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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: l <1 PERMIT NO. :______
DATE: ,-� / DATE ISSUED :._Ll_
OWNERS NAME :
ADDRESS:
CONTRACTOR :TEST : Air [, Water[] , Visual Laboratory E] 1
RESULT: Approved , , Disapproved O Pending p
SKETCH:
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INSPECTOR /DATE
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Cit of Tigard
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INSPECTION REQUEST
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INVECTION TIME: PERMIT NO. :_____ I
DATE: L DATE ISSUED :--LL—
OWNERS
SSUED :-_ / /OWNERS NAME :
ADDRESS: -eo 4 �i �•,�e. � I
CONTRACTOR :
TEST : Air ❑, Water[] VieuolI
X, Laboratory r]
RESULT: Approved , Disapproved ❑ Pending
SKETCH:
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INSPEC ;(1R DATE
CNOtF : Attach supplemeril ri r .,r ,1, ,
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City of Tigard
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INSPECTION REQUEST
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I INSPECTION TIME :aPERMIT NO.: -
DATE: DATE ISSUED:
OW,N�ERS NAME .
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ADDRESS :
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CONTRACTOR : , �,.z y1►� � �___
TEST: AirO, Water j Vieu�)o
Laboratory rj
RESULT. Approve Disapproved ❑ Pending ❑
I SKETCH.
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I01S CTOR DATE
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COTE: Attach supplemental lost data heret10
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HITT OF r 7>g 2 0815
BUILDING PERMIT APPI •ICATI�iiv TIGARD DATE May _— 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIE lSfT49.VS. OWNER PHONE_ _ —_
WNER %tub Smith 4W- ADDRESS 1 1.36." ��"!= X runwand Loup UILDER PHONE --tuner ENGINEER
BUILDER __ 11--11 ARPHITECT DESIGNER -
STRUCTURE ONEW 0REMODEL OADDIT!ON ❑REPAIR URENEWAL 01-IREDAMAGE ❑DEMOLITION
0 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSOPATIO ❑CARPORT ❑GARAGE ❑ST011AGCOSLAB CIFENCE
OBONC _ ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED LJSIGNS
OCCUPANCY _LAND_USE ZONE f{ = _•QLDG.TYPE_-__FIRE ZONE- PLAN CHECK BY� a HEAT.-,.-
Construct
EAT_ ___
Construct i4:35 sq. a t. fLame dwel,:ing with attached garage
No basement. Raissum 1.1371 Sod. Lakewood t.
3 bedrooms
QQC,LOAD "� FLOOR I`OAD 1' 1b. HEIGHT NO.STORIES, AREA 1 38 VAL.UE�M'g t CIf1O
_BUILDING DEPARTMENT SET BACKS FRONT Il t REAR "I f LEFT SIDE ! RIGHT SIDE a.
Permit --�.. 30'10 I =--- _-" =- ---------------------_--._-.- -------�_._»_,_
--"--'-- --- 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 COMPLI/INCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RFSTRIC"IVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BIJ!;Ir!FSS
t9!,state - �� LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
By --
- ----- --- APPLIrANT OR AGENT
Approved Receipt No. /
ADDRESS PHONE
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
-.� - �-- -
l/ ' 76 ----- Permit No. D tCX 3S- �vJ76
Rough-in _.-
(�_ •�G Fixture
016 - 'yam. _ y> '1Q �C' Final - ---
1 -- HEATING-
Contractor _
-- -- - Permit No. V-33 _ /76
Gas or Oi�A5�
--- - -- --- _ _----- Roug_h_in --- -
Final
------ ---- -- ---_- -- ---`S E W E R G-7.76 QIA --
Final
DRIVEWAY
Final
Storm D,-ainage
(Rain Drain) Final
Sidewalk 2S-74
- --- Curb&Street Final
I _-.- --- -__ ----- - Approach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY
7J Final
C Landscaping
/ Zoning Final
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ADDRESS (c ��� �.ua�, _rr'!_ PERMIT N0•_.__.?.5-
PERMIT CHARGE none
OWNER ���,4�.-�. '��_�... CONNECTION FEE
PAID 8Y ---
TYPE OF BUILDING ,�'�..��:s�� � DATE CONNECTED
SERVICE: RATE � INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNFCTION ASSESSMENT PAID
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