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INSPECTION NOTICE
City of Tigard Building Department
12423 S.W.Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection — '— —--
Date Requested_
/_� - 3 Time A.M. P.M.
Address / r ' � Permit #
Owner _ —.___ Lot #_
t
Builder --- _
The following Building Coda deficiencies are required to be corrected:
Presented to approved
� 7
Inspec+or q, U Disapproved
Datf
CALL FOR REINSPECTION
❑ YES it NO i
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BUILDING PERMIT APPLICATION TIGARD DATE.-*Tgt1y �* 19 19.53 4501,
THE UNDERF�'GNFD HEREBY APPLIES FOR A PFRMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE _292-3232
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND EPECIFICATIONS. OWNER PHONE-=
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DATF INSP. TYPE INSPECTION REMARKS PLUMBIN DATE
Contractor
I �e�Ef ,e/ — - ParmitNo. M i -
�����
Rough-in
O Fiztunt
Final
---- --_-- HEATING --
Contractor —
Permit No.
Gee or UII
Final
— — -------— -- -- SEWER ----- - --------
Final
----------- .---
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDn. DEPT. FINAL T TEMPORARY r_Eft7-IF IC P,rEOCCUPP,.ICY Final
CERTIFICATE OCCUPANCY
landscaping
Zoning Final
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BUILDING PERMIT APPLICATION TIGARD DATE �` � 19
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED 6JILDER PHONE21 S� 3_?
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER,PHONE
/ �(,I Lar No.
O'J1NEA�C�i'�F'RY /V/Cr NQLS JOB ADDRESS /�7j C'"� .S�t/ /.�•._ r ~ _
ARCHITE( T
� / ENGINEER
BUILDER ADDRESS = `' ;DESIGNER
STRUCTURE ❑ NEW ❑ REMOOEL__2 AUQITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
IS RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ ';I-ABC] FENCE
. ,.
OCCUPANCY �~'- �LAND USEZONE .n'�1 BIOG.TY/PE _� ��_FIREZONF - � PLAN CHECK BY HEAT—,. __V
---- �?� Wil.�'; c_ `T-�Z_ .�•�.1-_L?`_Z�r ` - -c'YSL'•+" _ �+`���C<G-- l _o•.�� -<n —
� / 1
V/
SEINER PERMIT M
OCC.LOAD FLOOR LOAD `% HEIGHT NO.STORIES AREA /30/ NO.BEDRCJMS/ VALUES,
BUILDING DEPARTMEr T SETBACKS FRONT /� REAR LEFT SICE RIGHT SIDE
Parml! --�G THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,Zow!`IG
'7,3 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check _- 3 �� WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COIAPLIA14CF
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV:
Sub-total c 3 • 3 RESTRICTIVE COVENANTS. CON i RACTOR AND SUH CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE SEPARATE PERMITS REQUIRED FOR SEIVER,PLUMBING AND HEATING.
State Tax
SDC-
Total _� y9 — ------- ---
PCOM
By
Receipt No.
Approved ADDRESS !�-!^ ----- PHONE
SDC -
PDC
SEWER CONNEC ION 5
iiEWER INSPECTION $
SEWER SURCHARGE $ _
Comments: it'�i v 3" ��� a/
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City of Tigard
'
T �
INSPECTION REQUEST
for-
INSFEC'TION TIME : PERMIT NO. :
DATE : r-2/ DATE ISSUED :_/-_._/ _
OWNERS NAME '.
ADDRESS: —
C O N T R A C TO R : -66�,-a,..��'�
1*S.'T : i%!r U, Water p , W sual ff, I_a boratory I]
;ES°ULT: AvrovedX, :')isapproved G Pending p
SKETCH: I
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INSPFCTOR DATE
NOTE: Attach supplemental test data beret,
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4A
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: L PERMIT NO.: Z�'/'/
D<�"rE: DATE ISSUED : c
OWNERS NAME :ADDRESS:
CONTRACTOR :CONTRACTOR :
TEST : Air ❑, Water 0 , Visual [a--, -La oratory p
RESULT: Approved D , Disap,iroved D Pending p
SKETCH:
INSPECTOR "ATE
LNOTH: AttocA supplomontal tout doto berotee
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Address 1172n S 5th Ave. Permit No. 4791
i Permit charge
Owner �aA &Y}Y��z� Custom Connection fee 425
Paid by
Residence Date connected 2-5-73
Type of building
Service rate ----3-nn month _ Inspection fee 25
Contractor rn1 uMhia_ Cus em HQmea Paid by aa_m__ date
Sizc of connection Assessment_ Assessment paid
S -0 rS- C/S
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UNIFIED SEWERAGE AGE14CY No. 4791
WASHINGTON COUNTY DATE 1.24-73
11(
CITY OF— Tim
APPLICATION FOR SEWER CONNECTION PERMIT a:
Oolusbia Custom Rams
OWNER'S ADDP SSS. - Jtfferew Terraot --- ----- - - --
STREET
gyp, -- ---- -- ----- __.�.— ----- -- — —
t 1 �7 a SYATE 21P
EUILDING SITE: LOT-_45 ._____ BIOCK _---____. ADDITION vlevwount _ --
TAX LOT NO. —_._ TYPE OF OCCUPANCY
ADDRESS
DWELLING UNITS l ____-_ .____— —_ FIXTURE UNITS50 DeM.
SURCHARGE IF APPLICABLE __ to D*Zl
PERMIT FEE . - -_ __ INSPECTION FEE �5__-_ TOTAL DEPOSITED
(N&AA (EXISTING) BUILDING SEW' 3 SYSTEM _____ Tlgrd
The Applicant agrees to comply with all rules and regulations of the Unif;ed SeweragE Agency.
APPLICANT_1
SEWER PERMIT
THIS PERMIT AUTHOPIZES CONN:-LECTION TO THE SEWER SYSTEM.
LINE SIZE _.__.4" !NSThLLER
RECEIVED BY_.
OE M, ITS AGENT)
d'
,
COMMENTS
This Application and hermit expires in ninety (90) days. Tne amount paid ill he forfeited )
should expiration occur.
CITY OF TIGARD ,
11110 f. W. Main Wrost
TIGARD, OR►OON "M
APPLICATION FOR BUILDING PERMIT
New Construction LrJ Demolish Addition Remodel Move ,
ZONING R-7 _ DATE ISSUED 1-1633 BUILDING PERMIT
1-5-73 BUILDING FEE $— 29. No. ,��
PAPE RECEIVED 7.� Cfi
PLAN CHECK $ 49.50_
BY---BIL- OTHER $ VALUATION $ 2SP468
TOTAL $ 148.50 RECEIPT No. 'Ae 7 7
7
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT M 45 _ MAP N_ 28.1 3W _ c,,NSUS TRACT W-19 JOB 1_
Architect or Engineer columbia custom bcves
Address-- - - ---- -,—_-- —_— —_ Phones
Owner_—` Columbia Custom HOMO --- -- ------._--___.
Address__ 9 xt,-,Lqnpxaou __------Phone
Builder -_ Bags _ —.----Y_�_—
•
Address _-- _nn — Phone
BUILDING UbE Single Res. Multi Res. l J Comm. Industrial
OCCUPANCY GROUP-I No. of Storie9 1 _ Total Height 16 Area of Lot 700
Type of Construction V Floor Area B_1989 LR—_
Set Backs: Front_ Back i5 L,Side7 — R.Side 8
Private Sewer Pipe Size_ 4" —_ Sewer U.B.A. Tigar�ept:ic Tank U
Water Service Pipe Size �L4" Storm Sewer 51 Ditch C] Drywell E
Street and Curb Requirements_—_ .Twisting — —
Driveway Width—— 16 —lNo. of Parking Spaces_` Z__
SEPARATE PERMITS REQUIRED FOR SEWER AND P:.UMHING
SPECIAL INFORMATION
ADDRESS ASSIGNED----------.-._9jm—DAIL"5.�.—____--._._.--- --
FIELD CHECK BY BH ---DATE— 1_16-73
PERMIT APPROVED BYMJ ��� ��=�+�i—�
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building wil
not be occupied until a Certificate of occupancy Via n i:,aued by the City of
Tigard Building Inspec`or.
ti na r f Applicant
"ermit issued � CITY OF TIGARD, OREGON Permit No.
city Hall
Application Approved Building Department cost of f4�jr Installation—_—_—
By._._ c�a` PAIN11t4", i" P""011 , AL.N.brraq .90d".12111.90d".90d".121111" Fee for Permit��el-
/� Applicant shall fill in cost of installation only,
Date-/-''� ._ above this double line. Street Sewer Permit_-__.—._.
Application is hereby made to *A&w-�lumbing Pipes -rr Fixtures according to plans and specifications and
install description as given below:
Location of building—Number and Street-
Lot --- _ Blocr - Addition-
Name
ddition_Name and Address of Own e �22![ r��r
Name and Address of Plumber _ _ _ __��, vr•3•��7r � �t� _�_
Building (Old or New) 'Perda' Height in Stories — _ Occupied as__.-�,1
SCHEDULE OF WORK
_ NUMBER � � NUMBER
FIXTURES
- I + - FT —RES..New 1 New 1--Move I-R-'-
pl'cc
Water Closets.- __.__ � __ I Fountains, Drinking.
I ,
Bath Shower __ _._. �._. _�.__ Fountains, Yard..._.__
Bath Tub Fountains, Soda.
- _ 7i7-
a�s__` I i
Basins ___. .._ .._ Hot Water Tank
Sinks, Ordi4t 'g-,r Sinks, Bar.
I -- - - I I
Sinks, Dishwashing Sinks, SI( y
Automatic Dishwasher _ Drains,:7Rte rIgerator
Laundry Trays __...i Drains, lee Box _-. —__.I
Drains, Floor_ urinals
I
Dr•alns, Area - / oa itch-Basins, Yard_
Rain Drains �`�'*' '� Catch-Basins, Garage
I
Automatic Washer - -.._i. �_ _ Catch-Basins, Sub Soil_
11'atcr Permit No..._.. Illdg. Permit No.
f IMPORTAN I! - Plumbing shall not be Installed In any building, (either new, altered,or repaired), except as shown or designated
/ on the come+ponding building plans as filed with, or required by, the Building Department In accordance with the
provisions of the Building Code and Ordinance 62.19 of the City of Tigard.
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theinstall piumhing svoteln according to this description. plans andps ecifteations and the Plumbin Code of the
;r)rer' to I r't' (yty of 1'Igard. g
� ��. ,�.• �;
Plumbing Firm
Supervisor —-
�_ ____.--...'.�-_x_:'-..-.=:ice:•..S L'�l _.�.. - �: .41.._`.-__. ,�._�