12665 SW 127TH AVENUE 12665 SW 127TH AVENUE
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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard, Oregon 97223
Phone 639-4171ti
Address----- ,.r''r - -- '-.�' z — permit
Type of Inspection
The following Building Code deficiencies are required to be corrected: . -
Presented to-,--. Inspector ---
Date --
CALL FOR REINSPECTION
❑ YES ❑ No
BUILDING PERMIT APPLICATION TIGARD DAIE_marroi aha 19 i 3126
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED I,UILDER PHONE 6.39-1458
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS ANO SPECIFICATI•:ONS OWNER PHONE
LOT NO.
OWNER ztn �r 'r iv,�ai1 JOBADDRESS -
ARCHITECT
ENGINEER
BUILDER :;am<' ADr SS DESIGNER
STRUCTURE ❑ NEW ❑ REMODEL. N ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
13 RESIDENCE ❑ COMM ❑ EDUCATIONAL D GOVT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE O STORAGE_❑ SLABO FENCE
�— — — _
ocr,UPANCY !Z'3 —LAND USE ZONE _.R'7 BLDG.TYPE SN FIRE ZONE j_PLAN CHECK BY P"T HEAT bA
Gonstruct 1 bedroom, 2 baths. kitchen* dining room ad&tion to existing sial family
_dwolling. Convert garage to family room 1 Bedroom
Laths
SEWER PERMITB�—
OCC.LOAD FLOOR LOAD 40 HEIGHT 10 NO.STORIES t AREA_7 5" NO.BEDROOMS l VALUE 24,6011
BUILDING DEPARTMENT SET BACKS FRONT ?: REAH LEFT SIDE RIGHT SIDE
Permit _ _112.U0 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
6.n0 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check WORK �NILI. 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
Sub-total 168.00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
i LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax �+.�.8
SDC—
Total 172.48
PDCN APPLICANT OR AGENT
By
Receipt No.
Approved D11,411 ADDRESS----- — PHONE
I
ur �r � � ■ � ■ra
DATE INSP4 TYPE INSPECTION ^_ - REMARKS PLUMBING I DATE
-VO D-K Contractor -
Permit No.
$-a O R Rough-in
,!• �0 Fixture
w // ----- ------.— Final - --— —
�+_�%%✓ i <C — -- ---- HEATING
Contractor 1
Permit No.
--- ------ Gas or Oil
--.._- ---- ---- Rough-in ------
_ Final -
-- -- - ---- --- ----- SEWER
Final
--DRIVEWAY --
- ------ - ----- - --- Fine!
Storm Drainage
(Rain Drain)Final
Sidewalk
-- --_-. _------ Curti 8 Street final
Approach
BLDG,DEPT.FINAL TEMPORARY CERTIFICATEOCCIlr CY
CERTIFICATE OCCUPANCY Final
Landscaping
Toning Final
�.
h "t:
t
WMAUIRLMUNAMMUMUNUM ■�
Address 12665_S.W. 127th : Permit lam,. 4714Permit charge
charge
connection fere
Owner
Paid by .._�..� L--C •►� � :�...._n, _.�
Type of building _--_.. .. Dente Connected
Service rake ,..,_3 ..der ?n#6?�.... ...W_.....,e.. Inspection tee _,tt9O ,_�.,..___.:.n.a..�.�-_�.
Contractor
Paid by dame Date . ....�_...�.._......
� ���a •ons. tructio� ,�.,..,. -- "'"'"
Assessment Paid
Size of connection 4 _..�
ria U / - 30 v"
WW !AI ilii
PERMIT TO CONNECT A? 12
Tigard Sanitary District
PERMIT No 1293 DATE
I'l"11MIT IS GIVEN Tr ,✓� _ '��yt. -
or
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
ATTHIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE. AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID !._'- .�° .,,.,.,,,.„-,,.TIGARD SANITARY DISTRICT
By
-- - - ---- -- - - -
CONNECTION INSPECTED AND APPROVED
- ----Date