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MEN
INSPISCTION NOTICE
City of Tigard Building Department
1312S SW Ball Blvd. Tig Oregon 97223
Inapectio L;WP
-Phone}�_41 5 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Hoch. Rough-in A
ppr/Sdwlk
Found. Plbg. Top Out Gas Line
FINALt
Poet/Beam Struct. San. Sewer
Framing �d4 /
Post/Beam Mech. --- �/
<-Rain Dra
e
Insulation
Plbg. Underfloor Water Line Gyp. 6d.
/^� -Mach.
Date Requested: Q 2 6 -q —
/� ,^ Time: AM PH
Address:_ 5
1V — Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED: V)f I (yY
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Inspector:
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J APPROVED - DISAPPROVED APPROVED SUBJECT TO AROV2
Call For Reinap.
»iu sw HAIL M"i PLNCK/RECT #CITY OFTIGARD PERMIT # D
COMMUNITY DENE:LOPME;NT DEPARTMENT T,gan+.ckcg«,97W
(50')6'¢"" DATE ISSUED
JOB ADDRESS: .� �1��l� y (- TAX MAP/LOT
SUB: LOT: LAND USE: v _
VALUATION: _
3 Z U E SPECIAL NOTES
OWNER
NAME: o - L \ REISSUE OF: —.—
ADDRESS: r7 �� f LAST REISSUE: --- _—_--
FLOOD PLAIN/
PHONE: SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAML: '� (^DC7 f PLANNING:
� � `` 7 ENGINEERING:
ADDRESS: —
n G' ! FIRE DEPT:
<" —
^ OTHER: /,_1l )O V
PHONE: _ _
CONTR. BOARD #: `C� ' _ EXP DATE: ?/
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: _ OTHER: _
a PHONE: -- -- --
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FROPOSED BLDG. USE: -- N �'�
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COMMENTS: -
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APPLICANT SIGNATURE
Received By: ___ _-_ Date Received:
PERMIT k ACCT # DESCRIPTION AMOUNT AMOUNT PD_ BAL. DUE
1397 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%) ? 3-3 s-3
Build4ng
Plumbing
Mechanical
10-433 00 Plans Check Fee jZ S_ / 7•g _._,
Building _
PI unibi ng _
Mechanical
10-230 OG Fire
30-2.02 00 Sewer ,;onnection
30-444 00 Sewer Inspection
25-448-02 Comr,ercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) __— -- — — -- -
24-445-01 Water Quality (Fee in lieu of)
2.4-445-02 Water Quantity (Fee in lieu of)
TOTAL
nm/3587P.WPI
CITY OF TIGARD MOISTER PLRMI
COMMUNITY DEVELOPMENT DEPARTMENT -A"y!I it. ° . . ' ^ .
13120 SIV Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171
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