CODE, ZONING
Plan Check • REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANC- WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax • LICENSE. SFPARAIF PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total •
By
AP�"CANT OR AGENT_--�--
Approved --� - Receipt No.
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rou n•in
Fixture
Final
HEATING
Contractor
Permit No.
-- _ Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY"
Final
]OCCUPANCY
orm Drainage
ain Drain) Final
dewalk
—_ rb iL Street Final
BLDG DEPT.FINAL TEMPORARY roach
CERTIFICATE OCCUPANCY CERTIFICATnal
ndscaping
( ning Final
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IJN 1 1= I ED SEWERAGE AGENCY N0. ___ 11043
t/UASH I NG-TON COUNTY DA-1 E 1-10-77____
CITY OF_Ti ,, rd ---
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: . Robert G.racid,411 -Co. -
OWNER'S ADDRESS: _-
S'fREET
STATE ZIP
BUILDING SITE: LOT--_-_-- BLOCK ADDI TION ----
TYPE OF OCCUPANCY __._ cornmerc l ,
TAX LOT NO. _----------_
ADDRESS ___ . _-111570 SLI 121 at. Ave._ -----
DWELLING UNITS -- fi __ _________ FIXTURE UNITS - - - - - --
SURCHARGE IF APPLICABLE -
3450. 3485.
PERMIT FEE ._..-_-._ . _ _ INSPECTION FEE35-_ TOTAL DEPOSITED
Fanno Cree'gk
(NEW) (EXISTING) BUILDING SEWER SYSTEM -_ -
Tho Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
-
APPI.ICANT
1�
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO T14E SEWER SYSTEM.
LINE SIZE _ INSTALLER _, __ J, I - . -
RECEIVED
(AGENCY O AGENt)
C oMMFNTS Bldg. ,#1234
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.
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BUILDING PERMIT APPLICATION 10 Y TIGARD DATE
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE_
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE —
LOT NO.
OWNER iL�el} ('':➢OB ADDRESS ,�7 S �U .0*�/�a. HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER ADIPRESS DESIGNER
STRUCTURE ❑NE_W ❑REMODEL ❑ADDITION ❑REPAIR [:)RENEWAL — ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE QCOMIVI ❑EDUCATIONAL, ❑GOV'T ❑RELIGIONS❑PATIO ❑CAR PORT ❑GARAGE^ ❑STORAGE❑SLAB ❑FENCE
❑BOND OMOVINd ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED [:]SIGNS
OCCUPANCY—IL._LAND USE ZONE BLDG.TYPE FIRE ZONE_ _PLAN CHECK BV HEAT,.,___,_
kIL,,c� :Jtility 01du. per plans for swilping pool. ----__--
A 1tJC) N0.BEDROOMS VP,LUE 1 I'con.
HiEl�iki.L_.____�+dQ;zTQ ;z�—_AB)✓--- 1
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE _ RIGHT SIDE
Permit
—_—� 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 I: HEREBY AGREED THAT TILE
-- ---- WORK WILL BE DONE IN ACCORDANCE :NI'TH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE'
Sub total ALL APPLICADLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT W:
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
StateTax 0 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING
Total 10.30 Bv _
_ _ APPI (CANT OR AGENI
Approved Rvcpipi No
DOR S iii(�cru
! Wiwimfwxq
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
~�
Rough-in
Fixture
Final
HEAIING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
-- --- ._ Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
Approach
BLDG DEPT FINAL TEMPORARY CFRTIFICATEOCWPANCY Final
CERTIFICATE OCCUPANCY
landscaping
Zoning Final - I —
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��BUILDING PERMIT APPLICATION 11 Y TIGARD DATE_ A-12-7 r 1734
I THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER PHONE
tLOT NO._.
OWNERJOB ADDRESS S J "�� i • A V 4 HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER
ALDRESS DEciGNF_R
STRUCTURE ❑NEW _ ❑REMODEL__,__❑ADDITION ❑REPAIR _❑RENEWAL —❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL QGOV'T ❑RELIGIOUS❑PATIO OCARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW []COUNCIL APPROVED []SIGNS
OCCUPANCYs--LAND USE ZONE —BLDG.TYPE
FIRE ZONE PLAN CHECK BY TLI HEAT _
units A 1B
Li�.L:il{• ij• �..QE.�1 •,�iy. .,.►^'; kf1�i1..! :?F:i..• LJf Ut..::, yl:. , ci;,,,�__� � --
'a�1e Ul Hsllor br outf.l .1 thou Ti- Ific"14("a X11 attu Isr;�uil, , planning � 1 ))cit�craiz,
14 bedLoUM6 b b6th
20 AREA NO BEDRO
OCC LOn.Q FLOS�t;
LOAD _EIGHT NO�L(2R1E$
BUILDINIDEPAHIMM41,
�rFJ[a ' REAR LEFT SIDE RIGH)'SIDE J
SETBACKS FRONT
Permit
THIS PERMII IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check RFCULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SubtotalALI. APPLICABLE CODES ANL ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS, CONTRACTOR ANn SUB CONTRACTORS TO HAVE CURRFNT CITY BUSINESS
State TaxLICENSE. SEPARATE PERMITS REOUIREOFOR SEWER, PLUTAPING AND HEATING.
Total By APPLICANT OR AGENT
ApprovedReceipt No,
nDR SSS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
e'.4 zi :A Contractor
d1l Permit No.
X-
—,-7 Rough-in
Fixture 16W,S,
Final
HEAY.Nr-,
Contractor
Permit No.
Gas or Oil
------- Roughin
Final
SEWER
Final
DRIVEWAY
Final
Sturm Drainage
(Rain Drain) Final
Curb&Street Final
-- ADDroach
1 C—T 1 OCCUPANCY
C U—P A--NC Y
BLDG DEPT. FINAL TEMPORARY c i rIFA
CERTIFICATE OCCUPANCY Final
Landscaping
I Zoning Final
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Address _ IOS ld /,7/ i7'(c�.ti Permit No.
Permit charge c:5
Otiner (jv Connection fee
Paid by
Type of building Date connected
Service rate �� (� Inspection fee
Contractor _ Paid by Date
Size of connection Assessment _ paid