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BUILDING PERMIT APPLICATION 1O1F TIG.AD
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
JR AS SHOWN AND APPROVED IN THE: ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE
LUT NO.
OWNER c t♦♦x ._ JOb ADDRESS I'% �'j11l51,IE ADDRESS y— +
YpiL :L�1f'tyM — / ARCHITECT -- _
.BUILDER (,tk�' + �J !=E' tl ENGINEER
ADDRL SS DESIriNrr7
STRUCTI'RE �ONEW ❑RFM:7DEL EIADLITION OREPAIR —_QRENE 1W-AAL` ❑FIRE DAMAGE i�DEMOLITION
RESIDENCE ❑COMM DEDUCA.TIONAL OGOV'T ❑RELIGIOUSOPATIO ❑CAR PORT ❑GARAGE [:]STORAGE EISLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITI! NAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY_' .LAND USE ZONE_.__' BLDG.TYPE--' ' _.FIRE ZONE—3 PLAN CHECK BY__ HEAT._ - _
IA (si9till 'NOter_twiro i f 2:u) !129r 1 4"W^f x 24•-4�" --- ---------
"r
-- - —
HE1aR7__-_-- NO.STQ.RIES— APMA..=� -pgo
PLIILDING DEPARTMENTW +
SET BACKS FROM REAR LEFT SIDE ° RIGHT SIDE
Permit
THIS PERMIT IS ISSUE.') SU13JFCT TO THE REGULAfIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 14 REGULATIONS AND A• I- APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
VIM •�, WORK WILL.BE DUNE IN ACCO„DANCE WITH THE PLANS AND SPECIFICATIONS AND IN rOMPLIANCE WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOFS NOT WAIVE
--” RESTRICTIVE COVENANTS, CONTRACTOR AND SUR CONTRACTORS TO HAVE -ARRENT CITY BUSINESS
State Tax LICFNSF. SEPARATE PERMITS REOUIRFD FOR SEWF.4, PLUMBING AND HEATING.
Total 4 x•17. ---
P.Y _
APPi iCANT OR AOF.1lT
Approved` - If -` Receipt No — --�
islr itlM ® w .� � tas
DATE INSP. TYPE INSPECTION REMARKS kLUMBING DATE
Contractor
Permit No,
Rough-in
Re" _ ._--- Fixture -- —
'�'
—C Final -- ---`- --
/- !!I iAi _
HEATING
Contractor
-- Permit
Gas or Oil
Final
SEWER
Final
DRIVEWAY_ _--__ —_-----
Final — -- -
Storrs Drainage
(Rain Drain)F al
Sidewalk
Curb&Street Final
Apr roach
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Finul
CERTIFICATE OCCUPANCY
Lendscaptag
Zoning Final
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City of Tigard i
INSPE=CTION REQUEST
for
IINSPECTION TIME : 42,41-6 — PERMIT NO.
DATE . lZ,Z DATE ISSUED'_1-1_
OWNERSNAME : <-��_ _
IA D D R E S S : L��-= ��5 QZI: —v,' QA-
CONTRACTOR : zVA
A-
CONTRACTOR : '
TES r .J ; Water L] G)"N, La' rotor ('I
i
n,SULT Approved , DisrpprovO 1 Poinding
i SKETCH:
I
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I ,
I INSPECTOR DATE
rNOTE Attor,h supplemental fest „ o#a hnrotol
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME ' V D C% PERMIT NO. :. .. ...
DATE .* _�1��11�� DATE I S S U E DOWNERS NAME '
NAME : --
A D D R E S S: ---
C O N T R A C T O R : ._-------__ --__-- ------------�..----
TEST : Air [-], Water❑ , Visual p , Laboratory 0
RESULT: Approv6d Disapproved D , Fending []
SKETCH:
__s
, 73
INSPECTOR DATE
LNO?E Attach supplemental teat data hereto']
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME ' – 9 ,t <^ PERMIT
DATE : . -)7/1k171 DATE ISSUED '.--/
OWNERq NAME - — / ,
A D D R E S S: _ /G S"S Sr :_ Zx e k
CON.j R A r,r O R .' QLt:36-ka:�&,A,,- ._ ,
TEST : '•-, Neter El , V:suaI !.I , I_aboratory 0
RESULT: Apormed )isapprovad ❑ , Pending X
SKETCH.'
w aTvK Te57'
INSPECTOR DATE
NOTE: Attach supplemental test data heretO
.rMAllr.
PLUMBING PERMIT APPLICATION
Jurisdiction of
INo, Type of Fixture Fel-- 1 Perfr_ Nr,.
I Per.n L t. fee
_ Water Closet- Tcil? •._ � Pear -
Da t. i�lb., +6' Approved by _ 1
-.3 i.•avat-)ry-- W,:!.,h Aasxn _ ;/ e , Building Perm:' `,; ��
Shower Receipt No. 2&L—
.rt 7-.; I ng
S1.nk� • kitchen
SLnk
Ordinary _- — LoWion of Buileing Q.
Sink-,. p�,1-
-- Au t,,m a t. =W._-e r •�--- -- --- ----�7--------_-------
Di5L
--- L�aundry Na a Addre > c�.r„-r
rain .i / ...__.1.-..
k3�tl Dra1n ` -
Aut,,mati. � .her �t}c Na e & Address or P:.umb J. ,-4
UunLx1!n,Dr].aLln� --- '
Fountain ��`cd —
_i CI_74 to r ant _ _,_
'1 „ - r�Lze '7 -
U; ,nai , _ Bu _Ln C:_jr_. � w AItur, R.�. e�a�.
Ya rd
�)w_mr•j.:.Iig- .0 + F
Thi . I- �rn.. r:' . .fz = r'•.�1'1 nnn vu+ . if work r,r i - n')t
:rlrtfflen�iU W 'Yi:.^. t `J o if -onstructlon o wo: k i.!; n(
.vii t.,v_ at -Any time after work L:. mrn= r.
i p: umr..1r,g firm; :.,,ast be licensed by the Ci- ty of Tigard and poet .
$1 ,000 bon:
i ner•abv c.�rti f y that, I nave --ad and exami.nF,d this apps i .a ti.:-n and knew the :gar
to be ti '.;'• and _ �,rrect. All. provisions )f Laws and :r Ji.nancF =. g�.v<_rning +.his ty}
f W':,r'k %V],' i t~�' ..n,'Pr�' i ► ed wi th whether specs f ied herr Ln c: r rot thr- granting
berm: r. (i,-e3 nto give 3uthorily t:, vC�:)lat . c +.nCt''I rhrfprmance' pi
t ;ny trf�r .:�t� r. c r to:a1 law regulating construe t,i,n r the .
' 1
I �
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME ,'30 PERMIT NO. :
I DATE : /c DATE ISSUED:.�aiLlf
OWNERS NAME : -7-,1D,
I ADDRESS :
I CONTRACTOR :
�i
TEST. Air [1 , Water [� , ual a , Laboratory p
I RESULT: A roved, Disapprove) 0 , Pending L]
SKETCH: yLl"0.�/L
I
INSPECTOR DATE
CN,)TE Attach supplemental test data et]
1
CITY OF TIGARD
11420 S. W. Moto these
TIGARD, ORNGOK 9721E
APPLICATION FOR BUILDING PERMIT
New Construction 1XI Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING P-D _ DATE ISSUED 4-5-73 BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ 89.00 No.
r•.
PLAN CHECK $ 44.50 -- u rt rr J-�
BYi OTHER $ VALUATIOD1 $ 24,864
TOTAL $ 133.50 RECEIPT No. -,777 7
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N_30 MAP M 2R 11M CENSUS TRACT y„g — JOB A
Architect or Engineer Tualatin Navelopmpnt ggaanv _
Address 15:icy, 51-u ,t„.b Ave , Viempt _—Phone
Owner
Address __ !Phone
Builder
Address_ „�, _ `Phone_
BUILDING USE Single Res. a Multi Res. ❑ Comm. lJ Industrial❑
OCCUPANCY GROUP I No. of Stori!ts 2 Total Height—l.,_ Area of Lot41r0
Type of Construction VXl.1W;aMLG'.1XY V Floor Area B _ 1 1A), 2� _
Set Backs: Front L, Back,_' __ L.Side ( R.Side—.)
Private Sewer k1pe Size _ Sewer` Septic Tank ❑
Water Service Pipe SizeStorm Sewer ❑ Ditch ❑ Urywell❑
Street and Curb Requirements
Driveway Width 1A No. of Parking Spaces c
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMA'PION
ADDRESS ASSIGNED 1-05P5 8 W. 0eptu�r _Okk 0, _
FIELD CHECK BY v-------+. DATF. 4-4-73
PERMIT APPROVED BY
It is understood th4t all work will conform with applicable codes and ordinances
of the State of Oreqon and the City of Tigard, O.egon, and that the building will
not be cccupied until a Certificate of occupancy has been issued.-lye the City of
Tigard Building Inspector.
Slgnati ePL*pplicant
•�A6 10=0 or_”. 3",S U6;mi