12775 SW 111TH DRIVE 12775 SW 111TH DRIVE
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CIT`r OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 9723
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
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9jA4'a—rteB' .4z__ —
Date: /O/c7 _ Permit No.
Inspector -
CALL FOR REINSPECTION
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City Of Tina d Medianical PErmitrcrrni�
NaYl Inst311atiCn Re lace Fee Cid
p ❑ Relocation [] Addition [] A!,�ration LJ """ 4 % State
HEATING TOTAL_____'
CONTAACTOrR � t ',
A00,3Ea, _ WORK ADDRESS L1>�
PHONE
� ?k� APPLICANT
Heat Input Rating (BTU Per H lip L Vent Size r
Flu Siza
=UEL OIL ❑ GAS Er ELECT ❑ OTHCR
ITEM NO. FEE ITEM
:or Issuance o°Permit N0. FEE
5EE ABO Air Condition Compressor 15 to 30 HP
,V-up to & inC.100.000 BTU 4.00 Air Handling 10,000 CFM _ 10.00
z 100.001 BTU & over S.n0 Air Handling Over 10,000 CFM _ 3.00
=1oor Furnace 4.00 Evaporative Cooler 5.00
Pall •Floor •Suspendvd
•+-� _ — 4.00 RPrao Vent
— 3.00
--:II Vents Only 2'0;2.00 Vent System2-?pdir •Hea & Cooling---
d,00 Hood Corr-nercial 3.UC
kir Condition_Compres;or Und,?r 3 HP 4.00 Co ----- al Dunt System 3.OC
sir Condition Compressor 3 to 15 HP50 10.0r,
ISPECTOR'S CorNIMENTs
'TY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUBCONTRACTORS — —_—'
ROVED BY- DATE ISSUED BY j
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=CEIP i N0. A �
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BUILDING PERMIT APPLICATION 10 Y TIGARD DATE_. _-_ ___, 19
THE UNDERSIGNED HCREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPH0111
LOT NO.
OWNER ')8118 Gottor JOB ADDRESS 12775 SISI 111th P1. _ HOME ADDRESS
ARCHITECT
";am Gott.er Lun®tr. 1263:) Slit U98f 091111 4d Cf. ENGINEER honk HaIfikeiiwf1
BUILDER •" ADDRESS
ADDRESS DESIGNFR
STRUCTURE IbNEW ❑RFMf1DEL_ ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
0 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOWT ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL. USE ❑LESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY_ � LAND USE ZONE_i -14 BLDG.TYPE —FIRE ZONE; PLAN CHECK BY� HEAT_ywv
x2natruc:t kiinjle fimily cswelliny w/atteched ,„arsge. 3 i;®rjioumsi aths.
SEE CORRECTION SHEET ATTACHILD. - -
Sower Permit ;1808.1 - 717 x.00 s+, *+
4D 27 �i�a 39�,bOP AO.
QQQ,�QAQ___ _ __ FLS��2A LSD FiElSilil—__�� NO�TQt31G�_____,AR A NSL_B�4F;QQMS--YGI IIF
BUILDING DEPARTMENT SET BACKS FRONT 20 REAR ��7 LFFT SIDE 21) RIGHT SIDE 10
Permit
–' THIS PERMIT IS ISSUED SUBJECT 1'0 THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 140. •:Q REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
'- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 313•`_74 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax �� 1•i6 LICENSE. SEPARATE PERMITS RF_OUIRED FOR SEWER, PLUMBING AND HEATING.
4()Q.f1U
Total J. 4100.0u
QU
By P1
-- _
APPLICANT OR AGENT
Appioved -- ?__J Receipt No
DATE INSP. (TYPE INSPECTION REMARKS PLUMBING DATE
Contractcr
Permit No. oZ 114,b'O 3-&b
V Rough-in
Fixture
Final
HEATING
jNEETROcA- Contractor
11 4w;T[ � "r' Illlorw� -- Permit No. Q
�v-
i,Ui¢ nf,�,p�;�'� Gas or Oil
Rough-int
Final
SEWER
Final //—.24V r,Of
DRIVEWAY —
Final
Stoft Drainage
�(Rain Drain)Final
Sldevvqslk
_- Curb&Street Final
_ Approach
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
BUILDING PERMIT APPLICATION CITY TIC-"1RD JATE_,L _ 0 _. t8 N°e-A7428u�
,HE LINDERSI GNED HEREBY APPLIES f OR APERMIT FOR 7i •1E WORK HE RL IN INDICATED BUILpERPHONE_p�/� -4
UR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPF 'IF ICATIONS. OWNER PH
/� LOT NO
ER- SC^W% L: .r JOB ADDRESS I IS Sw mflk _ HOME ADDRF_SS
ff� q ARCHITECT
DER s 1-6 tr l^egs7l• ADDRESS r��3S S. �r `(-E V"r 1_e4j' ER Ftil1�k r+�•
UCTURE L.'JNEW _ JREMODEL ❑AOJITION ❑REPAIR _ OR!h;WAL ❑FIRE DAMAGE ❑DEMOLITION
4E5IDFNCE ❑COMM ❑EDUCATIONAL 0GOV'T ORELIGIOUSOPATIO ❑CARPORT LO. GARAGE ❑STORAGEOSLAS ❑FENCE
1:3FONR_ DMOVING� DCONDITIONAL USE ❑DESIGN REVIEW - _OCOUNCIL APPROVED ❑SIGNS
DD
k ;•C it. cyQ ___LAND USE ZONE._27. =BLDG.TYPE SA) _FIRE ION PLAN CHECK BY _. v _HEAT�_4
EJ"C_LQS F1QOR LOAD _ -----HEIGHT �,.NSZ,.$I9�IL;Z_ _►� ---ROOMS VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
----- 1HIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 1�4+��o REGULATIONS :IND ALL APPLICABLE CODES AND ORDINANCES AND IT IS HEREBY AGREED THAT 1HF
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS ANDSP.CIFICATI7NS AND IN COMPLIANCE WITH
Sub—total ALL APPLICABLE CODES AND ORDINANCES. THE IS.,UANCE OF THIS PERMIT DOES NOT WAIVE
RLSTRICTIVF COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax �,3` LICENSE SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 8�►
AVGI ICANT pN AGE N1
Approved Receipt No. ���
An g� Boit Aar-
10#4+
%s+ ROO,.- ��-�jt x Z s t l t u•
F P �-L. ,� s-•3
l l o w 2G•sp .2
gGe.oaK Flao.�- 34-`��/t K '30 14 'C �7• � 0 a.-•
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