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PEPPITT NO . BUI[390A,11
CITY OF TlSA RD cffoi�60
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COMMUNITY DEVELOPMENT DEPARTMENT 0 311.5109
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard.Oregon 97,23.(503)6394175
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HIL'AALEVIT NO
Thl%permit is Issued subi ict to the regulations contained In Title 14 ..........
of the TMC. State of Cirr,-gon Specialty Codes zoning regulations
and all other applicable codes and ordinances. And it is hereby ":i':
acireed that the work will be done In accordance with the plans end ..r..Wi;..0
specifications and In compliance with all applicable codes and 0 TIAEA411111
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void It work Is not started within 180 days.or It work is Suspended or
abandoned for a period of 180 days Any lime after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections are requested Arid Approved
lure 4, 41111: i 11(3 IfillAW.1r,
Issued Hy 1 1 1 1.f 1)
SEPARATE PERMITS FiEQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
r
CITYOFTIIFAPLAN
RD CHECK APPLICATION
(C7ffYOf'TnWG-ARn PLAN CHECK H —
ueoow
C0MMUNITY DEyELOPMENT DEPARTMENT PERMIT H
13125 SW HO 8lvd-P.O.Box 23397,Tigard,Oregm 97227.(503)63941 r5 DATE ISSUED
_
i - .�/ 79J -(AX MAP/LOT �
JOB ADDRESS:
SUB: _ _ LOT: LAND USE: __---
VALUATION:
� ----• SPECIAL NOTES
OWNER
NAME: i I k' f REISSUE OF:
ADDRESS: _ - LAST REISSUE:
_ FLOOD PLAIN/
SENSITIVE LAND:
PHONE: --
A_P_P_ROVALS i2IRED
CONTRACTOR PLANNING: —
NAME: _ Z;z ��oi.csT/Z ENGINEE=RING:FIR
ADDRESS: _ ;:Z ��-SS L ��,�C i�C r•A"e OTHER:Lam-�� E DEPT
OTHER:
t
PHONE: S 1F� - G� 7� ITEMS. REQUIRED
E_TST/SUBCONTRACTORS:
ARCH/ENGINEER DU:; TAX:
NAME: CALCULATIONS:
ADDRESS: _ TRUSS DETAILS:
PARKING PLAN: -
- LANDSCAPE PLAN:
PHONE: - OTHER:
COMMENTS: --
PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. UAL. DUE
' 10--432 00 Building Permit Fees ---
10-431 00 Plumbing Permit Fees -
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5X) _ - — '
Building
Plumbing
Mech
10-433 00 Plans Check Fee
Building
Plumbing -_
Mech _
30-202 00 Sewer Connection
30-444 OU Sewer Inspection
51 9 (10 Street System Dev Charge
52--449 00 Parks System Dev Charge (rDC) ---
31-450 00 Storm Drainage Syst Dev Chrg (SSDC) _
10-230 09 TRFD --- - - -
10-230 06 Washington County Fir•a H1 (95X) -
10-220 00 Amart/Wedgewood
TOTAL 1 _2S
REC b
APPI-ICANT SIGNATURE_
Received By: _ hate Received:
cn/3587P/18P
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BUILDING PERMIT APPLICATION "OF
TIG ARCD DATE
.Ht UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUII-DER PHONE—
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NCL_-
OWNLR ]rfj �i°Dl` ' �T JOB ADDRESS lid+ (a �4 'd2i"!L1 HOME ADDRESS" -- _
ARCHITECT
ENGINEER
BUILDER 1 t i ADDRESS _— DESIGNER
STRUCTURE ❑NEW ❑REMOTDEL [:1 ADDITION C3 REPAIR ❑RENEWAL - ❑FIRE DAMAGE -_❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSOPATIO [:]CARPORT ❑GARAGE []STORAGE❑SLAB ❑FENCE
❑BOiJD� _ ❑MOVING
❑CONDI"TIONAL USE -❑DESIGN REVIEW ❑COUNCIL APPROVED - ❑CIGNS
OCCUPAN_CYJ-_-___-LAND USE ZONE- —_BLDG.TYPE l j-' FIREZONE PLAN CHLCK 9Y_._._. HE'1T-.__-_=
I
' additiuii to LaxA.Aii l ljuilditlyjp all ;)I:.:
'J4.0-' UL Lid 1di n(,iCI
O� ,J.Q_ F-L(,IQfiJ.QA9HLGJJ.L._— NO..I_OB-1 ES ._AH�CL--_NS)..UEUB-40MS VALU.E__. __v►..
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT BIDE
Permit -- -- -� .-
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED 114 THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 11 IS HEREBY AGREED THAT THF `r
---- WORN WILL BE DONE IM ACCORDANCE WITH THE PLANS ANO SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL. APPLICABLE 'ODES AND ORDINANCES THF ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- RESTRICTIVE COVENI.NTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
TotalBy
«
--
APM 1(ANT OR AGENT
Approved . T. 14eceipt No. r .
DATE INSP. TYPE INSPECTION REMARKS PLUMBING - DATE
Cr,rtractor —
Permit No.
A ` Fixture
Final
01
HEATING
Contractor
/ Permit No. --�
--- - Gas or Oil
-'— -
Rough-in
-- _ Final
---..- ------- ----- SEWER -.-
- — -� Final
--- DRIVEWAY
--_. ------ ----- ----- � Final--
Storm Drainage
-` (Fain Drain)Final
- —_-- J"----.- Sidewalk
Curb&Street Final
Approach _
BLDG.DEPT.FINAL Tt:MPORARY CERTWIC.ATE OCCUPANCY sinal v
/ CERTIFICATE OCCUPANCY ------- - -""-
/
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