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City of Tigard
INSPECTION RE0UEe.S, 1
for
INSPECTION TIME : PERMIT N1-
DATE* —31-2-31,76— DATE IS UED� "—a-L-2-1'
OWNERS NAME : .
ADDRESS :
CONTRACTOR :
TEST. Air 0, Water Ll , Visual 0 Laboratory
RESULT'. Approved • , Disapproved 0
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INS iCTOR DATE
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Cit; of Tigard
lNSPEC,"TION REQUEST
or
MPE�:TION TAME: /4'0 PERMIT NO.
DATE: —/ 1511 ;;' DATE ISSUED :—
OWNERS
SSUED :_OWNERS NAME : � ..� —���, /—) H _
ADDRESS:
CONTRACTOR :
TEST : Air C, Wete:C , Visuo: Lnborotory C
RESULT: Approvedw. Disa-pproved C Pending ❑
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INSPECTOR DATE
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City of Tigard
INSPECTION REQUES
for
IN't, "I '.TION TIME ; J1a_ PERMI" NO. " ..--...
DATE: DATE
OWNERS NAME '
ADDRESS :
CONTRACTOR :,__t�bll
TEST*. Air El, Water L-1J , Visual Luboratorv,
RESULT.' Approved Disapproved EJ
SKETCH'.
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INSPECTOR OATI
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ADDRESS `1 ,���) h��•��� ' �� PERMIT NO.
PERMIT CHARGE. none
OWNCR CONNECTION FEE
PAID BY
1 YPE OF BUILDING !Y`�'C� `"`� DATE CONNEC TED
')FRVICE RATE _`IAC -ua ' INSPECTION FEE
CONTRACTOR �' �' `�`" PAID BY DATE
SIZE OF CONNECTION ASSESSMENT PAID
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DATE: io �_� ?s" OA7E 'SS ED
CWNE("AS NAME :
C G N"?A C TO R
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IN PEC OR DATE I
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7� CITY OP Nu 0519
BUILDING PERMIT APPLICATION TIGARD DATE_ — _-,
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK hEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHgNE_ _—
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,QWNER uob 3Mitrh—_----- — ADDRESS 1.L'.13,59 . ' . I r.ranuood L.s BUILDER PHONE _
Owner ENGINEER
BUIL ER ARCHITECT —�_ DESIGNER _
STRIJCTURE _ ONEW _❑REMODEL ❑ADDITION El REPAIR ❑RENEWAL ❑FIRE DAMAGF []DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOIJS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
_ ❑FOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED DSIGNS
OCCUPANCY _LAND USE ZONE — BLDG.TYPE— .—.FIRE ZONE. PLAN CHECK BY � HEAT_
1ruIj Lruut 14: ;'juW111.+tw W-L ol garew&
—� — no basement
3 bsdrooina -- — -
- --- - -
OCC.LOAD FLOOR LOAD40 1h__— HEIGHT — NO.STORIES _ AREA VA-UE ---
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 1.27•00 — --- -- -=—=--_
THIS PERMIT IS ISSJFO SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 10.00 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 COMOLIANCE VIITII
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
1%State • LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total • •
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APPLICANI OR AGE T ------...-_. -.�
Approved Rpweipl No .G'/ 2-
ADDRESSPH(INE
DATE INSP• TYPE INSPECTION REMARKS PLUMBING DATE
7,.vG Contractor
Per.nit No.
Rough-in _
Fixture _
Final -- �� —
HEATING
Contractor
Gas or Oil- •'I�n /G/ //- S'�S
Rough-in
Final
SEWER/ado-y-- B,W
Final
DRIVEWAY)')-](0 Die,
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
_ Curb&Street Final
A�roach -------- L G /-D . 7
61_DG.DEPT. INAL TEMPORARY CERTIFICATE OCCUPANCY
7 v, ✓l� -�J� CEF TIFICATE OCCUPAN( v Final_
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Landscaping
72lm Zoning Final
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