12430 SW BROOKSIDE AVENUE cl
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43012BROOKSIDE AVENUE
WASHINGTON COUNTY WIPARTKENT OF P'Ui3LI^ HEALTH
EN`r!ROIMNTAL :iI:ALTH St �:ICW-PI.UI413nfG ii;SPFCTION
e�.413 (Ale^phoae 648-8688
N 0 T 7 C E (GROUND)
�JT4iE�P� iB1NGIN THIS }iL'ZLLtNG 1tAS HAD THF' .A, 7
(ROAN"DRAIN)
INSPECTIGN AND MAY BE COVERED "'TER BUILDING
DEPT. IIEQUIREMEF"': RAVE BEER MET. PMAITpNO. J_
a
. lumbi^rig Inspector
WCDPH PL 12 7/64 (240U)
r
BUILDING PERMIT APPLICATION of TIGARD DATE 0-276 I i47
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
LOT NO._ - —
OWNER melon Anderson JOB ADDRES91i430 5W arooksids HOME ADVRESS -`
ARCHITECT
rytf ENGINEER
BUILOERF .�T Rh Gleam HOPI" • r"M)DRESS^y 1pQ r�tj� "��t�rR1�n _DESIGNCR
STRUCTURE ❑NFW ❑REMODEL UADDITION ❑REPAIR ❑RENEWAL ❑FIR�IEDAMAGE ❑DEMOLITION
RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO [:]CAR PORT ❑GARAGE U STORv.GE❑SLAP ❑FENCF
❑BOND ❑MOVING OCONDI1lONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY 1�—LAND USE ZONE - _BLDG.TYPE Wil--BLDG.
il FIRE ZONE, PLAN CHECK BY__ HEAT
pxlG room. addition includes bath room and extantion to t_o.iroom all
si r plan dated 10--2::F-76 Plumbing permit re€ shied _
G1 J4R LOAD-----HEIGHT SL9 STORIES ,PBFAl6Q NO.BEDROOMS VALUE:" U.-.
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
IPermit 32*aq _� ---_--- — —-- - —�_�.--�--
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODC-, ZONING
Plan Check 16.0() REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HFREBY AGRFED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPI IANCE WITH
SUb•total ALL APPLICABLE CODES AND ORDI'IANCcS. THE ISSUANCE OF THIS PERMIT DUES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax lsLICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, F. UMBING AND HEATING.
Total 49*44i
BY --- - - -
____-_. _ -.-- APPLICANT OR AGENT
Approved Re:vipf No
�tSdR E 55 PIiO fV E
. ...„,.e....rwY.ii...wrrrr..wrJn:s.W..mrwarr..�......M,,,..na.........aw....,tw..wi.u.r"'�::::�:-'.'y..:�'•11iYY[�.htiro►.:J.�Ww-4.� �:s:>.w:waxW� --.:..,.,....i..wr,..oM�.r....--.�..-...r.:..iWL..a....
Ue,YE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
ontractor
Permit No. H
Fixture
io✓G .1&)_7 M!!Vm" /9 Final
_ w4_ HEATING
Contractor
Permit No.
Gas or Oil
---
Rough-in
Final .,------ —
SEWER –
_ Final
_ DRIVEWAY T
�—
�__ Storm 6raina e
–– - — ___ — --
-__— (Rain Drain) Final
Sidewalk
Curb 8r Street Firal
J
___ A roach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY —
CERTIFICATE OCCUPANCY
Final
Landscaping
`— Zoning Final
i
an► � or aw sear rr Aa ar
City of Tigard
INSPECTION N ILEO U E ST
for
p07,_ t4dc'! — — ---
INSPECTION TIME : — PERMIT NO. '.
DATE: 7I//ZDATE ISSUED:__Ll_.
OWNERS NAME : -4,04
IADDRESS :,L!y L:
CONTRACTOR :
TEST: Air G, Water ❑ , visual 0 , Laboratory ❑
RESULT: Approvdd,Ar , Disapproved ❑ , Pending
SKETCH:
I
I
I
i
I
I
i SPECTOR DATE
COTE Attach supplemental test date heist]
JL
r,.?.a 9, .,wowto, "..I"R'Y
CITY 0' 7-11 74,N2 0 n
DUI;_DING PERMIT APPLICATION TIGARD DATE.— 19-- `J 0 16
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE ---
�1l :,.•J• Anuarson D
ADRESS '�24'3U -Sct rookeld® BUILDER PH
OWNER _ u8LDONE— _
R*W* Decker ENGINEER
BUILDER — _ ARCHITECT _ DESIGNER
STRUCTURE ❑NEW C.]REMODEL ❑ADDITION ❑RF.F'AIR ❑RENEWAL ❑FIRE DAMAGE ODEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAG'c ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APP1'jVED ❑SIGNS
OCCUPANCY— _LAND USE ZONE.-_._____ BLDG.TYPE _FIRE ZONE— PLAN CHECK HEAT
THIS I3 A DUPLICATE rop OUR iit Cc wos -- --- --
OCC, LOAD FLOOR LOAD y HEIGHT NO.STORIES _ AREAVALUE 429
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Pr rmit 5.00
— 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 WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
196 State r LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 50 U.7
By
--- — APPLICANT OR AGENT
Approved Receipt No.
Ab UUFSS -- - - -- -
i
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
7"30"� Contractor
Permit No.
Fiough•in
Fixture
_ Final _
HEATING
Contractor
Permit No.
Gas or Oil
F;nal
S:WER
Final
DRIVEWAY v
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Uu.1,&Street Final
BLDG.DEPT, FINAL i EMPORARY CERTIFICATE OCCUPANCY Final
CENI'IFICATE OCCUPANCY
Landscaping
I
Zo iing 'sinal
Zi.G; C L o Q/< en e ,%,' Pi"
Address 0 / �1P.rmit No.
r 6 Li
Name of Occupant_____._____ Permit charge !j
Connection fee c'
--------- ----- --- — Paid by ,-,Id, V C
- -- -- --- ----- Date connected
Type o, 3uilding VC -A < <_iZ Inspection fee
Service Rate _ Paid j q �i� 1�2 �1Date
Contractor _ Assessment___ Paid
Size of connection y
qG
I
I
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 682 DAT$ ,
PERMIT IS GIVEN TO
OF 1,�. X 1 `' ..�r .� .k ''ty^1.,7►.. �..> r k.�tJ�r��
TO CONNECT A .41
TO THE.SYSTEM OF TIGARD SANITARY DISTRICT
`-
TRIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PI.vTF.D.
PERMIT FEE PAID $....................................
CIGARD SANITARY DISTRICT
BY (�-�r-,I -
u..n.r`r�w.w..n. R.h.n,weA,Ary,r
CONNECTION INSPECTED AND APPROVED
Dates Superintendent