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15955 SW QUEEN VICTORIA PLACE
--KING CITY —
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BUILDING PERMIT APPLICATIONl�c.cm!�x �__ 19 r�._ 1327 �r
KING CITY DATE
THF UNDERSIGNLD HtHFBY APPLIES FOR A PERMIT FOR ['HE WORK HEREIN INDICATED BUILDER PHONE t,44-9424
OR AS SHOWN AND APP ROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE-
LOT
HONE—LOT NO.
OWNER Ar. Tice JOB ADDRESS 15955 SW Victoria P1•
0 1e ARCHITECT
ENGINEER
BUILDER SordonrlyJman G Sona ADDRESS 17595 SW Johnson DESIGNER
STRUCTURE Ll NEW IK1 REMODEL ❑ ADDITION ❑ REPAIR 0 RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
D RESIDENCE 1-1 COMM 0 EDUCATIONAL I-1 GOYT ❑ RELIGIOUS ❑ PATIO I I CARPORT ❑ GARAGE ❑ STORAGE ❑ SLA817 FENCE
OCC PANCY ft�3 _ LAND USE ZC NE _BLDG.TYPE —At--_FIRE ZONE._PLAN CHECK BY _B(.R HEA i
-Luclose existing cove redap tion_to sun room_
SEWER PERMIT#
OCC.LOAD FLOOR LOAD _HEIGHT NO.STORIES AREA 190 NO.BEDROOM VALt! 31,.'10( .
BUILDING DEPARTMENT SET BACKS FRONT — REAR LEFT SIDE RIGHT SIDE
PermED_ I1 44.50 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAININ T BUILDING COriE, 'ZONING
_ REGULATIONS AND ALL APPLICABLE CODES AND ORD'NANCE.S, AND IT IS HEREBY AGREED THAT THE
Pian Check 2K.a 3 _ J WORK WILL BE DONE IN ACCORDANCE WITH THF. PL,4NS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. T!& ISSUANCE OF THIS PERMIT DOES NOT W.1%IVE
Sub-total _ 13*43 RESTRICTIVE COVENANTS r:ONTRACTOR AND SUB CJNTRACTORS TO H!VE CURRENT CITY BUSINESS
State Tex
1.jH LICE VSE.SEPARATE PERMITS REQUIRED FOR SEWER.PLUMBING AND HEA ING.
Total 75.21 SDC— ---
----- PDCM APPLIC TO AGENT - — -- - -
ByCz
--- -
Receipt No. —
Approved BCR ADDRESS -^ PHONE
i
DATEJINSP. TYPE INUPIXTION REMARK! PLUMBING DATE
� � _�� ConIroctor t►� Permit No.
Rough-in
fixture
-- �._—
Y
Final --_.-
-_ HEATING -
Contractor —
Permit No. --i
Goo or Oil
Rough-in -- v
i —
Final —_�_-
- —SEWER —��—
Final
DRIVEWAY v
Final
Sto•m Drainage
(Rain Drain)Friel
Sidewalk
Curb&Snaat Final
Approach
BLDG. DEPT. FINAL —TEMPORARY ��CERTIFICATE OCCUPANCY Final
—
CERTIFICATE OCCUPANCY
Land%capin')
C11Y OF TIGA RD N o. 1046
12755 S.W. ASH
P.O.BOX 23397 pate 17 _7 `
TIGARD, OR 97223
Name J
Address
Lot Block/Map Aubdivl3ion/Addres3
Permit M's Bldg. Plumb Cash Check
Sewer Other Other Rec. By
Acct. No. Description Amount
10-432 Building Permit Feesqq,S
10.431-600 Plumbing Permit Fees i
10.431-601 Mechanical Permit Fees
10-2_30.501 State Bldg. Tax
10.433 Plans Check Fee__
10-435 Other Licenses & Permits
30.443 Sewer Connection _
30-444 Sewer Inspection --
24.448 Street 5 st. Dev. Charge _
25.449-610 Parks I Syst. Dev. Charge
25.449-620 Parks II Syst. Dev. Charge
31.450 Storm Drainage Syst. Dev. Charge
10-430 Business Tax
10.434 Alarm Permit----
10.227 Bail -- - ,-
10.455- Fines -Traffic/Misd/Parking — u'
10.230- _ CPTA Traffic/Misd/Vic. Asst.
10.456 ;ndigent Defense �'-
30.446-401 Sewer Service/USA
30.446.402 Sewer Service/City v
31.447 Storm Diainage
40.475 Bancroft Prin. Pymt.
40.471 Bancroft Int. Pymt.
10.451 Other Charges for Services
TOTAL j
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DEPT. ti. }
i
City of mind City
15390 S.W. 116th Avenue
King City, Oregon
97?23
Ref: L . E. Tice application for patio enclosure
Bob: Plans submitted are incomplete , the committee want the
following things clarified :
1 . Electrical - must have separate circuit ( 220? ) for electric
heating system.
2.Do not approve of carpet laid directly over concrete .
3.Details of interior finish and ceiling insulation.
4 .Must obtain building permit from tigard .
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