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City of Tigard
INSPECTION REOUEST
for
I INSPECTION TIME : PERMIT NO. : -...
DATE: �7- DATE ISSUED-. '
OWNERS NAME : , 1-/
ADDRESS : 407CONTRACTOR :_)- 4— -
ID TEST' Air 0, Water ❑ , Visual VI Laborc+toi L]
RESULT: Approved , Disapproved 0 Finding [j
SKETCH:
:
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INSPECTOR DATE
rNOTE Attach supp!emenral test data hrieto
city of Tigard
INSPECT a ION REQUEST
for
INSPECTION TIME -.-1—,'11:— PERMIT NO.: —
DATE:
O.:DATE: .. /L DATE ISSUED*�
OWNERS NAME :
ADDRESS : / qv
CONTRACTOR : 0
TEST. Air O, Water [3 , Visual 0 , Laboratory ❑
RESULT: Approved„, Disapproved L , Pending []
SKETCH: c
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INSPE TO DATE
NOTE, Attach supplemental test data herst:01
ADDRESS .� - PERMIT NO._
PERMIT CHARGE none
OWNER � _ CONNECTION FEE
PA?D BY
TYPE OF BUILDING £..-!tel t-�E.fr�e.c� _ 0ATE C0NN'EI:TED
SERVICE RATE 9/� INSPECTION FEE , °�
CON,rHACTOR PAID BY DATE
BILE OF CONrJF"CTION ___. _. .. �.�.� _. ASSESS19ENT _._.�._ PAID ___
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BUILDING PERMIT APPLICATIONCITY n P March 9 7'i N° 0700
TIGARD DATE __� Iq
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN ;NDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANY1013 PLANS AND SPECIFICATICN,t $W R PHONE
VQ_VNER— ADDRESS —_—
Rob G. Smith 11!;70 S.L. Hozallwood LoO
UILUER PHONE
`Iwt1er ENGINEER +
Fill11L2F>i — — ARCHITECT_--__ �— DESIGNER_ _
STRUCTURE C_ NEW ❑REMODEL LI AUDITION,—❑REPAIR ❑RENEWAL ❑FIRE DAMAGE _L1UFMOLITION_
rJRESiDENCE ❑COMM ❑EDUCATIONAL. ❑GOV'T ❑RELIGIOUS❑F'ATIO ❑CAR PORI ❑GARAGE.. ❑STO11AGLLJSLAr1 ❑FENCE
_ _JBOND -]MOVING [']CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED r ❑SIG's.; —
OCCUPANCY LAND USE ZONE____ BLDG.TYPE,_—F ZONE__ PLAN CHECK BY— HEAT__—� --
Conast�ruct lfrd"., q. t. frlame dwsIIIng��.;.a tmT t�et�rage - _--- -
No b**WmaiiT. 4ccording to approved pl ns. ---
Us .
OCC. LOAD 6 FLOOR LOAD QfZ L� HEIGHT NO.STORIES � AREA p F.� T.U --
VALUE t .'
BUILOINVDEPARTMENT �, (ae 301 �---_
ET BACKS FRO14T REAR LEFT SIDE. RIGHT SIDE
Permit —I - 1-1.5b 0 Q THIS PERMIT IS ISSUED SUBJECT TO THE RI.gULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICt%BI_E CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DCLNF IN ACCORDANCE WITH I HE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PFRMIT DOES NOT WAIVE
—" ,jtj RESTRICTIVE COVENANTS. CONTRACTOR AND SUR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1 .;tate LICENSE. SEPARATE PERMITS REOUIRED FCIR SEWER, PLUMBING AND HEATING.
?Otal— �
BY
f APPLICANT OR AGENT
Approved Receipt No.
w DDRFSS '_ __...----.-_--- --
�A------ REMARKS PLUMBING DATE
DATE INSP. TYPE INSPECTION
-
--- — Contractor
Permit No.
-7! Rough•in �
Fixture
Final _
HEATING
_ Contractor
Permit No.
-----.._— y 196
�T
Gas or Oil
—� ----- Rouyh in___ — --_
—_ -------- — _
Final ---
SEWER
Final_ 3 v
-- — _--- DRIVEWAY
-- --------____ -- _—_.�__ Final ___--
- Storm Drainage —
-_ —� ---�-----�----- _ (Rain Dain) Final
Sidewalk 76
Curb&Street Final _
-- - ------ �� Approach __ C= u-'r`74
BLDG.DEPT. FINAL TEMPORARY - CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
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(� ' Zoning Fine{
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