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13125 S.W. HALL BLVD,
P.O. BOX 23397
TIGA,-ID, OR 97223
���OF T117A P0 (503) 639-4171
OREGON
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SIGNED—
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PLEASE RETUr,N ORIGINAL COPY WITH REPLY. KEEP PINK COPY FOR YOUR RECORDS
FILE COPY
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INSPECTION NOTICE
Cily of Tigard Huiloing Deparlment
P O Box 23397
igard, Oregon 97223
Phone 639-4175
Type o1 I-+spection
Date. Requested_ �' z� Time L�f A.M.--...P.M.
Address _ U 3 3�J Sly✓— Permit
Owner ---------. __..__ Lot # _
Builder----
-Me
uilder----Me following Build'r+g Code deficiencies are required to be corrected:
Presented to {aApproved
Inspector C1 Disapproved
Date – —,
CALL FOR REINSPECTION
❑ YES 0 NO
IF LOW
CITY OF T I GA RD 131.11.!.,:,Lt�(.: L''�.I'tlq:l
CITYOF TIM
COMMUNITY DEVELOPMENT DEPARTMENT 0*190N
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 97223,(503)639-4175
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This permit is issued subject to the regulations contained in Title 14
of the TMC, State of Oregon Specialty Codes.zoning regulations -367 -3
and all other applicable codes and ordinances. and it is hereby
agreed that the work will be done in accordance with the plans and
specifications And In compliance with all applicable codes And
ordinances The Issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits This nermit will expire and become null and
void if work iq not sta-ted within 180 days,or if work is suspended or
abandoned for a p3riod of i80 days any time after work has
commenced. 11 shall be the respot.slbllity of the permittee to assure
all required inspections are requested and approved
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Issued By
ABATE PERMITS REQUIRED FOR'WORK OTHER THAN DESCRIBED ABOVE
C11YOFTIGORD rLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT MAI -MENT
(C:1T�Y=0FjTWARD PLAN CHECK, I
131255%Vl . Jwd P.u.fjcKZW,Tjq&A0r*q"W= ))00_4,n PERMIT /
DATE ISSUED_
JOB ADDRESS:
SUB: TAX NAP/LOT
VALUATION: r LOT. _ LAND JSE:
/ , DO. OD SETBACKS: FRONT: REAR: LEFT: RIGHT:
WORK CLASS: HEIGHT: -
_ TOTAL AREA:
USE TYPE: FLOOR LOAD: 1ST: _
CONSTR TYPE: HEAT TYPE: 2ND:
OCCUP GROUP: DWELL(UNITS; _ 3RD:
OCCUP LOAD: NO BEDROOMS: BASEMENT:
N) STORIES: NO BATHS: GARAGE:
PAP SURFACE: _-
APPROVALS RE 'D
PLANNING. SPECIAL NOTES ITEMSUIRED
REISSUE OF. .IST SUBCONTRACTO&S:
F.NGINEEPiNG: LAST REISSUE: BUS TALC:
FIRE DEPT.: FLOOD PLAIN/ CALCULATIONS: _ "-
OTHER: SEN IND.: TRUSS DETAILS:
PARKING PLAN: -
I.AHDSCAPF PLAN:
PLAN CHECK BY: OTHER: --'—
COMMENTS: � �' _-�'L/'d
-tit
1� -
oar .3
CDRSCR1rPTI6N UNT
OWNER 10-432 00 Building Permit Fees .,.
NAME:
i. " 10-431 00 Plumbing Permit Fees 3 --
ADDRESS:1/9 ?O S ��!i 10-431 01. Mechanical Permit Fees s
zya ~ 10-230 01 State Building Tax (52)
10-433 00 Plans Check Fee t
PHONE: 30-443 00 Sewer- Connection (202)
30-202 00 Sewer Connection (80X)
CONTRACTOR 30-444 00 Sever Inspection t
NAME: , .51-448 00 Street System Dev. Charge (SDC)
ADDRESSs w "•52-449 01 Parks X System Dev. Charge (PDC) $
52-449 02 Parks II System Dev. Charge (PDC)
31-450 0 0 Storm Drainage Syst Dev Chrg(SSDC) t
PHONE: G' / 10-230 09 TR.FD (95x) s-
"40•.5 ��rG' gjG� 3.0-1435 00 TRFD (52) -
ARCH/ENGINEER 10-230 OG Washington County Fire 11 (95x) �
NAME: 10-435 00 Washington County Fire /1 (52) �
ADDRESS:_ 1.0-220 00 Anart/Wedgewood s
1'NC.NF.: - TOTAL S
PREPAID
RFC I
BALANCF DUE -- - f
APPLICANT GNATURE
Received By: Date Received: