12255 SW 126TH AVENUE-1 12255 SW 126TH AVENUE
t
PLUMBING PERMIT APPLICATION
Jurisdiction of. ��c+
No. Type of Fixture Fee Permit No.
Permit fee wi
Water Closets (Toilets) Permit Issue �v
roved b
Bath Tubs App y
-avatory Wash Basin Building Permi AZZ
Shower Receipt No. IV3o
Sin s Dishwashing
Sinks. Kitchen
SinksOrdinary Location of Building
Sinks. Bar
Sinks
ME
Au oma--iq—s�Dishwasher —------
��.____
Dis o3al
Laundry Trays Name & Address of Owner
-�Dr---aTins. Floor A,
Ura. nS Area
Drains. e rator
J Rain Drains
utonlatIc Washer Name & Address of Plumber _
oun gins, Drink!n
Fountains oda yg A'C 411W k
Hot Water Tank
Water ServiceSize
Urinals _ Buildina, Old or New Llter, Repair, or
.atc as ns - ar ns a
Lawn Sprinkler r stem _
SwimmingPool Mier
SPrinlcler
r -
This permit becomes null and void if work or construction authorized is not
commenced within 60 days, or if construction or work is suspended or abandoned
for a period of 120 days at any time after work is commenced,.
All plumbing firms must be licensed by the City of Tigard -amdi.- r9 �crndo
I hereby certify '.,hat I have read and examined this application and know he same
to be true and correct. A1.1 provisions of laws and ordinances governing this type
of work will be complied with whether specified herein or not, the granting of a
permit does not presume to give authority to violate or cancel the provisions
of any other state or local law regulating constriction or the performance of
construction.
Signature of Applicant -
.
,N.R....wyr... ..,,aN:p,... ... - ..,_+Mn•+-+.... a ...,........wwa+�yrw•.,r .:. .._..... ....,_ .. _. _ -. ........�.....
CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE— April 1 is 71 No 0 7 0 6
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE W0?;: :iERE1N INDICATED
OR AS SHOWN AND APPROVED IN THE .ACCOMPANYING VANS AND SPECIFICATION$. OWNERPHONE
OWN Mail Erickson ADDRESS ,`i`j`J � � IVO. BUILDER PHONE
'19.11 K011Y Cri. ENGINEER
BUILDER _ __ RCH!TECT DESIGNER
STRUCTURE ❑NEW ❑REMODEL ❑ADDIT1011 0REPAIR _❑RE_'EWAL CIF IRE. DAMAGE []DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCAITONAL ❑GOV'T ❑9ELIGIOI;oI ]PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND i ❑MOVING CCONDITIONAL USE rJOESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS_
_OCCUPANCY LAND USE ZONE ' _Bi-E)G.TYPE- FIRE ZONE____ PLAN CHECK BY._ HEAI__._��_
Conet,i�.J4..L r:i l k�...I frame ik'. � ..i, lC7 "nd rt,i k!u I. i ? khan• —
LOAD •_ FLOOR LOAD HEIGHT NO.STORIES AREA _ VALUE
BU: !ANG DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RiGHT SIDE
Permit '"44,0n -THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL A ICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL.BE DONE IN AC. }NUANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOS WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUR CONTRACTORS TO HAVF CURRENT CITY BUSINESS
State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 4-73.
By -- ---- -- -— -- .`- - ---
_ � 1 APPLICANT OR AGENT
Approved Receipt No
AO RESS
jug
DATE INSP. TYPE INSPErTION ` REMARKS PLUMISMG DATE
y y /fit= �� i `rc•L�r Contractor — -- —
Permit No, 0
—
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rou h-in
Final
SEWER
—� Final
DRIVEWAY
— Final
Storm Drainage _ —
__ (Rain Drain) Final
Sidewalk
Curti&Street Final
_ Ap roach
fiLOG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY -
Landscaping
I Zoning Final
(
CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE-__-.- ---__, 19 Nu 0403
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPAN, ING PLANS AND SPECIFICATIONS. OWNER PHONE—
OWNER
HONE OWNER _ _ _ _ ADDRESS _ _ BUILDER PHONE
ENGINEER
BUILDER ��-+.�y ARCHITECT tt DESIGNER
STRUCTURE _
❑NEW ❑REMODEL O ❑ EI
RENEWAL REPAIR L. RENEWAL ❑FIRE DAMAGE ❑DEMt—O�LI[ION
(3 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB [FENCE
❑BOND _ ❑MOVING ❑CONDITIONAL USE 0DESIGN REVIEW ❑COUNCIL APPROVED 0IIGNS
OCCUPANCY_v LAND USE ZONE_ BLDG.TYPE 1 - FIRE ZONE-- PLAN CHECK BY HEA?
C WAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE
BUIL.DIfJG DEPARTMENT�.-- SET BACKS FRONT fiF.A.R LEFT SIDE RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITS T;:E"'.ANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALI. APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CON I RACTORS TO HAVE CURRENT CITY BUSINESS
I%State )� LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
By
APPLICANT OR AGENT
Approved r it `� Receipt —
ADDRESS PHoNE
DATE INSP. TYPE INFECTION ,C1 REMARKS — PLUMBING DATE
pl.� --__— Contractor
Permit No.
Rough-in
Fixture
_ Final _
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage _
Rain Drain) Final
Sidewalk
Curb&Street Final
_
Approach
a LOG.DEPT FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANC"/
Landscaping
Zoning Final
z•
,I
4
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i
, y
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° 16 2)0 DATE
i
PERMIT IS GIVEN TO ( `
or
.eY t
TO CONNECT A
TO TSI1 SYSTEM OF TIGA.RD SANITARY DISTRICT
AT rA
THIS PERMIT MIDST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM
PLETED.
PERMIT FEE PAID a.... ..:...:..........1,.......TIGARD SANITARY DISTRICT
By
- --------- - - - - - - - - - -
•
CONNECTION INSPECTED AND APPROVED
Dat! y Superintendent ~��--�
Address 12255 S.W. li-,6th Permit No. 1ti20
Permit charge
owner Mr. and Mr;,. ,deil S. Ericks;On Connection fee 400
Paid by Dale Construction
Type of building lie idence Date connected 7-6-72
Service rate 3.00 per month Inspection fee 25.00
Contractor Dale C(,astruction Paid by Dale Const. — Date -15-7-'
Size of connection ���� Assessment Paid