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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Pho ie: 639-4171
Type of Inspection
Date Reque�ste�dTime A.M. P,M.
Address yL{11�r7 ?�[�_ % _ Permit
Owner Lot #
Builder (it
i
The following Building C e deficiencies are required to be corrected:
Presorted to _ � — ----- _ r_T APPrnved —�-----
Inspector y�, 7t G
----TG. -v�-�S44�1 //i.teIrie.,1
. Disapproved
Date
CALL FOR REINSPF.C770N
i
i
C7 YES 0- NO
W W W W �!
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
Gate Requested Time rL A.M. M.
Address — �� ci !.0 cSr 7� — _-- Permit # L_�
Owner_ . Lot #
Builder
The foglowing Building Code deficiencies are vee., .ired to he corrected:
Ir h
Presented to
_—.-. - . ---- -- D Approved
Inspector Disapproved
Date
CAL FOR REINSPECTION
L-1 YES ❑ NO
� �i � IRA► �! � � Rf' � �' �
Nove
BUILDING PERMIT APPLICATION 'TIGARD DATE _--
TH"UNDERSIGNED HEREBY APPLIES FOR A PERMIT FO'i THE WORK HEREIN INDICATED BUILD pHI.NEE
OR AS SHOWN AND APPROVED IN THE.ACCOMPANYING PLANS AND SPECIFICATIONS. OW N R PHI-�e4ratg
OWNER JOBADDRESS 15817 .Sli 87th -
-- Ore8uu City OR 97W*5 ARCHITECT
ENGINEER
ADDRESS IOU S. Uak Tree TerraceO ____
ESIGNER
BUILDER
STRUCTURE ® NEW ❑ REMODE.L L-1 ADDITION ❑ REPAIR _ ❑ RENEWAL ❑ FIRE DAMAGE CJ UEMOLIT ON
a RESIDENCE 11COMM ❑ EDUCATIONAL ❑ GOWT FJRELIGIOUS E) PATIO ❑ CARPORT El GARAGE El STORAGE ❑ SLAB❑ FENCE
� ' - HEAT-
OCCUPANCY LAND USE ZONE 4 BLDG.TYPE v _FIRE ZONE. _PLAN CHECK
Construct single family residence W/attached garage
t��issue. of #5.340 -- --- --- - -
i
SEWER PERMIT 1 951 --- —_._S�ilLtil�tt�'- ;rw 4U VALL
�
OCC.LOAD FLOOR LOAD '4'� HEIGHT lb NO.STORIES1436 NO.AREA NO.BEDROOM
BUILDING DEPARTMENT - SET BACKS FRONT Zt> REAR L6 LEFT SIDE- RIGHT SIDE
Permit 30i•� THIS PERMIT IS ISSUED SUBJECT 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 40.UUA WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
-- I WITH ALL APPLICf.BLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal 341.UU RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARAI E PERMITS REQUIRED FOR SEWER,PLUMPING AND HEATING.
State Tax 11.Zt€
$5U(j:0l_' *w a. NU.uU rot:eiPt
Total_t)u, 319.28 S�dC - SUU.UI} fr' 7
PDCII111150.OU APPLICANT OR AGENT^
6y f - -
Receipt No. —PHONE----
p
HONE
Approved ------ � rh jam'"--..�-_._
w w N w�W-14FIR
DATE INSP. TYPE INSPECTICN REMARKS PLUMBING DATE
c �
Contrac'or �F– 2
No. ---
i,� Fluugh-in ------
�rL)/q�� - (✓� — Fixture —
`—►a" Final ----- -- --
/ HEATING
j !r q►� /79 /� —_— �d Contractor ^
/� 7 F –_•.�Y��sa� _ Permit No. g.X7
Gas Oil --- ---
.
��/Gj/�l r – nM TRTC7aT'RT7�`�r— Final ---- — —
�` SEWER
Finan /.2��6�y� L
DRIVEWAY
Final
i
Storm Drainage
(Rain Drain)Final
Sfdev.alk
Curb&Street Final
Appronch
BLDG. DEPT.FINAL. TEMPORAR'( CERTIFICATE OCCUPANCY
CEPTIFICATE OCCUI74NCY d Final
Landscaping 1
\� Zon,ng Flnal
o�
i
C'ITYOF TIOrARD No. 872.5
12755 S.W. ASH
P.O.BOX 23397 Date
' TIGARD, OR 97223
Name
Address !
Lot — Block/Map Subdivision/Address
Permit#'s Bldg. Plumb Cash Check
Sewer Other Other Rec. By
Acct. No. Description Amount i
10-432 1 Building Permit Fees _
10.431.600 Plumbing Permit Fees
10.431.601 Mechanical Permit Fees
10.230-501 State Bldg. Tax
10-433 _ °lens Check Fee
30.443 Sewer Connection
30.444 Sewer Inspection
"1.448 Street Syst. Dev. Charge _
52-449-610 Parks I Syst. Dev. Charge
52-449.620 Parks II Syst. Dev. Charge
31.450 Storm Drainage Syst. Dev. Charge
10.430 Business Tax
10.434 Alarm Pe,-mit
10-227 Bail _
10.455- _ Fines TrafficlMisdlParking
10-230- CPTA TrafficlMlsdlVic. Asst.
10-456 Indigent Defense
30.122.401 Sewer Service/USA —'
30.1224_0_2 Sewer Service/City 30% _
36.123 Sewer Sev!.elCity Maint.
30-125 Unmatched
7117.4 — Storm Drainage
40-475 Bancroft Prin. Pymt.
40-471 Bancroft Int. Pymt.
TOTAL f — c7
DEPfi.
MUM
v
BUILDING RECEIPT /
NAME: L�E�--� DATE':
ACCT. M DESCRIPTION
LJ AMOUNT
10-432 Building Permit Fees s r
10-431-600 Plumbing Permit Fees $
10-431-601 Mechanical Permit Fees $
10-230-501 State Building Tax $ _
10-433 Plans Check Fee
30-443 Sewer Connection (20X) $
30-202. Sewer Conriction (80X) $
30-444 Sewer Inspection $
51-448 Street System Dew. Charge (SDC) $
52-441•-610 Parks I System Dew. Charge (PDC) $
52-449-620 Parks II System D,ay. Charge (PDC) $
31--.450 Storm Drainage SyAem Dew. Chrg (SSDC) $
10-230-505 YRFD (95x) $
10-435 TRFD (5%) $
10-230-506 Washington County Fire N1 (95x) $
10-476 Washington County Fire N1 $ _
10-220 Amart/Wedgewood $
TOTAL
(bs/1214P)
F 1�
THE UtiUEH51GNEU H'LiALOY AN✓LIES 1-UH AI'EtIhU I Wit IFIL IVvI%I% ftLl'�^• "'• MI
OR AS SHOWN AND APPROVEO IN THE ACCOMPANYING PLANS ANO SPECIFICATIONS. or^t"o-Zotl[--
., LOT /4'
own[w //dlt_S r ,110/'-11!