12455 SW 122ND AVENUE 12455 SW 122ND AVENUE
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City of 'Tigard
INSPECTION REQUES .",
for
INSPECTION TIME '. PERMIT N 0-
DATE: --f d&76 DATE ISSUEn .!2,2-,,r
OWNERS NAME ' LOL
ADDRESS :
CONTRA CTO R
TEST*. Air L7 , Water [] Visual El , Luborator� L
RESULT. Approv, 0 Disapproved C3
SKETCH:
0 Jos I
6PIECTOR DATE
ILNOTF Attach suppiementol I $I data herbl2i
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City of Tigard
INSPECTION REQUEST
for
MPECTION TIME: Z �'� � PERMIT NO. :_____�
DATE: 1.!9612 DA' E ISSUED : I
0Vh VERS NAME : /'
ADDRESS: / 2 V-.,'J-- J-W 1:9te 1
CONTRACTOR : rzA,, r.
TEST : Air p , Wcter❑ , Visuol 4, Laboratory r
RESULT: Aprroved Disapproved ❑ , Pending ❑
SKETCH :
INSPECTOR +DATE
COTE: Attach supplemental test data i) .v ;.J
City of Tigard
INSPECTION KEDGES
INSPECTION TIME ---/±�f- PERMIT N(-.
DATE: DATE ISSUE 0 --.---..4- ...
► OWNERS NAME *
ADDRESS : —
CONTRACTOR
TEST*. Air 0, Water Lj , Visual E) Laboratory
RESULT* Approved Disapproved [I Pundinij
SKETCH.'
-e
/.2 Z-
INSPECTOR DATE
50TF Attoch SUPPIOMenfo' fest u ofo here
N�NKW*
ADDRESS /� �/Ss"- C✓ / ��� PERMIT NO.
PERMIT CHARGE none
OWNER w CONNECTION FEE
PAIO BY
TYPE O i BUILDING .•—k•t- .�c_ DATE CONNECTED
S r R V I C E RATE 9 -�� INSPECTION FEE
CONTRACTOR � _ _ _ PAID BY ' DATE
SIZE OF CONNECTION _ '� ' ASSESSMENT PAID _
�•O `'
i
CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE N° U 5
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE --
OWNER ADDRESS BUILDER PHONE
ENGINEER
P-UILDER t?iJt'IeP AR.Qj I± CT IfruInisi r — — DESIGNER
STRUCTURE ❑NEW ❑REMODEL C3 ADDITION ❑REPAIR ❑RENEWAL []FIRE DAMAGE 1-' ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR POf77 ❑GARAGE C3U
STORAGE SLAB ❑FENCE
BOND ❑MOV ING �[:]CONDITIONAL USE ❑DESIGN REVIEW ❑CC`UNCIL APPROVEV ❑SIGNS _
OCCUPANCY--..---LAND USE ZONE—BLDG. TYPEFIRE ZONE— PLAN CHECK BY HEAT
cunstruct I'+. PI; • -.i dwell-In'., with at
basement according to Etpproyed plal,-
5 bedroom
Hae ily1hif
OCC. LOAD FLOOR LOAD 4L lU HEIGHT NO.STORIES baAsmanjiREA ..fit I VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR r LEFT SIDE 62 LRIGHT SIDE
Permit 1 U 2.ilii
— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 91•pA REGULATIONS 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
Recording ALL APPLICABLE CODES AND ORDINANCES, THF ISSUANCE OF THIS PERMIT DOES NOT WAIVE
— 4J•nf] - RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO H4VE CURRENT CITY BUSINESS
1`I6State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total '27b. 46
BY
_ ----- APPS (CANT OR AGENT
Approved ' Receipt No
�_ ADDRESS -- — -- _r'IUIN
DATE INSP. TYPE INSPECTION REMARKS R�k1MBfNS DATE
SIV
Z"
Contractor
Permit No.
/� 3! 7� cR'�-� ���j, ll�ytl�°/LdvC1�_ w �✓c 4.,q 1W lRough-in
Fixture
Final
Contractor
��li3z .
Permit No. � ?,3
/-`=`,7 Gas or Oil
Rough-if) --------
Final
-- ---- ----- -- - —
SEWER// -21/-A
Final _
--- DRIVEWAY -
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
-12proach
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY
/, CERTIFICATE OCCUPANCY Finxl —_
3- IT 7 [Landscaping
ning Final