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12410 SW 124TH AVENUE i ! ! �► fi � t ! ! 0 +fit 12410 SW 124TH AVENUE ._ -) I F, H a to o w I `. I� .w r. � G o � � Ao �1 H CA . r� gum MWOW BUILDING ',TY t '_-111—lb _._ . --- PERMIT APPLICATION 0� TIG ARD THE UNDEr")IGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHO'IF OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PIANS AND SPECIFICATIONS. OWNER PHONE_ �//�I�, LOT NO.— OWNER'1 •' �FT ADDRESS 1241.13 5IJ il4th AV6. HOME ADDRESS _�..—._..—._...�.�.__ ARCHITECT ENGINEER BUILDER ADDRESS _ DESIGNER STRUCTURE ❑NEW ❑REMODEL K)(DADVITION ❑REPAIR LIRENEWAL !C]FIREDAMAGE []DEMOLITION [:),RESIDENCE ❑COMM ❑IcDUCATIONAL ❑GOWT ❑1ELIGIO--US❑PATIO ❑CARPORT ❑GLRAGE ❑STORAGEC1SLAB ❑FENCE ❑BOND ❑MOVING ❑CONDITIONAL USE QDESIGN AF.VIEW ❑COUNCIL APPROVED ❑SKINS OCCUPANCY—_—LAND USE ZONE—_ BLDG.TYPE-_ FIRE ZONE_ PLAN CHECK BV _- HEAT._ r;u,-,4,t. to oxiatirig single family QW611109 all Peer Plst-s �---- — OCC.L.Qf1p �LQ9H �.9111(� `__.._.1 IS�HI �.5).�.IVn_ _._. _ _AREA __Nv"0E25?Q!��.__.Y.AI�- _..._ .------- BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE HIGHT SIDE Permit 60000 finn� THIS PERMIT IS ISSUED SUBJECT TC THE REGULATIONS CORTAINED IN THE BUILDING CODE, ZONING . Plan Check REGULATIONS AND ALLAPPLICABLE 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 Subtotal �� rin ALL APPLICARLE CODES AND ORDINANCES. THF ISSUANCE OF THIS PERMIT DOES NOT WAIVE Au LICENSE. COVENANTS. CONTRACTOR AND SUB CONTRACTOR!, TO HAVE CURRENT CITY B.'SINESS Stats Tax 4• LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMPING ANO HEATING. 1 otal )41,40 By APPLICANT OR AGENT Approved Receipt No. w I iDATL _INSP. TYPE INSPECTION RIrMARKS PLUMBING DATE termit ctor _ No. Ndae 5-5-1,42179 Rough-in Fixture - - Final HEATING T Contractor Permit No. — - -- -- Gas or Oil — Rough-in Final - ---- ---- - -- SEWER -- '�- ---^- —— Final --- - - — - T - DRIVEWAY ----- -- --- ------ ----- ----- Final Storm Drainage (Rain Drain)Final -^—� - Sidewal k -- -----� -_--- Curb 6 Street Final Approach ULM DEPT.FINAL. TEMPORARY CGRTIFlCATr OCCUPANCY Final CERTIFICATE OCCUPANCY ] ,n ap'iq Zoning Finnl - - -- - ytygyllNNuy. F. M I 1 �a� UMUE "UILDING PERMIT APPLICATION 1 TIC .".RD DATE-_-�' - 1­1­ 19-2j- OF 77 HF LIhDF RSI(',NED HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATFD BUILDER PHON�4 -14(4 q C-P AS SHC)WN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIE ICAT IONS, OWNER PHONE___ ' LOT NO__ J B ADDRES 2410 � 1C+ (A- � t/ _ I. MD _E ADRESS _ ARCHITECT ENGINEER r ADDRESS DESIGNER RE 0'.F WCl REMODEL_— ZADDRION _C�HLPAIR _— ORENEWAL ❑FIRE DAMAGE ❑DEMOLrTION XN(-.f CI CAAM-❑EUUCATIONAL - ❑GOV'T ❑RELIGIOUSOPATIO ❑CAR PORT ❑GARAGE DsTORAGEOSLAB QFENCE ❑MOVING ❑CONDITIONAL USE rOLSIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS vry lAND USE ZONEA��_ BLDG TYPE __FIRE IQNE3 _PLAN CHECK — HEAT—­ 4D D.--- __ F L OSZR i.S?Eil2._ . l/_ 1 QHt- �_._N9..�I4I;l€.S._ .-- Aft A 2 =1N�ED�Q_M5_'� VALL z T` - -PUILDING DEPARTMENT SE I PACKS FRONT REAR LEFT SIDE RIGHT SIDE I .•unit �Q — —. _ THIS FERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING "Ian Check 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 `uh lntal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE "' - --- RESTRICTIVE COVENANTS, CONTRACTOR AND SL'B CONTRACTORS TO HwVE CURRENT CITY BUSINESS ' ia11TTax - ---,-- a� U LICENSE SLPARATE PERMITS REOUIRED FOR SEWER. PLUMBING AND HEATING. 7 Utal Hy _ APDL ICANT OR AGENT -----__--- - ---- I I rrl ReCeipl No In City of Tigard INSPECTION REQUEST for INSPECTION TIME : PERMIT NO. : DATE: 6,!i-2.1-7DATE ISSUED : it_'Y�?� OWNERS NAME : -- ADDRESS: ley/a C O N T R A C T O R : _ E ST ' `Notp , �..aboratory n RESUL : /+p,'roved uppro�a�' v ;�endi ly O SKETCH; 73 INSPECTOR DATE NOTE : Attach supplemental test data heretical w i l t City of Tigard I INSPECTION REOUEST I for INSPECTION TIME : PERMIT NO..: DATE: DATE ISSUED:__1_L OWNERS NAME : � -) w C-k) ADDRESS : d 41-1 - CONTRACTOR : t ')Tz 'I � TEST- Air 0, Watar [] , VisualV, Laboratory ci RESULT. Approved , Disapproved Cj , Pendlny L I SKETCH: I I � 1 INSPECTOR DATE EOTf ' Attach euppfaM6001 test data haraf] I City of rFigard INSPECTION REQUEST i for I ECTION ?IME: �� Uy PERMIT NO. : — I INSP - DATE . --S /25 Ln DATE ISSUED :--L i OWNERS NAME ' - w � n ADDRESS. _ CONTRACTOR . _ - - - - -- - I -FEST . Air ❑, Water 11 , Visual, Laboraiory ❑ I RESULT . Approved Disapproved ❑ , Pending f-1 SKETCH: INSPECTOR DATE COTE Attach supplemental teyt data beret I I � City of Tigard INSPECTION REQUEST for lINSPECTION TIME : /0 30 PERMIT DAA E. 1;71112-2' DATE ISSUED OWNERS NAME : I AD DRESS2H/ U _-- I CI)NIRACT0R : TEST .' r J, Water [] , lilisl!a{ 0 , La' .ratorj rt RESULT. A roved , Disapproved 1 , P-inding `j SKETCH: u1�C //7 INSPECTOR DATE �f11E Minch supplement "t jOr; her©t� k i I. i I City of Tigard INSPECTION REQUEST for INSPECTION TIME : PERMIT NO. .- -. DATE : q L 1Z DATE ISSUED : Z OWNERS NAME : ____._— � ► -_--- ADDRESS: CONTRACTOR '-_ , «►.i� —____-- I TEST : Air �] , WoterEl , Visual-p , Laboratory RESULT. Approvod Cr;Disapproved EJ , Pending S KETCH: �c I INSPECTOR DATE [OTE Attach supplemental est data beret] I I I City of Tigard � INSPECTION REQUEST I for INSPECTION TIME : PERMIT NO. : _43_ I p,s,TE E . DATE ISSUED : /s�/,J' j OWNERS NAME : �, c�/-Zl I ADDRESS: _.12141 v ---- CONT:IACTO R : i TEST : Air G, Waterfq, %usual-C7, I._aboratory (] RESULT : Approv©d -L , Disapproved O , Fending [] SKETCH: t E INSPECTOR DATE LN07E Attach suvplementoi gest data her eta i 1 , KEKSOLMEMPIA-1MRIFIRIF9 a' Address 12410 S.W. 121+th Ave. Permit No,. � 46L)i Permit charge Owner was D.W.D. Connection fee 425 Paid by D.W.D. Type of building Residence Date connected 4-24-7" Service rate 3.00 Per month 1nspe.•tion fee — 25 Contractor D.W.D. Paid by Dnte Size of connection 4" Assessment Paid _ y S3-/o "I mwllw a City of Tigard i INSPECTION REQUEST I for IINSPECTION TIME : -.� — PERMIT NO. :'f` i DATE : ..7�� — DATE ISSUED'�1�L1.j OWNERS NAME '. -- - I ADDRESS : Xr 4L'-2 -- -- CoNTRACTOR : I TEST ' Air 0, Water ;_] , ��isi cI La'- ratory r � RESULT: Approved , Disapproved 1 Pending 3 SKETCH' I INSPECTOR DATE I [OTE: Attach supplemental feet data heret-10 1 w w w w w w w w i city ty Q of Tigard a rd INSPECTION REQUEST for I INSPECTION TIME : t o r> PERMIT NO.: 1 3 6 DATE: �--�-- DATE ISSUED: I OWNERS NAME : I ADDRESS : — , I CONTRACTOR :------- TEST'. ONTRACTOR : ---- TEST. Air ❑, Water ❑ , Visual Laboratory ❑ IRESULT: Approved Disapproved 17 Pending [I I SKETCH: I I I I I "Or—, 4 !J I INSPECTOR DATE ICOTEAttach supplemental test data hereto] i 1 1 TON ' JuriecTxctti.arl �X:• �- 'rppe of Fixture Permit No. Permit fee Water Closets Toilets e3 ' Hermit Isau - Y+.a-:o;: Ba .ibs _ Approved by �. a story, as es n Building Pem-T- Shower Q ae >eipt No. sir 8 Dishwashing B C e � s Ordinary � Location of Building _/2y/- S•W n sBev ~Automatic_ s�3 hwasher „w Di s ceaT ir ria s - Name rk Addr ta+ C, Owner pinsnor - r'. 5�[� �__._an ,• 4� ____ .... airi�e r orator an ans u oma c War r"- Name & Address oz lumber -Fountains ode Water orvi.ce z --'""""""`"" '"' ri Urin s Bu.ildi (U-1-d or New Z (Altar. RePa,Ir orBasins a 3L tiWit, .awn vriinkkller o 8 em �w rte, `_` Other §prIncler .,ys em w This permit becomes null and void if work or construction authorared is not h commenced within 60 days, or if constructic;n or work i.9 suepeniei -.r abandoned for a period of 120 days at any time after work is commenced. ;.'`' . r All plumbing firma, must be licensed by the laity of Tigard and post a Il,000 bond.,k T hereby certify that I have rmsd and examined this application and know the now to be true and correct. All provisions of laws and ordinancr3 governing this tyj of work will be complied with whether specified herein or not, thk granting of a permit does not presume to give authority to violate or cancel the proviaions of any other state or local law regulating construction or the ytrformance of construction. 22 Signature of Appli.can ._ , r f # �K M 1a 1 Y UNIFIED SEWERAGE AGENCY NO. 4823 WASHINGTON COUNTY DATE 4 4 4� CITY O F —moi .__---- -------- APPLIC.kTION FOR SEWER CONNECTION PERMIT OWNER'S ADDRESS: — STREET _21or Or�gnn -- . 97223 --- _ ------ - CIT" -----BTATE ZIP BUILDING SITE: LOT____-._-3_ BLOCK. - -__ _ _.____ ADDITION TAX LOT NO. __— TYPE OF OCCUPANCY Residence_ ADDRESS DWELLING UNITS - - l_- --- FIXTURE UNITS I SURCHARGE IF APPLICABLE — G PERMIT FEE 425 - - -- INSPECTION FEE 25- - TOTAL DEPOSITED (NEW) (EXiSTING) BUILDING SEWER SYSTEM -_._-.-.Ti�t>i____ -_.__ 1 The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency. APPLICANT ��_�_•'r� �� _ �L,a_• - _. SEWER PERMIT THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER F EM. LINE SIZE 4" INSTALLER D.W.D. -•-�••_- 1 _ RECEIVED BY AA Cl OW ITB AOINT) 1, r COMMENTS: 111'e ., ,15c')`;' tt>tsF ClL►i r.ti� r,n._ 5 Cz'.T ��l/ r3 i This Application and permit expires in ninety (90) days. The amount paid will he forfeiled shou!d expiration occur. `t CITY OF TIGARD Iwo & W. Mew arew TIGARD, OR600M OM APPLICATION FOR BUILnING PERMIT New Construction Q Demolish u Addition ❑ Re-odel move ZONING R-7 DATE ISSUED 4-4-73 BUILDING PERMIT DATE RECEIVED_ AUILDING FEE $ 101.50 No. ` '�67 PLAN CHECK $ 50.70 BY on YP OTHER $ VALUATION $ 29► 0 TOTAL $ 152.25 RECEIPT No. 77464 �/- TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION LOT # 3 MAP # 281 3M CENSUS TRACT W-19 JOB # Architect or Engineer__ nanlelu viaainA -- Address _ Box 23551. TiBa_rd� OreBo? Fi,one Owner— n 1�„ Address 12410 8.w. 124th _ Phone_ Builder Address BUILDING USE Single Res. ® Multi Res. ❑ Comm. ❑ Industrial❑ OCCUPANCY CROUP_Z__- No. of Stories _ Total Height _ Area of Lot Type of Construction jXXXn00LEDWj0= V Floor Area B_ 1 1,)b2 2 Set Backs: Front_ 2y' Back d0' L.Side_ 10' R.Side_ 10'(�I Private Sewer Pipe Size__ 4"' Sewer us& T_ igArd Septic Tank I___J Water Service Pipe Size 3/4" Storm SewerU Ditch ❑ DrywelI❑ Street and Curb Reyuirementa T►IdaLltl�_______—_--_ _ —_–_ Driveway width _ ��! No. of Parking Spaces_ SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING SPECIAL INFORMATION ADDRESS ASSIGNED 121110 FIELD CHECK PER4I'f APPROVED BY ir,7 (� It is understood that all work will conform with applicable codes and ordinances of the State of Oregor, and the City of Tigard, Oregon, and that the build ng will not be occupied until a Ccrtifi,.ate of Occupancy has ben issued by the City of Tigard Building Inspector. / Sig(ature of Applicant ,1