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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard, Oregon 972.23
Phone 639.4171
Address. _ _ c ` FormIt
;�
Type of Inspection __...
_._�—_
7
The following Building Code deficiencies are required to be corrected"•
17
Presented to _Y __ Inspector
DAte
(ALL FOR RUVREMON
❑ VES C) NO
I
.i
-ar ar � `
PLUMBING PERMIT 1V
Ori',�pdJ ? l�/ ' _. _...__ holder of a valid ijiumbing contractors license is hereby
autharized to cause plurnhing work ai, harein noted to be irist.ilkd in accordance with the plumbing code. of
I idard. Such installations require inspection by the City Inspector who shall be notified not fess than four f
(4.) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for ,-'I contractors and sub-contr,icrors.
_Own ar AnE�A��(_�DA?•'s _.�_ - _Add a ss.!_,21yo s��v'G���.��,l./�G?% Qa te_7/Y D _..... . t
NUNI 8cA OS TOTAL
TYPE of PEWIT �rtr:1S FEF ON C:nC,H � A.11+10UNT
singe Fam;l,/_1_bath-each .,r--
Ouel x_Each t ba*h unit.__.__
AGditir,n31 bathrooms—eer_eh 10.00
I yhlobit+! Homu space—each _ _ ._15.00
IN01vIDUAL FixTuREs(C0r�f'1F.:ftC^1Al
I to_50 Fixtures In 1 building cacit ,w M, _. _.3_00_ ._—. _ -4
I 51 to 100 Fixtures in 1 buildin -e'ich 2.5t
101 to 200 Fixtures in 1 t+uildinccach - 2.00
_201 o• more Fixtures In 1
14I5CELLANE0USM__� _
al 100
�r5ewerSeach aio bonding-- t�._._____._____..� _ _-y___ -'
YJa:ur Service to building w� 6.00 ~�
1 �F.RM1 IIT �O For PhImbing lnspixtion Phcuip 639.4171
S+ate _ - L�On Plumbing Contractor By t � i,✓ .v
id[CFI111' NO. Issued By
�► a� err reg r
BUILDING PERMIT APPLICATION TIGARD DATE– b/22/ jq !a 31$5
THE UNDERSIGNED HErIEBY APPLIES FOR A PERMIT rOR I HE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHGVJN AND APPROVED,. HE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOTNO._ Ji — '_,,LIart
OWNER T iadetriark„Homme JOBADDRESS12940 zj41 Glacier Lily Lircla _ Summar Laker
ARCHITECT —
ENGINEER
BUILDER same ADDRr.SSi10J 51J 5andbur9 St.T DESIGNER J
STRUCTURE IN 4NEW ❑ REMODEL ❑ ADDITION IJ REPAIR ❑ RENEWAL C FIREDAMAGL`• ❑ DEMOLITION
0 RESIDENCE ❑ COMM ❑ EDUCATIONAL C7 GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CAR PORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY -R73 LAND USE ZONE '.. "7 FSO BLDG.TYPE —ar” --FIRE ZONE_ 3 _PLAN CHECK BY �WH HEAT
Construct single family dwelling u/attached garage. 3 Vedrooms 3 bathe;. !
SEE CORRECTION SHEET ATTACHED.
;EWERPERMITN2-'• ' .• T�7oQ.uc _;gLI t-,— ---
OCC.LOAD r q DAD 40 HEIGHT 20 NO.STORIES 2 AREA 2221 NO.BEDROOMS VALUI159,700•
BUILDING DEPARTMENT _ SETBACKS FRONT 21 REAR_ 40 LEFT SIDE 7 RIGHT SIDE l
Permit X227.00— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
— REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 113.50 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 340. 50 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMI S qUl FOR. WE ,P SIT TING
State Tax i; 9.013 11 !T,, � �'I € - j H ! I "
— _'. sac -
A00,00
Total S349.58
By P1 PDC# .I.or.Q roA.� P'PucANT
Receipt No.
Approved ()UH
I
DATE INSPP, TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
„- Permit No. 1
Rough-in
Fixture
Z"s4'_-:6v ►-+�C .t Tis r.! _—.--- � --- --
,►.7, IM�. _- _- — -- - -- Final_ -- -- -
♦OP��wT --_ -- - - -- HEATING
o Contractor
- -- - -- Permit No. Sot s-24 $O
--- -�_
Gas or Oil --
Rough-in
----- — _—.._ - - Final--
- SEWER
- -- ---- -------- Final
— — V - DRIVEWAY `
_� _— --------- -.. Final
-- Stona Drainage
- �-� _ - ------- (Rain Drain)Final
— � ~- _---- Sidevuelk
— — Curb&Street Final
-- ------- -- __ ._.. _ Approach _
BLDG. DEPT.FINAL — TEMPORARY CERTIFICATE OCCUPA Y Final --
CERTIFICATE OCCUPANCY ----
6 V LandwAving
Zoning Final