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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard, Oregon 9722,3
Phone 639-4171
Address-__----_ Permit
Type of Inspection
The following Building Code deficiencies are roquired to be corrected:
Presented to Inspector
Date
GALL FOR REIMPECTION
YE9 NO
/ / i [W//KEW
KEW
BIJI'_DING PERMIT APPLICATION TIGARD DAI 12�.�F/ 1e_ 1.;0 3500
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE 232•-4175
OR AS SHOVJN AND APPROVED IN THE ACCOMPANYING PLANS AN()SPECIFICATIONS OWNER PHONE _—
LOT N0. 4'-T i 9-a Ta...�.q__�.9
OWNER J--Ent Constr. JOBADDRESS 13bbb SUi 104th AyalluEi
ARCHITECT
ENGINEER
BUILDER saMe . __ ADDRESS : 203 SF., 28th, Ptld. _DESIGNER R. Jeans Designs
STRUCTURE "NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL 7 FIRE DAMAGE ❑ DEMOLITION
RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT-0 GARAGE El STORAUE ❑ SLAB❑ FENCE
OCCUPANCY R"'1 _ LANDUSEZONE_-Rw�—BLDG.TYPE JN—FIRE ZONE---PLAN CHECK BY _ HEAT _—
Cunstruct single family dwelling_W detached garage, 3 Bedroome 1 bmth.
Re-Issue of Permit x'3497 (13931.) SW 104th Avenue)
SEWERPERMITM 23207 - $750.00 oaraus 400 sg•1't.
OCC.LOAD FLOOR LOAD 40 HEIGHT 12 NO.STORIES 1 AREA 1000 N0.BEDROOMS 3 VALLJO41, L,li ,
BUILDING DEPARTMENT
— 1
SETBACKS FRONT 20 REAR 24 LEFT SIDE u RIGHT SIDE
Permit $163.00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
lDOII REGULATIONS A►JD ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
.
Plan Check 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
Subtotal 173.00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
S1a,eTAx 4 .s2 $4ao.,
Total $179.J2
SDC- _. -- ---
PDCM I I S l Oil•00-APPLI ANT OR AGE
ey-_-_— -- pl
Receipt No.
dWh
Approved / ADDRESS ------- ------ PHONE
I
ir
DATE IINSP. TYPE INgPECTION —REMARKS PLUMBING
� Contractor �>MD
/? 1Y Ti --- --- -- — �^ Permit No. 2TTJ 7'-zo !Z-zzu$o
Rough-in — 7— --�
Fixture --
/'Jo FirC.nt',.v
,2 t — —HEATING -or >tiOHt
— —
Per,tit No. 2�/ )
Gas of Oil
— Rnughin—� -
------- `"� Final -- ---
---- .---�_ SEWER -- -�.--
----- -- -- — Final •/s S^/ f v�
__--—_----------- DRIVEWAY - -----------
— ------ Final — —
Storm Drainage
(Rain Drain)Final
Sidewalk
_ Curb&Street Final
APProadt
BLDG. Q PT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
` CERTIFICATE OCCUPANCY Final
I - —
-�J r Landecaping
Zoning Final —
DATE-
BUILDING PEPNITAPPLI^Ai ION TIG^, DATE-�_'F!� 2 ___ie
THE UNDERSIGNED HEREBY APPLIES FOR A PERMi f r-JR Th E'. ORK HEREIN INDICATED BUILDER PHONE ZM-_175
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AN SPECIFICATIONS. OWNER PHON-
LOT NO.
E ? .! 'LJ11r�OrUy� JOB ADDRSSS
Q_ �j6 ARCHITECT
ENGINEER
BUILCER X�4me� ADDRESSM203 26" U, DESIGNER-R• PIAS De$11 pc ^�
STRUCTURE )� NEW_ ❑ REMODEL ADDITION _❑ RE?A1R L RENEWAL ❑ FIRE DAMAGE Cl DEIfOLI T IJN
RESIDENCE C COMM C EDUCATIONAL =1 GOVT C RELIGIOUS u PATIO G CAR PORT C GARAGE ��. STORAGE ❑ SEAL'C FENCE
CC.COFANCY LAND USE ZONE ��BLDG.TYPE ,�-�._FIRE ZONE PLAN CHECK BY HEAT_
axa'�Yt�� St l F 'lu lwe11g__.4 w de.4 F p
SEWER PERMIT M — Q►rAOD -�
OCC.LOAD FLOOR LOAD � HEIGHT 12 NO.STORIES
AREA 000 NO.BEDROOMS 3 VALUE y1 SO ID
i — BUILCING DEPARTMENT — SETBACKS _FRO14T 70 REAR 24 LEFT SIDE -$— RIGHT SIDE
(P"-rm�t _- ��• THIS PE;;?wlIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE fiLi3LOi\v CODE,
�
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HERc3Y AGYEED TeAT TFE O�An Check ex) WORK WILL BE DONE IN ACCORCA4CE 'WITH THE PLANS AND SPECIFICATIONS AND IN C01.1PLJANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PER'AIT DOES NOT WAIV=
+.c�.li`.Yt.^tal - --It / 3•a� RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CON T AACTOns TO HAVE CURRENT CITY BUSINZEC
• -2 LICENSE_SEPARATE PER-MiTF. -HOUTAED FOR SEWER,PLUMBING AND HEATING.
G.
a ate Tax �/
r-- —� SDC-
i Totl al �jQ �'
i hA 91
��-1 PDC# APPLICANT QR AGENT ---------- - ---By
Receipt No. —�L � ��7�_���
Approved ADDRESS PHONE
DC
0C
;EIJER CONNECTION S
EWEF INSPECTION S
,EWER SURCHARGE s —
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