Permit - ..- ' W a.
IN PERMIT APPLICATION T
BUILD G c�
of Y TIGARD DATE 19
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONF
LOT NO.
OWNER 4 LeFt JOB ADDRESS at, 11Unilker F!C HOME ADDRESS
• ARCHITECT
^ ,�
��Pt I>sM
75939 .4t fi t. Helens P . ENGINEER rli t,
BUILDER ADDR ESS DESIGNER
STRUCTURE DNEW ❑ REMODEL ❑ADDITION ❑REPAIR DRENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM DEDUCATIONAL ❑GOV'T ❑RELIGIOUS ❑PATIO ❑CAR PORT OGARAGE ❑ STORAGE ❑SLAB ❑FENCE
❑BOND El MOVING ❑CONDITIONAL USE 0 DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE M_ BLDG. TYPE �� FIRE ZONE PLAN CHECK BY HEAT
coda. icy, Li- attic• area,
OCC. LOAD FLOOR LOAD HEIGHT NO. STORIES AREA 21 ' 0 O. BEDROOMS VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 1 2.00
n THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 16.00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub - total 48.00 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 1• 2C LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total c 49. 2 +.
By R
z' 03Y APPLICANT OR AGENT
Approved Receipt No
----- ounnic
DATE IN$ TYPE EMEPEcTi ON REMARKS PLUMBING DATE
- . _ ad • • ,{ Contractor
E!', 1 yr x
•
10 -_3o- ; ['t . I- ��H.tA. Rough -in
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough -in
Final
SEWER
Final
DRIVEWAY
Final
Storrs Drainage
(Rain Drain) Final
Sidewalk
Curb & Street Final
Approach
BLDG. DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY I Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
e 2T S � �
_ 1 ING PERMIT APPLICATION CITY TIGAR DATE 5 / _ •
. t '
JNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE__ _ � ( , ,� _
n `� 3 -* /./ 3 4
AS SHOWN AND APPROVED IN THE y ACC � O M LAYING PLANS AND SPFCIFiC.- •TIONS. OYJNER PHONf�
. _ LOT NO -_ - -.. -
(J77u ^, TY �afr5 , o L e'en/7 1c3 /66'aesr
JOB ADDRESS 7:$ 5,�UN?.,.KE --
WNEF2 ARCHITECT •
Q E GINEER
BUILDER �3�NGr'�� ADDRESS
❑
S 3 9 3 9 N S ir _ If7 �t/5 DER _____. —
-
STRUCTURE DNEW A REMODEL _ [..1 ADDITION J _ REPAIR , 0 ENEWAL - OFIRE DAMAGE ❑OFMOLIT!Df !
❑ 1� N
RESIDENCE COMM DEDUCATIONAL ❑GOV'T DRELIGIOUSDPATIO ❑CAR PORT OGARAGE ❑ STORAGE ❑SLAB DFEN:
QQ S1V PLAN Y__ 42 _ _ HEAT_
OCOCCUPANCY OCCUPANCY l??_ LAND USE ZONE !M'Y_ = _ Dl DG TYPE __ .,: -._ FIRE ZONE_' - AN CHECK � -- -. - - .
& ?4/e--10-Ort ___712-e:0--- .Gte,__,_ _-_.-_- ____.
SEWER PERMIT # _ _ — __ _. —___,
QCC_LOAD _ _ ._ H
FLOOR LOAD _ __ — __ E I GH T _ -_ NO USX; _ •--- - AREA 24000 NO BEQROOMS VALUEsa� a __
- SET DEPARTMENT SET BACKS FRONT R1 R- RIGHT SIDE
Permit 3 2
all - - -- = -. - -. _ -- -- - -- -- -- -
- -- "— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING C ODE, ZON!N
Plan Check /4' 0-f) REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAY ,
�- - - — - t v',ORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COM ?L' WIT
Sub -total _ -- 98 eta ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WA,;'.
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINE
F Tota Stat e Tax , L LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER- PLUMBING AND HEATING.
! Zi S DC / / •
I ------ �:� - 40-4, 41_1_4; . -- _- APPLICA OR AGENT
Ipt No C' /��,g - 2. '3 -// 3 II
L App uvEd 7 S �/1/ Jf!j _
AnnaF55 PHONE --
SDC - $
PDC - $
SEWER 1ONNECTION $
SEWER INSPECTION $ i �
SEWER SURCHARGE $
Comments: Q /$ -74 1 394 40 IRFJ'.
BUILDING DEPARTMENT, TIGARD NO
11c) , PLUMBING PERMIT
I
k', T 1 ' P L c esf , 3 , a ‘ _, holder of a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required -
i for all contractors and sub - contractors.
Job
i Owner OTi i i y - • / ie K Address mac" ff �n Zi &mate S/Ag/77 •
NUMBER OF TOTAL �.-
TYPE OF PERMIT ITEMS FEE ON EACH AMOUNT
RESIDENTIAI $ — ) !- -
s ing!e F amily -,1 bath- -each 25.00 �r,l
Du !ax- -Each 1 bath unit - -_ — 25.04 — ji- f.
Additional bathrooms —each 10.00 j t - `- It
. Mobile !- ^ma ST ,c —each 15.00
[INDIVIDUAL F$xTUR E3(COIti111ERCIAL) _. _ -� - -- — r':=
1 to 50 Fixtures in 1 building —each 111 �j 3.00 _ lo gv°
51 to 100 Fixtures in 1 building —each �, 2.50 ^� ` gt
10i to 200 Fixtures in i buiidin e ; 2.00 1
241 or more Fixtures in 1 bui!din — •a . ir — 1,50 - - -`— �
lA
MISCELLANEOUS \ ' A -- --
__ —
Sewer —each additional 100 ft. r j, CO 10.00 ! p �'
Water Service tobuildin. i :Cg i3T,n 5.00 1
_ .
Other (5pe.ciry): , •
t
PERMIT ,7 ' ' For Plumbing Ins .i 1f, 'l� e 639-4171
4% State 1 i� Plumbing Contractor By ;cep_ ....a„.431....
TOTAL 6 to RECEIPT NO. Issued By