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INSPECTION NOTICE
�i City of Tigard Building Department
P.O. Bc x 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
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Date Requested 7 -c? Time���'` A.M. _P'd.
Address 7/ ��?r 1 C= Permit #��
Owner _ _ _ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to —___ ___ F�Appmved
Inspector Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
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INSPECTION NOTICE
City of Tigard Building Department
.1 2420 S.W. Main St.
Tigard,Oregon 97223
Phone. 639-4171
r /
Type of Inspection
Date Requested__ y Time A.M. P.M_.
Address _ Z v '/> Permit #
Owner _ Lot #
Builder
The following Building Code deficiencies are required to be corrected•
Presented to IA_Xpprosed
Inspector ❑ Disapproved
Date
CALL FOR REINSPECTION
❑ YES 0 NO +
BUIL DINU' PEFOAIT APPLICATION TIGARD DATE-__ 19 5 71
THE LINDEHSI ONED HER EBI APPLICS FOi'.A PEHMI r ! UR'FII WORK HEREIN INDICATED BUILDERPHONE
OR AS SHOWN AND/'APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHON
OWNER
4111 JOB ADDRESS 1155 Sid 134th ler LOT NO. _—_ —
li.gardr, Ok ARCHITECT
BUILDER Sume ADDRESS ITU SWbooner Fem ENGINEER
- DESiGIvL:q
STRUCTURE 13 NEW L REMODEL ❑ ,DDITION ❑ REPAIR C' RENEWAL ❑ FIRE DAMAGE Cl DEMOLITION
0 RESIDENCE ❑ COMM ❑_EDUCATIONAL ❑ GOWT L RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY i'" i LAND USE ZONE li`Z BLDG.TYPE 2 FIRE ZONE_ PLAN CHECK BY I'7 i` HEAT_
ilt'nxtruc-t single family dwelling w/al tatl.►ed x,er8peMAT-40".02, 1A 8* S j&fij
lir—ISSUE of # 5050 AL"
JT usowt 044T TMII T4�H—#'0.
--- s ARRA L%joi A jeffAff felt.mAMIt AL&L.E_—
l. •. i''t:l to ;OUTGO AuirC/ioedgewood ► .$150.00 I.eran h:f • 1 �Ci,r �. Kc+o•�i•
SEWER PERMIT# Z8 736 Gil
OCC.LOAD FLOOR LOAD 411 HEIGHT I6 NO.STORIES I _ AREA 12 14 NO.BEDROOMS _ VALUE
BUILDING DEPARTMENT SET BACKS FRONT 211 REAR 151^ LEFT SIDE RIGHT SIDE —
Permit _ AL3•UU THIS PERMIT IS ISSUED SURJ7CT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES AND IT" IS HEREBY AGREED THAT THE
Plan Check AU-00 W09K WILL BE DONE IN ACCORDANCL- WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
I WITH ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal I � � RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax
11,32 LICENSE.SEPARAT E PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
Total 334.3: SDC—
Y- I
ey druj
PDC# I +'ISG1•(afi APPLICANT OR AGENT - -- -
Receipt No.
Approved ADDRESS -- ---___-- —— PHONE
1 /
DATE INSP. TYPE INSPECTION REMARKS PLUMBING � � [►ATE
A;,
�p!' /� ��f:1�r.�`�•sr:.� Permit 1J5 ---J—
� R'oug n —
Fixture _
F nal
` HEATING
; - -
/ contractor
Permit No.
Gas or Oil
Final -
SEWER
J� f"inel
�Yrv�rJJ DRIVEWAY
Final
• ��/� �o��It� � Storm Drainage —
% (Rain Drain)Final _
t Sidewa I k
Curb b Street Final
Appr.,
�HLD�+.Oti T.FIN. ~��—TEMPORARY ERTIF'L ATE: OCCUPAhCV `..,nai
i' RTIFICAT ANCY A -- --
Lindsciping
�_- �toning Final
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Ilu i I d i ny 11vrm i I No
Locat ion 75:3r" Ski /35
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Uat�
Certification of Registration
With the Guilders hoard
doing business as dba
_ am registered under the provisions
of ORS Chapter 701 Oregon Homebuilders Law) .
My Builders Board Registration Number is
My registration is in full force and effect and expires on
Signature
TME UNDERSIGNED HEREBY APPLIES FOft APE A&III FOIL THL 'WORK FIEII061 INUILAI LU uUILUL14 1^IUW
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLA.... . '0 SPECIFICATIONS. Lot PI.
� oi ryo
! n JOB ADDRESS
-t-(� ARCNITEC
YI 1CNGINEER
:iUl�_O.'T _ �D✓} Y� _ AOOF,'FS: �a Ll( / .�" t OESIGNER
STRUCrI"IRE NC-W ❑Ri:%tnOEL sa. ❑A001!;ON QREPAIR ORENEYIAL QFIREOAMAGE ❑OEt
ITESILICNCE ❑COIL~+ ❑EOUCATIONAL 0GOV'T O."IELIGICUSCQPAr10 CICAR PORT ❑GARAGE v [ISTORAGE Cl SLAB
5S,l;(jfAf._Y�.}LANO USE ZONE-�` 1, 0LOG TYPE_5N — PLAN CHECK BY— _ HEAT
_ � S�Q.I�TBUSiZl�-��SILY.IJ.�Y Lh(LbCI�_TAC:HF.D (;ARA(;E
47?,S BATHROOM BEDROOM
..SEWER. PERMIT If z641,5ei� G a r a 2 e S/A
QQsFLOOR LOAD HEIGHT NO TORIES AREA/,-2/5/N0_BEQRQ0k15 VALUE
I BUILOIN-7 DEPAR rMENT SET BACKS FRO_r_1f -7) r� REAR 5 LEFT SIDE RIGHT SIDE
1 THIS PERMIT IS ISSUEO SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING ^00
11-:An Check I AND ALL APPLICABLE CODES AND ORDINANCES, AND ',T IS HEREBY AGREED
(-- =- WORK WILL BE DONT,IN AGCOROANCE WITH THE PLANS AND SPECIFICATIONS AND IN COh%PLIF
Sia caul �Z ALL. APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF VHIS PERMIT DOES N(
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CUIRENT CITY
`:-atm lax LICENSE.SEPARATE PERMITS REOUIRED POR SEWER. PLUMBING AND HEATING.
I — SDC
Tut11 I J 3� PDC#
APPLICANT OR AGENT
!Approved Receipt No.
-" n"RF%-.
S1)(; c S t o t-m�
s0C - ! c
PDC -
SEWER CONNECT X-ON $ '�
SEWER INSPECTION S � S
SEWER SURCHARGE— s �' r�.1`Al 7 4�;\\4n7 0
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