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BUILDING PERMIT APPLICATION DATE Uri
THE UNDERSIGNED HEREBY APPLI--S FCR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER,PHONE G�f7-T68'
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND V.ECIFICATIONS. OWNER PI- N - —Co
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v ARCHITECT
ENGINEER
BUILDER ��w g ADDRESS Vox A " DESIGNER �n� +0 y-cor- -
STRUCTURE NEW ❑ REMODEL ❑ ADDITION -_❑ REPAIR ❑ RENEWAL ❑ FIREDAMAGE ❑ DEMOLITION
RESIDENCE C COMM C) EDUCATIONAL :1GOV'T C3RFLIGiO``USC''i PATIO ❑ CAR PORT GARAGE C STORAGE C3SLAS❑ FENCE
OCC OPANCY -LAND USE ZONE X�BLDG.TYPE r-AA ._FIREZONE �' PLAN CHECK SY _ HEAT
W GAP
SEWER PERMIT MQ�_3q�
3QC.LOAD FLOOR LOAD HEIGHT 1/ N0.STORIES / AREA/0/7 NO.BEDROOMS 3 VALUE GQ
BUILDING DEPARTMENT SET BACKS FRONT 3,2 REAR -40 LEFT SIDE f,� RIGHT SIDE �5-
?^�It �� �_oo
_ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,� ZON:`4„
�,�v REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREFD THAT THE 931-in �JJ WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CO,;aLIANCE
r p WITH ALL APPLICABLE COO 1 AND ORDINANCES. THE ISSUANCE OF THIS FER`+IT DOES NOT WAIVE
4 ��
Sub-total _ RESTRICTIVE COVENANTS. L NTRACTOR AND SUS CONTRACTORS TO HAVE CURRENT cirf &USINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
state Tax •
Total 2.SS (04 To& //wo Keo
P000 APPLICANT OR A—f++
By
— -- _. Receipt No
ApptOwd ADDRESS PHONE —
'DC X00
oc /V Q
EWER CONNEuTION
:SEWER INSPECTION S '23
EWER SURCHARGE
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BUILDING PERMIT APPLICATION TIGARD oA,E ts_ �.1 3659
THE UNUEHSIGNED HEREBY APPLIES FORA PERMIT FOR THEVVORK HEHEiN INDICATED BUILDER PHONE _ 47-
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO.
OWNER Linca Hames, InC.JOBADDRESS 119UU 561 122nd Lourt L-Lr m•f— _
ARCHITECT
ENGINEER
BUILDER BaMe ADDRESS Rt.`3 ` BOX 446,11119bLaSIGNER Dun K10Var --
STRUCTURE_ 11 NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Cl RENEWAL LJ FIRE DAMAGE ❑ DEMOLITION
00 RESIDENCE ❑ COMM EI EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLABD FENCE
77
OCCUPANCY R73 .LAND USE ZONE ���� BLDG.TYPE FIRE ZONE- PLAN CHECK BY -K---HEAT-
Construct
HEAT_ -- __
n�truct sin le faalil dWellin u attached ars s. 3 Bedroome 1 t,eth.
— Co -9 -- --�------ a 1 --_�1.— 9 - - --
5EE CORRECTION SHEET ATTACHED.
SEWER PERMIT# 23304 - S7Sa.011 a- r4=-f t_- - -
OCC.LOAD FLOOR LOAD 40 HEIGHT 13-_ NO.STORIES 1 _- AREA n j NO.BEDROOMS VA1.11E V
BUILDING DEPARTMENT SETBACKS FRONT REAR /if) LEFT SIDE . ': RIGHT SIDE
Permit _ s1('6•00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check .1.110 WORK WILL. BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal i49.00 REST RICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
StateTax 11. . 64-- SDC_ aoa.no
t
Total a.64
PDC# I $100.00 APPLICANTORAGENT
By _ P1 _
--- —� dt~�Receipt No.
Approved ADDRESS -� PHONE
DATE INSP. TYPE INSPECTION _-----REN9ARK.5 -- -- PLU' GING DATE —
Contractor
Permit No.
i
Rough-in --
`� Fixture
Final
L HEATING
Contracto
---- -- / 7 77
— -- -------- Permit No.
Gas or Oil
----- ----- Rough-in
Final
SEWER —«
— — Final Y-;o
DRIVEWAY —`—^-_---
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY ��/�- � I /_� 11 _
Landscaping
Zoning Final
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;�e�v-itT_♦allationQ Replace E] Relocation Ej Addition E] Alteration DATE:
HEATING
CONTRACTOR Imperial Mech. OWNER Cinco Homes
ADDRESS PO Box 06327/97206 JOB ADDRESS 11980 SW 122nd Ct.
PHONE 777-3801 APPLICANT ltnpc:rid I Mech1.,( /
x) RU "
Heat input Rating(BTU per Hour) _ 15. Vent Size Flue Site
FUEL, OIL GAS ❑ ELECTS; OTHER
ITEM —�NO. FEE ITEM _ NO. FEE
For Issuance of Permit SEE BELOW Each Air Handling Unit or Duct System _ 7.50`
New-tj to & incl. 100,000 BTU t' 6.00 Commercial Hood System__ 7.50
New 100,000 BUT's &_over _7.50 Other Equipment • Each 4.50
Woodburning Stove _ 4.50 1 Trip Inspection 4,50
Wall-Floor. Suspended --- 6.00 Air Condition Compressor - up to& incl. 3 H.P. 6.00
Vent System w/Fan A _ 4.50 Air Condition Compressor-3.1 to 15. H,P, incl. _ 11.00
^cNd llcat Cc^!ir,g �___
600
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CITY BUSINESS LICENSE REQUIRED BY ALL CONTRACTORS OR SUB-CONTRACTORS ! !
PERMIT ISSUANCE 10.00 Comments: — —
FEES
4' TOTAL (r •C{ -- —. __ _ _ _
% STATE Issued By-_---
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