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BUILD114G PLRMIT APPLICATION TIGARD DATE __—. _-, 19 N° J 8$
THE UNDERSIC"IED HEREBY °PLI:S FOR APERMIT FOR THE WORK HERFiN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
-
W� NER _ —_ .ADDRESS —_ BUILDER PHONE
colualbia POOl& ENGINEER 701i4a A I:auwldfl & AYIIIIC.
BUILDER ARCHITECT _ DESIGNER
STRUCTURE ❑NEW r1❑REMODEL [-]ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND C1 MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
s
OCCUPANCY_--LAND USE ZONE. BLDG.TYPE —FIRE ZONE— PLAN CHECK BY HEA
--- — uir'i1t16nc� and 15x30 1211 per plane sh t 1/1 dated act. 14, .19-14 -
QQC LOAD_ FLOOR LOAD ECEIGHT Nrd._STORIES. AREA VALUE
BUILDING DEPARTMENT SET BACKS FRON, K REAR LEFT SIDE r)k RIIIRI SIDE
THIS Pr'aMIT IS ISSUED SUBJECT TO Trlr. REGUI ATIONS CONTAINED IN THE 30ILDING CODE, ZONING
Plan Check F.EGULATIONS AND ALL APPLICABLE CODES AN[ ORDINANCES. AND IT IS HCRERY AGREED THAT THE
------- WORK WILL BL DONE IN ACCORDANCE WITH 1 H )LANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-' �'jly RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%state LICENSE. SEPARATE PERMITS REGUIPED FOR SEWER, PLUMBING AND HEATING.
Total •By
r---. —-- ---- APpI NT OR AGENT
Approvea R,celhl No
AODRESS - - PHf71V1^
PLUMBING DATE
DATE NSP. TYPE INSPECTION RZ M A R 7K�S
r- Contractor.7
% 7-26 -1�
Permit No.
f2H2_ha�_
119
77- Fixture
Final HEATING
Contractor
Permit No.
Gas or Oil
Rou h-in
Final—_—_
Final SEWER
DRIVEWAY
Final
Storm Drain—age
(Rain Drain) Final
Sidewalk
Curb&Street F inal
Aroach
BLDG.DEPT.Ff L TEMPORARY CFRTI' 1, ATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Fx-al
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City of Tigard
INSPECTION REQUEST
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INSPECTION TIME ' _�_.__� PERMIT NO.
DATE ' --P DATE ISS'.IED :.—L-Z—
OWNERS NAME
ADDRESS ' / 2-/" S-4V 1'147 -
CONTRACTOR
TE ST . Air u, Water L-1 , V.sual V, I_aboratory
RESULT: Ap-iroved 91 i)iaapproved 0 , Pending Lj
SKETCH:
I SPECTOR DATE
NOTF Attach supplemental test data her etJ
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City of Tigard
INSPECTION REOUEST
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IINSPECTION TIME : ���_� PERMIT
I DATE .' � , GATE ISSUEDZ1---
OWNERS NAME . ____ec��� �
ADDRESS :
IC0N1RACT0R :.-- _- --- ----TIEST x r j, Water L] , Visv-cl ❑ , La'- .rctor; n
RESULT Approved 0 DiscpproveH 1 rhnding J
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INSPECTOR DATE
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City of Tigard
INSPECTION REQUEST
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I INSPECTION TIME : ` 'w_._ aIERMIT NO- . .—.----
D A T E
C. .------
DATE ATE ISSUED'--L�
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ADDRESS : — -
CON1RACTQR :- ---- -- —
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` RESULTNppro4ed , Disopprove
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Address 1.2153 S.W. 125th Permit No. 4837
Permit charge
Connection fee
Ouner --•
mooPaid by____68A&
BuckarQ• omes�,InGy,..l�,
Type of building _•rag Date connect"d
Service rate m^^}h Inspection fve
Contractor saMiL—
Paid b y �m o date
AssessmentPaid
5iZ13 of connection 4" ,
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I Cit of Tigard
� e
INSPECTION IREC� FST J
for
I INSPECTION TIME : 1 - 00 PERMIT NO.: . ----
DATE'. J DATE ISSUED'— I—J -
OWNERS NAME .
C0NTRACT0 R
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TEST' .a r J, Water p , �,is,,,rl [3 , La" .ratori r
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RESULT, Approved , Disapproved J Phndin9 3
SKETCH'.
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NgpZCTOR DATE
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for
INSPECTION TIME ' PERMIT NO. : .__._
DATE: DATE ISSUED*—l -1--
OWN E RS NAME :
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ADDRESS : - —
CONTRA CTO R
DDRESS :CONTRACTOR :—t;-L-
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RESULT, Approved , Disapproved)< F'► ndlng
SKETCH: I
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INSPECTOR DATE
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City i of Tigard
INSPECTION REOUEST
I for
INSPECTION TIME .I 7 PERMIT NO.: .._ — 1'DATE: DATE ISSUED'--L-�--
OWNERS NAME .
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ADDRESS :
CUNT:lACTOR : ---- --- --
TEST' Water [] , N/isrcil 13 , l_a'- .rutor) (,
RESULT. Approved ❑ , Disapproved F-inding J
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i rl SPECTOR DATE
IOTE Attach suppleme! tol test dots heret J
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I City of Tigard
INSPECTION REQUEST
I for
EINSPECTION TIME : �:=���'' PERMIT NO. : .
DATE: . 1 DATE ISSUED'__Z
OWNERS NAME ' _.�4 t�+t',A+e )-Y'&4rS
ADDRESS : — '
I C()NTRACT0R :_- 097 PL, V-7 f
TEST � r D , Water , Vise of D , La'- atarl n
RESULT. ripproved , Dlsapproverl _I P-�nding J
SKETCH:
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INSPECTOR DATE
ICOTE : Attach ,>upplemental teat auto heret]
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City of Tigard
INSPECTION REQUEST
far
INSPECTION TIME: In----
DATE: DATE ISSUED '.
OWNERS NAME : _ '�i
ADDRESS: _
CONTRArJOR - ---
E ST ' pair LJ, Woter [I , Visual , 1_ab gyratory f]
RESULil _ 4p roved , nisopprovad 0 4le#"k-lTTq
SKETCH.'
1157/119 V
�SPECT06R DATE
NOSE Attacn suppiemenlal test dots hereto]
$016
UNIFIED SEWERAGE AGENCY NO. 4837
WASHINGTON COUNTY DATE 5-15-73
CITY
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: — Buckaroo Home
OWNER'S ADDRESS: H--H. 135th Agro.
-- � �� sTREET
-
CITY STATE
37_ BLOCK -- -_-_. . ODITION _Brook�rsy
ZIP
BUILDING SITE: LOT -
l!81C1AACP
'
TAX LOT NO. ___--- TYPE OF OCCUPANCY _ , --- - -
ADDRESS _ - _--. 12153 B-W, 125th Ave. -
DWELLING UNITS--.----------- 1 FIXTURE UNITS --_
SURCHARGE IF APPLICABLE ----
PERMIT
PPLICABLE _PERMIT FEE _.--425 - - -- INSPECTION FEE 25 TOTAL DEPOSITED 450
�NEW� (EXISTING) BUILDING SEWER SYSTEM -Ti�arb------ ------- ---
The Applicant agrees to comply with all rules and req to s of the Unified Sew age Agency
APPLICA
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM. ,
C. 2.
Young
LINE SIZE _—______ M_—_--- — INSTALLER _ -__—.-
RECEIVED BY.- - -- 1 `-` � -- --- - - -
NCY qR ITS AGENT)
COMMENTS: — 1.` , ., N�, x,
-,
71
This Application and permit expires in ninety (90) days. The amount paid will he fori_ited
should expiration occur.
CITY OF TIGARD
12420 S. W. Mein Street
TIGARD, ORIGCN 97227
APPLICATION FOR BJILDING PERMIT
Naw Construction ® Demolish 11 Addition Remodel Move
ZONING A-7 DATE ISSUED 4'6'7. BUILDING PERMIT
BUILDING FEE $_ 9�,�_
No.
DATE RECEIVED 3-28-73 ..n
BY FgPLAN CHECK $ 41.50_ VALUATION $ 22,
7
62.40
TOTAL $ 124.50 RECEIPT No. `/5'
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
281 3BD CENSUS TRACT W-19 JCB
LOT M � ,�7 MAP N N_ —
Architect or Engineer__ ijayarang. A. .aoniatea
Address gjj iiisboru._,QMiu Phone In 645-2316
Owner B B"me
Address jypg M.2. II la5tbeve., Portland — --_--Phor.c 3=1253-52 ,
Builder
Address _ -- - -_-._.- `_Phone`_
BUILDING USE Single Res. � Multi Res Comm. F1 Industrial❑
OCCUPANCY GROUP I No. of Stories 1_ Total Height-14- Area of Lot 8000
Type of Construction V Floor Area B __ 1 1538 _ 2`
Set Backs: Front 2 Back 1,.Side 1p R.Side 10 n
Private Sewer Pipe Size_ �� Sewer uea Ti acrd_ Septic Tank L.._' (('``
Water Service Pipe Size 3 4" _ Storm Sewer a Ditch Drywell[I
Street and Curb Requirements__ xj&L Rg
Driveway Width 18' No. of Parking Spaces_2
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL .NFORMATION
ADDRESS ASSIGNED B.M. 125th AV*- —_- _
FIELD CHECK BY
PERMIT APPROVED BY
It is understood that all work will conform with applicable codes and ordinsnees
of the State of Crvgon and the City of Tigar , regon, and that the building will
not be occupied until a Certificate of Oc p I has bew, sued by the City of
Tigard Building Inspector.
gnature of Apples nt
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