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U c C] C ro ro i I �a n c m cn a cn r t) u, MAA ,address /s SOo ,� ctJ � .P Permit No. Permit• charge 22 9urwr ronnpctton fee Paid by n Type of buil.dinr. � t , nate cnrfnected ,-�rv.ice rata `y1 / Ins>p cLion F n e "nntractor Paid by date i:�p of conn�ctian Assessment Paid lid City of Tigard INSPECTION REQUEST for -514 w 1 'x-11 INSPECTION TIME: PERMIT NO. : DATE: Z�- DATE ISSUED : I Z OWNERS NAME : Z-Z�L , - ADDRESS: CONTRACTOR TEST : Air p, Water , Visual ® , Laboratory p RESULT: Approved Disapproved U Pending p SKETCH; ` l f i / / INSPECTOR DATE I [NOTE : Attach suppiemental test data hereto' I e. rrs>z sW l 10f1N f. REI.{fiARDI PflJMOIHL INPUF_I-SAH FMLN I h Ic;AHL) NO P. 0 Pru 129 PLUMBING PE RMI r NOIRERG, OREGON 97132 holder of a vahr' 411umbing contractors license is hereby authorized to cause plumbing work as herein noted to be installed in accordance with the plumhinrl rode of Tigard. Such installations require inspection by the City Inspector who sl all be notified not less that; four (4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required for all contractors and sub-contractors. Owner_,�Sa,�r.S�.t.:(_1+~�-�S�U� - — ArJdress �'�st �!��_� /c-`�u� Date—' � � '_-- �NUMrIL11 OF TOTALr'ERMIT NO.'S e TYPE OF PERMIT ITEMS FEE ON EACH AMOUNT lollice Use Only) Single Family-1 both--ench 25,00 _Du lex—Each 1 bath uni_ 25.00 Additional bathrooms—ear.h �� _10_00 _Mobile Home Spoce=ench _ _ 16.00 _ INDIVIDUAL FIXTURE FEES 1 to 50 Fixtures in 1 building—p3.00 51 to 100 Fixtures in 1 building`encli —` 2.50 101 to 200 Fixtures in 1 biflding_ench — — 2,00_ 201 or more Fixtures in 1 buildina—each _ 1,50 ^— MISCELLA_NEOUS —Building Sewer-1st 50 ft. —�� i — — 10.00 �— Sewpr—each additional 100 ft. 10.n0I _ Water Service to building_ —� -- — — _5.00 _ I _Private Water—Systems—each 100 ft., _ _ 10,00 —_ Olher is ecify): PERMIT 3 (' C r ---- For Plumbing inspection Phone 639.4191 -31°6 State �, U Plumbing Contractor By �� L L(�- L..._ TOTAL y' RECEIPT NO. Issue:i Py _ City of Tigard INSPECTION REQUEST for INSPECTION TIME P&/ PERMIT NO. :.� DATE: DATE ISSUED , OWNERS NAME rAI)C- _ ADDRESS: go 'j4/ cam, CONTRACTOR : _ _. TEST : Air 0, Water* visuG46 Laboratory p RESULT: Appreved Disapproved Q Pending p VIK CM: — -- l a i ,e . --- VATE17"E _ ry I h, Tse , mPntrl cgs; dr !0 bhrAo i i 7! 1 w,�UYuu r� 1'�fly�f ..g/Y��Ys rt'PrvwN ,M • :s.f,.iyr.q.rww ..n.ry,.. R rn .:..�e,VMpW�IOCMl91N�i1il9Mr 'V''' �R'• �1'�Kr���► '�.''y.:ti�si �fir,.. �,y�,. .r1+/IMww*Y' w:`+Y,W.;m iY17�'nrrv.w CITY or day 3 W 0785 BUILDING PERMIT APPLICATION TIG�4RD DATE _'1Q_ ° THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICAT . "Qp!NER PHONE OWNER Tualatin Uavul.apmerlt CO 1E�800 S*1�'. Highlond U. 639-3161 ADDRESS BUILDER PHONE il,tF 16�i Z ENGINEER ~ BUILDER _ ARCHITECT DESIGNER _ STRUCTURE L1NEW ❑REMODEL ❑ADDITION ❑REPAIR []RENEWAL ❑FIRE DAMAGE []DEMOLITION RESIDENCE 000MM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS OPATIO OCARPORT ❑GARAGE ❑STOAAGEOSLAB ❑FENCE ❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS OCCUPANCY LAND USE ZONE r) _BLDG.TYPE U FIRE ZONE_,_ PLAN CHECK BY HEAT--- f;011cstrl+ct 1,54 erg. f rrI>ne dlr® ing withattscheltl ariBel txnell�meirt - CC. LOAD _FLOOR LOAD_ HEIGHTNO.STORIES ` ARFA VALUE L � BUI�.DING DEPARTMENT — -Kt_— - —T SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE Permit :L i 7.C10 ---- �— — .HO 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 WIT14 THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH Recording WORK APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE •- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS I%State LICENSE. SEPARAVE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING. Iotal `,$war lraaspectiun $2,':I.00 By a Foy /f API ICANT OR AGENT - Approved Receipt No. DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE �� Contractor ;i •! _ O Permit No. Rough-in Fixture 7 -62-4 Final HEATING _ LGas ctor No. S dao 612 Oil Rough in — Final SEWEH S Final DRIVEWAYGi-//- Final A Storm Drainage (Rain Drain) Final Sidewalk L d _ EAh treet Final BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY CERTIFICATE OCCUPANCY ping inal C jN 1 a