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INSPECTION NOTICE
Citv of Tigard Builc'.,g Department
12420 S.W. �Aain St.
Tigard,Orego•i 97223
Phone: 639 ".-171
Type of Inspection ---- 0Tr �-
DateRequested..___� =�-c�_ 5 _ TimeZ0= A.M. P.M.
Address/_� ?v.�1.._ l Z� Permit
Owner ._.---------
------------ ---- --- Lot #.
Builder - ---- -- ---The following Building Code deficiencies are required to be corrected: a
Presented to —_—_ _-Approved I
Inspector �_� Disapproved
Date
CA,.r FOR REINSPE HON
C1 Y28 "eiw
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1 r
of Tigard Mechanical Permit NO.
New Installation Q Replace ❑ Ralc,cation❑ Addition ❑ Alteration ❑ DATE:
HEATING Gl1�Lf
+' CONTRACTOR ,,� �/��� �/� -��- OWN[ '�
4 ' CG �. o /� S�
g ADDRESS Q9 ADDRESS
Ifs", �.�_�...�....
al. PHONE APPLICANT L4, ,
!oMost Input Rating(i9TU per Hour) _ �-: 4yU Vent Site
FUEL OIL❑ GAS n ELECT Q OTHER
ITEM NO. FEE ITEM_ _ _ NO. FIR".
ftE,L%%tnce of Permit _ SEE BELOW Each Air Handling Unit or Duct S tem 7.
I�lew•ua to & inc1. 100,000_BTU 6.00 Commercial Hood System ^7
.50
Now 100,000 BUT's d ove- _ 7.50 ~Other Equipment - Each
Woodbur ± Stove _ __ —__ _ 4.50 —1 Trip Inspection
f sdl-Floor- Suspended 0.03 Air Condition Camprenor - up to&incl. 3 H.P. 6.00
..
Yv-t Syttem w Fan 4.50 Air Condition Compressor-3.1 to 16.H.P. incl. 11,
"M!,Ir Most Cooling 6.00
CITU BUSINESS LICENSE REQUIRED BY ALL. CONTRACTORS OR SUB-CONTRACTORS !
PERMIT ISSUANCE 10.00 Comments:
FEES ._._ -
$TAT[ Issued By _
%P�AN CHEP
TMA
' C.vREG. M
rgneture of App►icar,t
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BUILDING PEWIT APPLICATION TIGAF;r) DATE___ ____ ,19 b' 3616
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR VHEVVORK HEREIN INDICATED BUILDER PHONE i53-1167
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNEri PiI�� ��W40d .�'i
LOT NO._
OWNERJ.W.brayson,E31L.. JOBADDRESS 12�U5 5IJ 119th Avenue
-- ARCHITECT
BUILDER £F1mU ADDRESS
110b9 SE P.vlgion DESIGNER M.L. Urayaon
STRUCTURE 13\NE'N L7 REMODEL ❑ ADDITION ❑ REPAIR _❑ RENEWAL ❑ FIRE DAMAGE _❑ DEMOLITION
CX RESIDENCE 0 COMM Li EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE STORAGE ❑ SLAB❑ FENCE
OCCUPANG'Y R'� LAND USE ZONEBLDG.TYPE--�- .FIR_EZONE______PLAN_CHECK rfY —E'Jrt HEAT_ &B _
Construct single rami dwa.11ing w/attachDd garages. 3 Badroome 1 —
SEE COPPECTION SHECT ATTACAED,
SEWERPERMIT# �,; j�[]_[]❑ _ __ ,�
OCO.LOAD FLOOR LOAD 40 HEIGHT 11 NO.STORIES 1 AREA 1U88 NO.BEDROOMS) VALUj47 r 4UQ•
BUILDING DEPARTMENT SETBACKS FRONT 28 REAR 98 LEFT SIDE 1.2- RIGHT SIDE "i
Permit «1`14•(j U, THIS PERMIT IS ISSUED SUBJECT T i THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
I'airj — REGULATIONS r�ND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check -� 81 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIGNS AND IN COMPLIANCE
WITH ALL APPI_ICABLF CODES AND ORDINANCES. THE, ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 1Ul•00 _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
-- — LICENSE.SEPARATE PERMITS REQUIRED FOR SEyyyyEEEi,,PLUMBING AbpfH E4 11 , .
State Tax 4' 7.24 t. �4�;�.IiAHUL Ui j JUU.U(
---- SDC— �40Q.q0
Tctal $185.24
PDC# t i1011-0f) APPLICANTORAGENI
—_ Peceipt No. �- _ – -
Approved dwh _ J� 7 ADDRESS PHONE
D: F: INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Gontractor�-�
��. Permit No.
2t,,'0_2_ 4�/
.
Rough-in
Fixture
Final
HEATING
Y Contractor
0JY �"
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final 3 —, 2_ �J
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approxh
E.DG.DFPT. FINAL TEMPORARY CERTIFICATE OC NCIf !final
CERTIFICATE OCCUPANCY " r ---
6 Landscaping
Zoning Final
ff
BUILDING PERMIT APPL.ICATIt_1N TIC,AR7 DATE_��� `g 19*11 3Gr��o
THE UNDERSIGN EU HER;-HY APPLIES FOR A PERMIT F:0R THE WORK HEREIN INDICATED BUILDER PHONE253
OR AS SHOWN AND APPJROVIED IN rHE ACCON.PANYING PLANS AND SPECIFICATIONS. OWNER.'HONE
JOB ADDRESS
t�.a� /r�P• LATt10.�Q_�,� �
ARCHITECT
BUILDER ,J G[ ADDRESS I I05 11ll ENGINEER if
C �� s�`�f.S1�N DESIGNER /i(tr �`raNsovj _
STRUCTURE NEW- N ❑ REMOOEL M ❑ AODIr!ON - El REPAIR_ - C3RENEWAL ❑ FIRE DAMAGE U DEtr01.171Or.
RESIDENCE C COMM 0 EOUCATIONAL 0 GOVT ❑ FIELIviOUS 0 PA710 ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
C ,vrANCY` _LANf1 .!SEZ0�NE OLuITYrC ,N...._ FI^nE70N—=_PLANCuECKBY HEAT
SEWER PERMIT# -
OCC.LOAD FLOOR LOAD HEIGHT I� _NO.STORIES - I^� AREA 1 0 98NO.BEDROOMS 3 VALUE77y!e0
BUILCING DEPARTMENT SET BACKS FRONT 20 _ REAR 8 LEFT SIDE RIGHT SIDE
(P--miit I ILLGO THIS PERMIT ISIS UEII SUBJECT TO THE REGULATIONS CONTAINED IN THE EUiLDING CODE,ZOWNC
GULATIONS AND ALI. APPLICAULE CQUES AND ORDINANCES, AND IT IS HEREBI AGREED THAT THE
an Check - WILL 6E DONE IN ACCORDANCE WITH 1FIE PLANS AND SPECIFICATIONS AND 1N COMIPLIAN%ZZ
s v WITH L APPLICABLE. 'D! '!!1'1 AOINP.NCES. THE ISSUANCE �lF T!{15 PEH7.11T DOES NOT WMIV_
Sub-total 71 RESTRI TIVE CAV S. CONTRA AND SUS CONTRACTORS TO HAVE CURRENT CITY BUSISaES
LICENS 5F_P _PLFIMITS A> UIHE UR SEWER,PLUMBING AND HEATING.
Scare Tax 9
Total 7�Ze�, soc- �!f
PDC* A P—UCA R AGlNT
By y_.
FI eel No. _.
Approver! A DRESS --- PHONL
0C r. .
oC - s 1— /00 ~ U� �u c�--: �ob'�. C Mda A Gtr a sso
EWER CONNECTION $ � ._ 6444S� �•�Sloc--Avt°� LA���°- we, �
EWER INSPECTION $ '041-5
EWER SURCHARGE S _...._ 362, Amo44w'DwvocQ
/& / 0
C.�.`-_•
spr""11( r- 40 hts ii- JGJ lglf
1888. 744
CITY OF TIGARD—12420 S.W.MAIN—TIGARD,OREGON L7223
RECEIPT
DATE: - 1 AMOUNT:
DOLLARS
l
NAME:
ADDRESS:
"CHECK._
•OF
FOR: ACCT. # PERMITS SURCHARGE AMOUNT
SEWER BILLINGS 4C-364
BUSINESS LICENSE 05-331 — M
PLUMBING PERMIT 05-332 $ __
MECHANICAL PERMIT 05-332
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
SYSTEM DEV.CHARGE 25-366
PARK DEV. CHARGE #1 30-361
PARK DEV.CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362
(- 1 TOTALS
RECEIVED BY � `�J_.
PIRMIT HUMSIR. At IGNID:
r Numb9r Am_ Runt Number Amount Numberr:cnount
7
RIC11P1 � "'
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04- Vfao*' : ! x .23 3
1osib e� 33. 80 36, 77q
cirf OF T117A RD
WASHINGTON COUNTY,OREGON
BUILDING DEPARTMENT
PLAN CHECK APPLICATION Date���
1
This is to certify that the Following plans have been submitted
For plan check pursuant to the Oregon Structural Code and Fire
& Life Safety Code, 1979 Edition.
Job Addressjz610460S0 121 A,e
Lot No. /4�) too 3
Owner/Applicant Address /G �e� 54)
Ave-
La�a 05cQe&2, Nzw2n Phone No.
Description: J �Q, rGl.w ,04 4edl'�,p
F� L
�03t I .e,4- -jo peXc20-vj 1 u°la�4r T►, _ _—
City of Ti rd, Bui cling pt,
By --
--- 12420 S W. MAIN P O. BOX 23397 TIGARD, OREGON 97223 PH: 639-4171 —