Certificate of Occupancy (20) S
CITY OF TIGARDIIII CERTIFICATE OF OCCUPANCY
ti . • Permit#: MST2016-00216
COMMUNITY DEVELOPMENT Permit Issued: 06/09/2016
T lt'ARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103BD11800
Jurisdiction: Tigard
Site address: 12610 SW 121ST AVE
Subdivision: 2008-056 PARTITION PLAT Lot: 2
Project Description: New SF. 7/5/16, Changed plumbing contractor. 1/25/17, REPRINTED to add washer and dryer
vent.
Class of Work: NEW
Type of Use: SF
Type of Constr: VB
Occupancy Group: R-3
Occupancy Load:
Fire Sprinkler Required:
Project Name: Nix
Owner: NIX, DAVID C
NIX, JULIA A
12630 SW 121ST AVE
TIGARD, OR 97223
Phone: 503-314-0798
Contractor: OWNER
DAVID&JULIA NIX
12610 SW 121ST AVE
TIGARD, OR 97223
Phone: 503-314-0798
Fax:
This Certificate issued 9/26/2017 grants occupancy of the above referenced building or portion thereof
and confirms that the building has been inspected for compliance with the 2014 State of Oregon Specialty
Codes for the group,occupancy,and use under which the referenced permit was issued.
Mark VanDomelen
Building Official
City of Tigard
POST IN CONSPICUOUS PLACE