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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigaid, Oregon 97223
Phone 639-4171
Address_---_�__ �.—�. Permit
Type of Inspection
tie following Building Code deficiencies are required to be corrected:
Presented to - --- -- - ----- --- -- Inspector -
DatR --
CALL FOR REIWECTION
❑ VES ❑ NO
BUILDING PERMIT APPLICATION TIGARD DATE 3754
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE W :R HEREIN INDICATED BUILDER PHONE -,6.36—b783
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS Ai�J SPECIFIGATION`� OWNER PHONE._. 644-6735
LOT NO. AN 4900 151-30(:
OWNER Larry JOB ADDRESS 116L)b SLI 113th Place
ARCHITECT
ENGINEER
BUILDERCalyin ahrGn9 Oldr. ADDRESS 23420 SU ti;ith, Tuela .iIjESIGNER
STRUCTURE FX NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR P RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
Vj RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT Ll GARAnE L_1 S`rORAGE ❑ SLAB FENCE
OCCUPANCY h"3 'LAND USE ZONE R"7_BLDG.TYPE �N FIREZONE -- PLAtJCHE:
DATE INSP. TYPE INSPECTION PEMARKS PLUMBING DATE {�
Convector 6
Rough-in -- -
Fixture
Final
HE ING
Contractor
Permit No. o?�r d, a0r
.�
Got or Oil
Rough-in
___---- - --_-- Final
-- ---- ----- SEWER
-- Final - -&
DRIVEWAY
— ------ -- Final
— Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
_—.--- -
Approach _
eLD6.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
4/L/ Landscaping
lJ J Zoning Flnel
f
i
t
Ik
r CITY OF TIGARD--124201 S.W.MAIN-^TIGARD,OREGON 47 223
RECEIPT16
l d�
DATE:_._ - -'2 6 _AMOUNT:S
crc i� — .DOLLARS
NAME:
CASH:
ALIDRES3: ` CHECK
M.O.: _
0 OF
FOR. ACCT.# PERMITS SORCNAROE _ AMOUNT —
i S
SEWER BILLINGS 40-3,A ---
BUSINESS LICENSE 05-331
k PLUMBING PERMIT 05.332
t
MECHANICAL PERMIT 05.332 -- ---
1 BUILDING PERMIT 05-333
SEWER CONNECTION 40-363 —
{ SEWER INSPECTION 40-3155 —
SYSTEM DEV.CHARGE 25-366
PARK DEV.CHARGE#1 30
i PARK DEV.CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362
r
OTALS
RECEIVED BY. l: ------—- -
PERMIT NUMBERS ASSIONED:
_Number Amount Number Amount Number Amount
rc� �-�
S
! S-- - -- --- S RECEI/T # rl
r
Lo+ 24, 1&4py' AA4.
//-o x !PL-f
20 x J14 Z
pp Z K 4
l 4 o B 33,feo
s
BUILDING PERMIT APPLICATIGNr �g U , ,✓
TlGAP3 OATS.
THE UNDERSIGNED HERECY APPLIES FUJI A PERMIT FOR Tt iE WORK HEREIN INDICATED D'JILDER PHON � 3
ORAS SHOWN NO APPROVED IN THE ACCON PANYING P NS AND SPECIFICATIONS. OWNER:•:r1;: PHONE
-� ���� �/ Lir LOT NO.
Cn /S{Z�i � .108 ADDFESS��w� -��L_Ll � -
Qµ0},jl�� ARCHITECT
ENGINEER
RUILDE ADDRESS _ DESIGNER
STRUCTURE -- NEW REMOCEL _ .� ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE 0 DEMOLITIO
RESIDENCE ❑ COMM_❑_-EDUCATIONAL ❑ COV'T ❑ RELIGiOUS ❑ PATIO ❑ CAN PORT ❑ GARAGF. ❑ STORAGE ❑ SLASf_! FENCE
OCCUPANCY }LAND USEZOTYPENE FIREZON =_PLN CHECK Y BLDG, AT_
E _G
lc�/2n��tK�' ,
SEWER PERMIT k
OCC.LOAC FLOOR LOAD Lip HEIGHT NO.STORIES AREA/Z/OPJ NO.BEDROOMS 2 VALUE—E,7
�
BUILDING DEPARTMENT —"
SET BACKS FRONT Q RFhR LEFT 51GE t,r RIGHT SIDE S
.203. da -- _._--____ ---- �.�•—__
Permit _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE EU1LD?NG CGDE,ZOP;;"iG
EGULATI0NS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HERFBY AGREED THAT THE
�IanCheck _ �0�. K WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IA CONIPLIANCE
WIT LL APPLICABLE CODES AND CRDINANCES. THE ISSUANCE OF THIS PERPA{T DOES NOT WAIVE
Sub-total 3 y4-,y RES7R1 IVE COVENANTS. CONTRACTOR AND SUB CON T RAC-i%J^nS TO HAVE CURRENT Cl Y BUSINESS
LICENSE EPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
i Stag Tax
Total z, SDC ay r—
PDC# APPLICANT OR AGENT
Receipt No.
Approved I(bDRESS PHONE
DC -
DC - iI )CO /SID 12•tL•8v�k� 7'�zo
rWER CONNECTION $ 725-
.EWER INSPECTION $ .Zls" LS
&��kW LI,C p,.,
EWER SURCHARGE $
90 104
_AV -1+ga" _.
. (Z � I2•L L .
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