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FOR .;O JS H 16(C i 1,014 d Q d O
Y> CITY OF TIGARD -Z 3
PERMIT NO. � SITE ADDRESSi,,:5-„ Ss
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BUILDING PERMIT APPLICATION �� DATE JAW te__:% 0#822
THE UNDERSIGNED HERERY APPI_!'-S FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE 639-6127
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO. 2:il 14A '1L .1.100OWNER Tigard St. Invest. JOE;ADDRESS 16235 SM. 85Uh, Sui.t:e 101;
ARCHITECT
ENGINEER
BUILDER 11• A..Gray Constr. ADDRESS DESIGNER
STRUCTURE ❑ NEW EY REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
❑ RESIDENCE Cj,,COMM ❑ EDUCATIONAL ❑ GOV'T 0 RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY __y!_2 LAND USE ZONE _..1�—BLDG.TYPE 1�FIRE ZONE _PLAN CHECK BY __LKn_HEAT _
1(iklllt. ..":�JC:S L 1CuI luTi lox c? �weall EiYJtL'Ii1Ei•
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H
SEWER PERMIT M
c,3 — — —
co OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES 2 AREA 2175 N0.BEDROOMS VALUE
-j BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 152•50 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CCNTAINED IN THE BUILDING CODE, ZONING
���t•13 REGULATIONS AND ALL APPLICACLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check _ WORK WILL BE DONE IN ACCOgDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH AL1 APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tex f'•1.0
_
SDC
Total
,115.7 1
Zltr. PDC#-
-- APPLICANTAGENT
l-)r).1.
;v. ti : . ,ff Receipt No. ADDRESS T j—
PHONE
DATE INSP TYPE INSPECTION REMAWKS PLUMBING DATE
.�
ContractorOCA
2.
Permit I4o. 1` J —
Rough-in I —
Fixture
*7—.2 if— Final
HEATING
VContractor
r'drmit No.
y Gas or Oil
Rough-in_ —
a Final
I—
to SEWER
F—
J DRIVEWAY
m
1.4 Final
W Storm Dreinspe
J
(Rain Drain)Final
Sidewalk
Curb d Street Final
Approach
�tLOM DEPT.FINAL TEMPORARY w II6RTIFICAT41 OCCUPANCY final
MPT OCCUPANCY
Landscaping
Zoning Flnel
CITY OF TIGARD PLUMBING 1;� ��`i
Applicants must hold Oregon Registration to conduct a plumbing PERMIT 639-4175
business or must be property owner/operato not hiring outside help.
�N Nairne of DewkoprrnnlPlumbing Permit Nn -
"0-,�k 0 V Add essr Description
ORS[114 21-010 DUAN. PRICE AMT
Job Tax Lot Map.No.
Addrese FIXTURES _
Lot Block Subdivision -Sink 7.50 /S _a'
ams or name 'lame-� Lavatory �_ 7.50 7 x
(�ti�`^ Tlob or Tub/Shower Comb -_- 7.50 —
a nq Address ShowerOnl/ — _ _7_50
- --- --- �- 7.50 /C.(AZro Water Closet ___
OwnerCity/ tate -- '" - - 750
Dishwasher _ -- - -. -- -
Phone Garbage 0lsposal --- -7 50
Washing Machine-
Name 750
1 Floor Drain
7 50
ai mg ress Phone Water Heater
Laundry Room Tray -_ 7.50 -
Occupant City/Statin Zip Urinal _ 71,50ams --
Ott"r Fixtures(Specity) - 7.50
- -
����„� � 750
MMWV Wil=sig•--
ress ALX-. Pt 7.50- -
-s W_i s 1t� +`tr ' 7.50
Contractor Chty/Stats rap
MISCELLANEOUS
Q t� City taus. Tax No Sart a 100' 30.00
S -es.Addit.100 15,00
ewer
Stale s. ardNo — tate s s o -
(Resrdential) Water Service 1 st 100 _
1 hereby sc*nowisdge that I have read this applics dal do k4orcnatioh
Wafer Service ea.Addit.2X� 15.00
given s oorred.that I am registered with the State .den's 9oard.trxl also Storm 6 Rain Drain 1 st��W
100 3000
have a State Pksnblrq 60wwe that the numbers plan ars oon•ecL that all 15.00 -
plumbw�g Mork wio be done in suoordAvrce with sppticable proviskvs of Ore- Storm fi Pyrt Draigon RevisedStatutes Chapters 447 and M3 and appYable codes and that Mobile Home c* - 25 00
no help wtll be employed unless Nceneed under ORS W3. (11 exempt from
State registration,phre give ave reabelow). Back Flow Prevenban��a My.��pn Dewce ?� _
HOMEOWNERS-I hereby oerliy that er d th
I am Ihs owne Prop"d*
scrt-d above,of whhch looaLon I propose to make a pkxnbtrq IrnuYatlan for Any Trap or W asW Nd
my own uee and this property Is not being ttxrtruc$Pd lot sale.lease or mint Qvineded to a Fixture _ 7.50
Catch Basle 7.50
InW.d EiM.Pkxrbng -- 40 00 Per Hr
--------- -- ---- - SpeciaM Requested Inapeoaona _ 40.00 Per Hr -
_
AiW of Pt bh V w1tt+M+
,{ -- -- - an Ex'A*V Bldg 15 00 min
g10q.or&iMd.Ad~ J 25 00 min
AU t2ED SIGNATURE c= 1 Dato
in Q Lin S—M_ e fa11u1 _
Describe walk new❑ addition❑ akerstlon❑ nor r7 d e.11 if,)
I to be done residential non-rosiderltlal ----
Exigk>Q use of
Mid-TOTAL
NAidtrlp Or
Pt47prd U40 of 411.�t!l1GMlgIC -
------------
-
LXAbdh a a -- - TOT" 1
NOTICE - -
TMs pend be=, mA and void*work or oonatnidbn audXW1,W Is not nortr
t+nanoad wlrtdrt ISO dwyarar M osnlrruesm or wattt Y alapainded or ab'a^Aon"d for
a period of Igo doM alt sny hna dMr wmt Is omvnerroad
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