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INSPECTION TIME'--- PERMIT NO.
DATE . _,#,10 76 DATE ISS ED .....1
OWNERS NAME . 1.__...-__
CONTRACTOR
T FE ST : Air r], Water EJ , Visu,31 Lih
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City of Tigard
INSPECTION REQUEST `
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IN8PE PTI ON TIME: `' /"'' '� " PERMIT NO. :-- f
DATE: !_.:L_,. DATE ISSUED :
OWNER', NAME : --
A-UDRESS: .
CONTRACTOR :TEST : Air 0 , Wote-Cl , Visual,; , Laboratory [
RESULT: Approved , Disapproved E Pending �]
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IN;iPECT0R DATE
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01ty of Tigard
INSPECTION REQUEST '
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INSPF 'TION TIME: PERMIT NO. :
DATE:.2 IS DATE ISSUED : L,r' I
OWNERS
ADDRESS: /.-' lk,6
CONTRACTOR : 1,, 7
TEST : Air 0 , WeterO , Visu� ,d , Laborotory ❑ !
RESULT: Approved Disup proved rJ Pending
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CITY OF N° 0611
BUILDING PERMIT APPLICATION TIGARD DATE_
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVE[') IN THE ACCOMANYIIING PLANS AND SPECIFICATIONS. OWNER PHONE,
OWNER ADDRESS� BUILDER PHONE
mmer ENGINEER
B IIl 112ER .— —. __-.._-_ EC
6RCUL T _- DESIGNER ----
STRUCTURE _CINEW 0 RE.MO_DEL CJADDI TION _^ REPAIR��11 ❑RENEWAL ❑FIRE DAMAGE []SLAB
[] RESIDENCE COMM ❑EDUCATIONAL OGOV'T ❑REL.IGIOUSOPATIO OCAR PORT ❑GARAGE []STORAGE SLAB OFE'HCF:
❑BOND ❑MOVING OCONDITIONAL USE DDESIGN REVIEW OCOUNCIL.APPROVED USIGNS
VCCU"NCY�—LAND USE ZONE BLDG.TYPE+__`FIRE ZONE PLAN CHECK BV _ HEAT__�__`
A tvz n - -- � x'11tac hed g&rL., r, -- no _
OCC.LOAD _ FLOOR LOAD _—. HEIGHT NO.STORIES _ AREA VALUE `
BUILDING DEPARTMFNT — SET BACKS FRONT REAR LFF'r SIDE RIGHT SIDE
Permit
—�- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED rN :HE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HERE 3Y AGREED THAT THE
— WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AIJD SPECIFICATIONS ANO IN COMPLIANCE WITH
Recoi Jing ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PE:LMIT DOES Not WAIVE
--- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
�1%State LICENSE. SEPARATE R,ErMITS REQUIRED FOR SEINER, PLUMBING AN:C: HEATING.
Total _ _ /I•r,�
Byrf, -----_. ---...__
APPLICANT OR AGEN'r
Approved Receipt No
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DA''E INSP. T'.'PE INSPECTION REMARKS PLUMBING DATE P
Contractor
Permit No. �3 VL (_ z�J j G
3 cl, Rough-in ---
3» Fixture _
Final--- ---_ —_
HEATING—.`--
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-76< J - 2./a;v_��?�. '.w � Contractor p---�.
Permit No.Poe
_-- —
Gas or Oil
Hough-in —._-- - — ---------
- Final
SEWEV- -
_ Final__ _
DRIVEWAY _—_ .1- 3-/S--74
Final
Sto,m Drainage _
(Rain Orain) FinaO
Sidewali•
Curb&Street Final
Approach _ .3-t�-
BLDG.DEPT.FINAL TEMPORARY — CERTIFICATE OCCUPANCY Final —
CERTIFIC!"'OCCUPANCY
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2t9-?h
��/ Zoning Final /
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ADDRESS PERMIT NO.—A 76
PERMIT CHARGE none
OWNER CONNFC-TION FEE a
"07
PAID BY
TYPE OF BUILDING DATE ctjt�wl-,'Vib
INSPECTION FrE
5LkVICE RATE
CON MACTOR PAID BY DATE
317E OF CONNUC [ION A55ESSMENT PAID
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MONOGRAM OOMFS
JAY HARRIS
646-0186
12125 R. W. 20
REAVERTON, OR 9700's