12480 SW KATHERINE STREET 12.480 SW KATHERINE STREET
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INSPECTION NOTICE
City of Tigard Building De-)artment
P.O Box 23397
Tigard, Oregon 9722.3
Phone: 639-4175
Type of Inspection
Date Requested �0 9 O Tiros A.M. _P.M.
AdmrPss I _�_�_ AZ Permit #_ c7- 0 7
Owner
-- ------ _ Lot #
P.."cler ,;_t__.V`-I 151 1 N_ti Du i -Z—(ejf 4- o 59 2
The following Building Code deficiencies are required to be corra;.t_-?:
Presented to
Approved
Inspector �-
.-
J [ ) Disapproved
Date 7 tt'd
CALL FOR REINSPECTION
YEB ❑ NO
CITYOFTI6i4RDDUTI._DI1.6 P E�R r I IT
a4 XR�D 1' 0. .. 1. . . .. -. "
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW FWl Blvd. P.O.Box 23397,Tigard,Oregon 97223(503)639-4175
JIN' (IDDRE55—. J.2480 SW KATHERINf:.' C0 PARCEL-- 2 6 3.0 13 L(.H,--('2 C
BROOKW(ly ODDITIC)II ZONING:
11.0CK. . LOT„ :2(.-
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1111"' ml:"Zz,: e RI:1141) (3L.I lWiCK0 1"i L-P U I R(:1)
L.1)0 R L.U fl 1). . . . 440 PS L.U FT w f t RGHT- f t FIR SF,KL.c SMOK DET. . s
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x.:'.480 £3W K,P I'll E R 114 1. ST PRMT 20.50
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"c 503 684 H",7:3 PAYN 34. 86 RJ-1 06,116190
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INSPECTIOW5 .......
This permit. is isSl+ed subject to the regulations contairpd in the 0 C)I.-/ C)V 11(1 1)'1 S P
Tigard Municipal Lode, State all Ore. Specialty Codes and all other P C)is t:/E4 k,�.A t :111 ri P ..................
applicable laws. All wirk will be done in accordance %ith F.(,a ni i.n g )-I%p .... .......
approved plins. Thii permit will expire if work it not s0v;ed 111%t.Chatic)r) IIII&P
within 188 days of issuance, or if work is suspended for more C'jyp PnAr,d Irisp
than 180 days.
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I I f C) 11-1 T, e c.-t 10)-1 6 3 9-4 L'I 5
A
.:,[TY OF 'rIGAPD PV:4.J-. [F'T Or PAYMENT PECE I PT HO. --.20 V7 Pi
CHEU.". AMOUNT tt 34.86
NAME s JC)Hi,—.,TUr4, EMIL, C'ASH AMOUNT a 0.01,'
A D D PE S 12401:1 EN V'.ATHf.-."RINE PAYMENT Di"ITE,
SUDD 1 11)T S I ON
TIGARD, OP 972227'."-
PURF 0517 (IF" PAYflF1',lT AMOUNT PAI f) F"UPPOSE OF ;"'AYMENT AMOUNT PAU
07:
C(Tj IT F-1 1 7.1 1
PLAN CHEC1. FE
OTAL AMOLIN T' PA I D
CITYOFTIIFA
1J12s&W-1+a,71 1111W CIiax APPLI ON
co.o.Box zMv� PIAN Ci�C
RD iignmd O(<sg- . I -Bb F1 Q U/.
COMMUNITY DEVELOPMENT DEPARTMENT (`�o3la�c4i71 n
DATE ISD __._..
Jon ADMESS: I .l 4-90 YJ <'A -iAx miyior .2JI- ,3S3-2G�o
a 1' +' un: .1 LAM USE:
SUB: ''' vAYJC>�1TION: �' 4/J,
OWNERSPR-'M NOWS
NAME: _�_h� I L � � 1 n IJ S Z U iJ REISSUE OF:
Arl)R>FSS: � ' "yJ() A-r 8 E.rz. O c LAST REISSUE.
G _� 7 "t ", �' _ F1JX ) PLAIN/
_ SENSITIVE IAND:
� RDDUIRFD
NAME: C'IUit D fit/ �.J � )�•. P'�II�. - ----
ADDRES'S: k1m DEPT _
OTHER:
PtME: _ `� ITEMS R
BUILDE2S ROAM) 1: E P DATE: _ LYSr/ -----
BUS TA)C: _
ARQ1 ENGIN)r t CAIIC UIJW1aIS:
NAME: _ TRUSS DE MIS:
ADCP2SS: ------- CJ►IIiIR: .
PRONE:
03144E2tM: _-ci; ,:_,c. -. C'�� ::�:21:i--` LOLL _.1 i i L S ext
SUBCTITIRACTURS: PlIM: --- MD31: --
PTIMT if AOM' if D03CRIMCN AM URr Alm JNT PD. BAL. DUE
U-432 00 I3tlildin_I Pei Foes
10-431 00 Plumbilr3 Ppxmit
10-431 01. Mechanical Permit Fees _
- --- 10-230 Ol State Building Tax (5%)
Building —
Plumbing
tkr ch _
10-433 00 Flans QYNA Fee -- /�: _ — f�3 , 3 3
Building - 1-3, 33
Plumbing
MPAJI
_.__-----.__-- 30-202 00 Sm- oer Connection
30-444 00 Sewer IrE pmt-ion
51--448 00 Street System Dev Charge (SDC)
52-449 00 Parks System Dev Change (LSC)
31-450 00 Storm Drainage Syst Dev C" (SSUC) __-
10-230 OG Fire
.111ML
RW
APPI,ICAW SIGMIURE
Received By: "�--� _��.__----------------_-.__-- Date Received:
eI/3587P.WI'F
xie w w a w w w w ewe
Permit No:
Address: -- _.. ----- ----- ---
z Issued by: Date:
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. Licensed Arc: * ect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. Thi-, statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 26:
1. I own, reside in, or will reside in the comp)3ted structure.
2. A. D My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. [ I will be my own general contractor.
if I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and do hire a general
contractor, I will cootract with a contractor who is registered with the
Construction Contrac'ors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above Information is corred and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
i
�.> Aj
Si natureo Pe,-,—Q,Applicar.i Date
CONSTRUCTION CONTRACTORS BOARD
0244) 10124189
"'HITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
as
Address 12480 s.w. Katherine Permit No.
Permit ebarge
Owner Emil Johnstun Connection fee 400
Paid by Emil Joluistun
Type of building die cidence Date connected
Service rate 3.00_per month Inspection fee 25
Contractor n, )i.l Mai johnstun Paid by _____same Date
Size of connection V AsaeBsmerit, Paid