12010 SW 119TH AVENUE-1 12010 SW 119TH AVENUE -
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INSPECTION IO T ICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phcne: 639-4171
_ -�Type of Inspection (�C'1 V —_- _
—— l
Date Requested _ �=� �U _ Time..�__�., A.M.,_--_P.M.
Address U U `a UJ .:
(
n� Permit
Owner_— ;J K ��a��- — -- Lot # --
( Builder
EThe following Building Code deficiencies are required to be corrected:
Presented to _-- _- _ A�,proved
f Inspector Disapproved
Date
CALL FOR REINSPECTION
0 YES ( NO
t
BUILDING PERMIT APPLICATION TIGARD -DATE_ Aril '5 19`13 4393
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR 1 HE WORK,HEREIN INDICATED BUILDER PHONE _233-7451
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_ 620—r)109
OWNER Aunt tar.i-ahzi11 JOB ADDRESS 12410 5.11. 119th AvLOT NO.e.
+� ARCHITECT -
BUILDER 1Qil F fOH • CO- NGINEER
' y ADDRESS SO4 ". AlAr.,arta Pit. DESIGNER
STRUCTURE ❑ NEW 11 REMODEL L3 ADDITION ❑ REPAIR ❑ RENEWAL C] FIRE DAMAGE ❑ DEMOLITION
RESIDENCE ❑ CONN_❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO P CARPORT 7 GARAGE U STORAGE C]_SLAB❑ FENCE
OCCUPANCY -._�+" LAND USE ZONE -7 BLDG.TYPE 5*,--_—FIRE ZONE _PLAN CHECK BY 1 HEAT %ati
Construct Family room, 3Utis, TTtility 1100111,, & fi1+op Nddition to ninRle
F3-lily i.AWhllint" Sec: ccwrection Sheet AttaChed. -
SEWER PERMIT# Shop (gara m 1"9 -
CCC.LOAD FLOOR LOAD 41; HEIGHT 13 NO.STORIES ?. AREA 754 NO.BEDROOMS - VALUE 31,ww
_ BUILDING DEPARTMENT SETBACKS rRONT _ REAR 64 LEFT SIDE RIGHT SIDE 13
Permit ".24.50 — THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
145.4.1 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED -HAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMP;IANCE
310.4;1 WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT VAIVE
Sub total RESTRICTIVE COVENANT!!. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
11.98 LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATINu.
State Tax __
SDC—
Total 3/9.41
— � PDC# APFL.ICANTORAOENT
By _
cleAt Receipt No.
Approved AbbMR —
DATE INSP. TYPE INSPECTION 'VEMARKS PLUMBING DATE
Contractor
Parmit No. 73�� .c 7• ;x':23-f�.3 11
Fixture --- —
Final
�► j 4 y �oHEATING
Contractor
Permit No.
- -------�__.�.___-- Gas or OR
Rough-in
n
Final
SEWER
-- - -----—
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
_
'Sidewalk
Curb b Street Final I
Apprnech
BLDG. DEPT. PIN.,L _TEMPORARY CERTIF,i.ATEOCCUPA::CI'
CERTIF•'ICATE OCCUPANCY I Final
Land.r.epin0 f
1
Zoning Final
— f
{
f
BUILDING PERMIT APPLICATION TIGARD DAT'4"_1 .2s--,191-3 ry��
1 HE UNDERSIGNED HEREBY APPLIES FOR A PERI�AIT►=0R THE WORK HEREIN INDICATED BUILDER PHONE'2v8-;Pq -/
Oq AS SHOWN AND fA�PPROVED IN THE ACCOtfPANYING PLANS AN SPECIFICATIONS. OWNER PHONE O.O!
O'NNER r'L A4 1 Jl4n Yt A JOB ADDRESS 0 LOT NO.—
i ARCHITECT
ENGINEER
BUILDER t I�k n11�• DESIGNER
---
STRUCTUF,E ❑ NEW ❑ REMODEL YADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE 0 COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CAR PORT ❑ GARAGE ❑ STORAGE Cl SLAB❑ FENCE
OCCUPANCY LAND USEZON( BLDG.TYPE —�f&—FIRE ZONE_"' PLAN CHECK SY _ HI J46
EAT
R l
SEWER PERMIT k -
OCC.LOAD FLOOR LOAM 1/0 —HEIGHT NO.RT0TO+-RIES AREA 70 Nn.BEDROOMS VALUE3/0(J�
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFTSIDE I,Z RIGHTSIDE gWI3
Permit 2p THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZON'.NC
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED TYAT THE
Plan Check S• WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT GOES NOT WAIVE
Subtotal 3'2�0, RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
UCENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMPING AND HEATING.
atits Tax
Total 7 Q•T SOC — .:.ADS.0-
PDCJ1 APPLICANT OR AGFN7
By
Receipt No.
Approved ADDRESS PHONE
SDC -
PDC -_ $ p
Tu
SEWER, CONNECTION
SEWEF INSPECTION $
SEWER SURCHARGE 8
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Address Permit No._��
Name of Occupant_ Permit charge
----- ---- . -.--- _ _ Connection fee
-- --- - - Paid by-
Date connected 1 -.2
Type of Building Inspection
Service Rate Paid by _- Date
Contractor-- - Assessment Paid
Size of Gonne lion '¢ -
--------__.___ .__.
PERMIT TO CONNECT
City of Tigard
Permit N") DATE __'
i
PERMIT IS COVEN TO .�`!__ __. ` 'A �N-�� �'—` --
OF
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD
AT-----l-}-1-1
THIS PERMIT MUST BF OOSTED ON THE DESCRIBED PREMISES UNTIL i ON-
NECTION IS MADE .AND INSPECTION OF CONNECTION HAS BEEN COMFIER EU.
PERMIT PEE PAID CITY OF TIGARD
CONNECTION INSPECTED AND APPROVED
()nt� Superintendent
I