11468 SW 115TH AVENUE r '
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CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD. OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
i
Date:. Permit No.
Ir,specto� '�
CALL FOR REINSPECTION
WF
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PLUMBING PERMIT
,Z'NL holder of a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less then four
(4) hnurs prior to the tinge the installations are ready for inspection. City of Tigard Business License required
for all contractors and sub-contractors.
Owner ' Address ��YC S s- '� Data % %9
NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ITEMS FEE ON EACH AMOUNT (Office Um Only)
RESIDEN
Sin la Family-1 bath—each 25.00 C,
Du lex-cava 1 bath unit 25.00
Additloaal •,ith,00ms-each 10.00
Mobtla Home SrJace-earh 15.00 L
INDIVIDUAL FIXTURE FEES iry �
1 to 50 Fixtures In 1 buildin -each
3.00
51 to 100 Futures in 1 building-each 2-50
101 to 200 Futures in 1 budding-each 2.00
201 or more Fixtures In 1 buii.iing-each 1.50 _
MISCELLANEOUS
Building Sewer-1st 50 ft. 10.00 -
i Sewer-each additional 100 ft. 10.00
Water S.rvice to building 6.00
Private Water Systems-each 100 It. 10.00
Other (Specify) _
P OMIT 3.5.+;>r, For Plumbing Inspection Phone 639-4171
StateZ 00 Plumbing C
TOTAL 0RECEIPT NO. Issued By
_..--'4„'t^�" �'""`aw"""`�'W�Y3y;rr�Yv?%' 76ElYfi��' ! ��1a�5:i`:�::�i ,gw7�Ri °'Mt�t�wtis?'"SFr'&$-',?9�C'Nk�'.'Aur;ry;�""'T" ..wa'.nNtidr�rr,Ow.�.iX�;�+n�yya,=,rt�y���Ir►-.�qe.�.
BUILDING PFRMIT APPLICATIONof TIC ARCD DATL t9_
1 THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK. HEREIN INDICATED BUILDER PHONE-
OR
HONEOR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND ;PE('If IC.(XI IONS. OWNF.h PHONE
LOT NO. —_
I.1nR1t'_n;)n -;
__,....., _
FC ;ITECT
E14GNEER
BUILDER ADDRESS ; FiAVrj
i,F�;1_rNF.R
STRUCTURE ❑NEW 0RMODEL ❑ADDITION ❑REPA iR _ t 1110',WAI ❑FIRE DAMAGE ❑DEMOLITIC"
❑ RRESIDENCE ❑COMM ❑EDUCATIt-ONAL ❑GOV'T ❑RELIGIOUS❑PA' 10 I �CA,� 1-11F'1 _]GARAGE ❑STORAGE❑SLAB []FENCE
DPOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW CICOUNCIL APPROVED [:]SIGNS
OCCUPANCY !: L LAND USE ZONE _BLDG.TYPE FIRE ZONF j PLAN CHECK BY_ _—_.°�� HEAT
nirst:ruc t _1,ddition tca a,1 , ! r woily dwelliriV and r�lcnodis
1,'tii � I• _ _
( ULt C:}6 .1.Y f�0 - dt_' 16111a �Jott"'s
_N_Q�SSQPI.I _ .__ Arlr�.f t+ N!Ja.�E.�L94.MS___ VAL
BUILDING DEPARTMENT SET BACKS FRONT fz REAR " ' r 511 F RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THF RF(:IJLATInN!' CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE Ci)DE;I ANU OAOINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITii THE rl_.ANE AIJD SPEI'IFICATIONS AND IN COMPLIANCE WITH
Subtotal AIL APPLICABLE CODES AND ORDINAtvCF5. IHI. ;!.J4PJCG OF THIS PERMIT DOES NOT WAIVE
-- RCSTRICTIVE COVENANTS. CONTRACIOR AND SI113 CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax « LICENSE. SEPARATE PERMITS REQUIRED FDR SEWliri, PLUMBING AND HEATING.
Total i r,
V
Approved "1 Re.telpt No t;6-1
I
IN
DATE INSP. "TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No. ?ol,
Rough-
in
-Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final
I DRIVEWAY
Inal
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
� s,
BLDG. DEPT._FINAL' TLMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landandsc
Laping
'I Zoning Final
, CITY TI'•. ARD DATE
UILDING PERMIT APPLILATtON of
�S 7ay�
THE LINDE RSIGNED HERLBY APPLIES FOR AP.RMIT FOR THE WORK HE RF IN IriC l(:ATEp BUILD�iRPHON— —
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND PL CIF ICA I IONS. OWNER PHONE
LOT NO
57 JOB ADDRESS ARCHI/ V/ J'11��j NOME AUDR_H
CT
ICER •�J ��IV�a I=y�AD0PESS I P-3 Y1//�
UCTURE ONEW REMODEL C, ADDITION ❑REPAIR ❑RENEWAI. ❑FIRE DAMAGE ❑DEMOLITION
)'a ES_IDFNCE ❑COMM ELDUCATIONAL ❑GOV'T DRELIGIoUSOPATIO ❑CARPORT 0GAR0%STORAGEOSLAB []FENCE
[22IOND ❑_ MOVING UCONDITIONAL USE uD SIGN REVIEW ❑CGUNCIL APPROVED []SIGNS
NCY LAND USE ZONE_ y BLDG.TYPE rv._FIRE ZONE PLAN CHECK BY HEAT,_-__
i!e.1Q9Q.�____ELO.'?R LOGO HEIGHTp-l� / I � L'ROOMS
BUIL'IING DEPARTMENT SET BACKS FRONT��b, REAR_ LEFT SIDE Ls RIGHT SIDE
Perm;t •,.d(I,Ml.7
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN TH6 BUILDING CODE, ZONING
Plan Cneck REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS 'IEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS ANDSPECIFICATIONS AND IN COMPLIANCE WITH
Sub•totat 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 � LICENSE. SEPARATE ►ERMIITS RE03U1RED FOR SEWER U RING AND HEATING.
I
w Totalj,L
j.
By A0 l(CANT _ A/ FRT ,r r
Approved _ 1 Receipt No.
ADDRESS H
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