12200 SW 116TH AVENUE-1 12200 SW 116TH AVENUE _
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CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE_-3une 9L. 9_76__N2 0374
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED owNER PHONE 6394806
OR AS SHOWN AND A{'PROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS.
OWNER IFIL .& Mrs Euqene Wi1SorAQDRESS 1200001 W jW J 1L6th_�.BUlLpER PHONE --
ENGINEER
SAIYI9 _ _ ARCLNITE�T DESIGNER
STRUCTURE DNI-W D REMODEL w—__EIAD.DIl�ION []REPAIR ORENEWAL []FIRE DAMAGE L]DEMOLITION
❑ RESIDENCE []COMM ❑EDUCATIONAL L. —OV'T ORELIGIOUSOPATIO []CARPORT [:)GARAGE OSTORAGE[]SLAB ❑FENCE
D.BOND []MOVING DCONDITIONALUSE �DDESIGNREVIEW OCOUNCILAPPROVED _[]SIGNS _ f
OGCUPANC :AND USE ZONE _ _L-=7=.-_BL DG.TYPE___. -.FIRE 7npjr'A PLAN CHECK BY HEAT-
Construct
EAT_ConstrL,ct 121-211 x 11' x3" Den and 181 -Ox 23' anvil oorr�Q—O ---
Dove existing Porch area all Per Code requirements
No additional Bedroom
Plumba.n.g ermit
._ _ 8U00.00
ocC.LOAD_._FLOOR LOr^_,) 40lb HEIGHT NO.STORIES AREA _ _—. VALUE _
BUILDING DEPARTMENT - SET BACKS FRONT Y REAR _LEFT SIDE RIGHT SIDE
Permit —A4_nn
THIS PERMIT IS ISSUED SUBJECT TO THE RL GULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULAT!7NS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIKICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE 0►' THIS PERMAIT DOES NOT WAIVE
-- -- -- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE .*URSENT CITY n0r1NrSS
I%State 1 LICENSE. SEPARATE PEHMIIS REQUIRED FOR SEWER, PLUMBING AND HEATIN33.
Total
BY
APPI CANT OR ACENT '
it
Approved _ ; Receipt No. �7-3L > C r' ,* J-, ��(,�_ (?�
L AnDRFSS APONE'r _
i City 9 of Tigard
o rd
INSPECTION REQUEST
for
INSPECTION TIME : '"' PURMIT NO. : ----
DATE:
O. :DATE: 1 DATE ISSUED:_•'--Z^
OWNERS NAME :
ADDRESS : 1c — - —
I CONTRACTOR : ---
TEST. Air 0, Water Q , visual CJ , LnboratorY 0
I RESULT: Approved �Disapprovsd O , pen-ling O
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SKETCH:
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I INSPECTOR DATE
IfNOTiE . Attach supplsmental test data h1�..t,
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City of Tigard
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INSPECTION RECDUEST
for
IINSPECTION TIME : PERMIT PERMIT NO. :
DATE: fl IY' DATE ISSUED:
OWNERS NAME :
ADDRESS : %1 a �✓ a .z << �/� rr..
CONTRACTOR : -- --
TEST. Air O, Water [j , Visual O , Laboratory p
RESULT. Approved Disapproved 0 , Pending ❑
SKETCH:
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INSPECTOR DATE
ILNOTE . Attach suprlemental test data hiret]
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CITY OF TIGARD
12420 S. W, Ma-n Street
TIGARD, OREGON 9722J
APPLICATION FOR BUILDING P1:RMIT
New Construction ❑ Demolish ❑ Addition L!&J Remodel ❑ Move❑ y
ZONING _ DATE ISSUED (, --:k 7 u BUILDING PERMIT
DA'I'S RECEIVED [•/::/7/ BUILDING FEE $ Lj 7�' No
PLAN CHECK ;1,1 a
BY � r OTHER $ 'q7VALUATION
TOTAL $— �
7 RECEIPT No. r _
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N ZI MAP # CENSUS TRACT _ JOB N
Architect or Engineer_LJJV
Address ;rl SCS C.,_. mss^ � �1 1 I ISL C`;c.C� hone
ownerCrJ/APUQI� —
Address IZ2C0 S _�uU l iC,la � � ,Phhone E3_ - 3(• _
eui lder� iy i \ ��ISN)c.�t2.'�__.TiL21`_'L�=_3_1_�3� ( __
Address '% ll �.
[y],j j / I�f'c',(:�h ��.J �+I �r>.� Phone
BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Industrial.
OCCUPANCY GROUP_,Z No. of Stories__(, _ Total Height__-_-- Area of Lot,-----
Type of Construction CI�? II III IV V Floor Area B 12,�_
Set Backs: Front Back_ _ L.Side R.Side
Private Sewer Pipe Size Sewer Septic Tank ❑
Water Service Pipe Size__ Storm Sewer ❑ Ditch ❑ Drywell❑
Street and Curb
_L
Driveway Width._______---No. of Parking Spaces V
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
c
SPECIAL INFORMATION
ADDRESS ASSIGNEDi
FIELD CHECK BY _ - _DATE_f�_J��[
PERMIT APPROVED 8Y/.;d,--,,
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 Qccupancy h a 1e i,Ss�u by the City of
Tigard B)ilding Inspector.
Signature of Applica►it
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11PROV'ED FOR CONSTRUCTION
CITY OF TIGARD `
r 744/.V2 SITE ADDRESS.y,� lcu .!`.
. .---TITLE G' ,t, c DATE,617/7
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City of Tigard
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INSPECTION REQUEST
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for
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IN1PECTION TIME: PERMIT NO. :.__
DATE: 3 iDATE ISSUED :
t•1R�E.s �� �YtNS
OWNERS NAME :
ADDRESS:
N��j� rte__; //}����jL?� �J , �c✓�?S
CONTRACTOR :
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TEST '. Air 0, WatsrlJ , Visual � Laboratory C]RESULT: Approved JzQ, , Disapprover! ❑ , Fending p
SKETCH. I
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INSPECTOR DATE
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ADDRESS PERMIT NO.
PERMIT CHARGE
OWNER r" `L f• R�/�-/ .wL CONNECTION FEE
PAID BY
TYPE OF BUILDING DATE CONNECTED G -f�
SERVICE RATE - INSPECTION FEE Q2 s'
CONTRACTOR ,�..�.� �',,�-, PAID BY DATE
SIZE OF CONNECTION �� _ ASSESSMENT PAID
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UNIFIED SEWERAGE AGENCY , NO. 4969
WASHINGTON COUNTY DATE 7 "
CITY OF �_--- - -
APPLICATION FOR SEWER CONNECTION PERMIT
-'--0 W N E R: 4/7 ia
--OWNER'S ADDRESS: ��0��-� SW / mac/ e---- - -- -
776 Ael STREET
CITY STATE 21R
BUILDING :')ITE: LOT--- BLOCK _- t,DDITION rg �e,
TAX LOT N0. -.--___- TYPE OF OCCUPANCY _ "G�2LCtt.fL__ -
ADDRESS -
DWELLING UNITS / _ FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE 2roo INSPECTION FEE - S_'_ TOTAL DEPOSITED
(NEW) EXISTING) BUILDING SEWER SYSTEM - 1
The Applicant agrees to compIv with all rules and regulations of the Unified Sewera a Agency.
A P P L I CA N T
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE - INSTALLEP
RECEIVED BY- <.t-�-•" - \ _�,QhG�
OWE CY OR ITS AGENT)
COMMENTS: ov
1 K� �./'ttG+CJ �_ •-!�K.�_ 4-G'Xi 9st/.r�. <'•l_'�1.t�.__.__ ^
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This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
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