12025 SW 122ND COURT � wIH ff
12025 SW 122ND COURT
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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
fcllowing item(s) require correcting:
Date: .,' Permit No.
Inspector __ �__
CALL FOR REINSPECTION
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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:
H Esq OCC
Date:./s 7- _ Permit No.
CALL FOR REINSPECTION
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BUI U)ING DEPARTMEN:, TIGARD I
PLUMBING PERM17-- -
holder of a valid plumbing contractors iicense is hereby
authorized to cause plumbing work as herein noted to hn installPri in ar-rnrdance with the plumbing code of
Tigan+. Such installations require inspection by the City Inspector vvho shall be notified not less than four _
(41 hour: prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractor, and sub-contractor-;,
Owner io '. � � Addressls���5�_Ls�an'��� Date
NUM6ER OF -AL PERMIT NO.'S
TYPE OF PERMI7 ITEMS FEE ON EACH INT (Office Uu Only)
R E S 10 F
Single Family t both-each _____�--_ ___-��. __.__.
25.005 C_ _
Du lex-•Exh 1 bath unit 2y 00
additional bathrooms jach T-,
_-
Mobile Home Space- each 15.00
INDIVIDUAL FIXTURE FEES . - -
1 to 50 Fixtures In 1 building-each 3.00
_ 51 to 100 cixtures in 1 building_each - _ 2,50
101 to 200 Fixture+ in_1 building-each _ _ __ 2.00 -
201 or more Fixtures in 1 building-each ` __ `^ 1,50
MISCELt-A_NE0US
_ Building Sewer--1st 50 ft. -� --_—_�_-- �. 10.00_-_�-
Sewer--each additional 100 it, 10.00 _
Water Service to build_iM� 5.00
Private Water Systems-each 100 ft. -_ _ 1000
Other (S ifv):
PERMIT— 670 y J For Plumbing Inspection Phone 63.9-4171lVe�Q„��t
16 V State o7 0� Plumb;ng tontractut By
TOTAL So? fiECEIPT NO. Issued By
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BUILDING PERMIT APPLICATION 11T TIGARD DATEOF
_--
THE LINDENSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE_y
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHONF
LOT IVO.
UWNER,.:[li_c{i 1 LiL lui 1{L11111v1 S# I fJQRA•)DRESS �. �Ua ;% :/li .r�'P1C'i i. . HOME ADDRESS
—ARCHITECT'
P�
ENGINEER q
F3UILDFR L�ilAl. ADDRESS O,) �a ,1�.'a�mJ, A1011@i DESiGNFR l�''J "IclDr
STRUCTURE_ ❑NEW _❑FIMOD EL ❑ADDITION ❑REPAIR_ ❑RENEWAL ❑FIRE DAMAGE ❑DE.MOLITION
❑RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE[:]SLAB ❑F•ENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED 0SIGNS
OCCUPANCYI-_.LAND USE ZONE IT..1—.—.BLDG.TYPE 'F" FIRE ZONE PLAN CHECK BY ' HEAT d -
nnr[>1.reJct �1r►Qlm Pft�1ily dwe�lili10 w /attsched^y+�Ireglr. _ 1 l�elt9rUtrl�c�_ k3ethi`s.
3F t` C )SHECT ION SHEET ATTACHE 0. ---
--- 5sw®r Permit .203til
OCC.4,2A1Z' FLooR LOAD _AQ lQiliT 14_NQ.iIQAl �_1 yAr m.3 N--Q-BERLQQM_..__=�YALS�F, '�I.00iG.
BUILDING DEPARTMENT SET BACKS FRONT �� REAP LEFT SIDE 7 RIGHT SIDE Per nit fa.f)Y.0U ALS': LEfi.VN HF j(,I-v ' }:ti'F I; c,Uul H A f I r;
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
Pla i Check HiQ* !i{„ REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WII I. BE DONE IN ACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUb total 2133. 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 ,1 7. '�e LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
5291.06Su[. - .*JU.'UL
Total }2g1.O
PDC ; 1 10fl.0Q
By fa — -- ------
__ ._._ APPLICANT Oq AGENT
Approved t;WFI Receipt No ��
sWrW s i o w
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
i4 0 GAJ L> Contractor (�
Pe:mit No. i ?D 5�,rd 3,- 79
fi=fsfJIM&^?10 Rough-in
[w_ ��,,� s� Fixture
fry n J• ^f 41 O ti n - Final —
HEATING
Contractor
Permit No. �3 ��fY J/—>1-71
Gas or Oil A
— ---_-- Rough-in -
- - - - __.._--------- -- -- �Final
SEWER
Final
!DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidavwilk
Curb&Streat Final
Approach
BLDG. DEPT.FINAL TEMPORARY CERTIrtCATE OCCUPANCY Final ^
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
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BUILDING PERMIT APPLICATION "'y `�IGARD DArE__ _._._
THE UNDERSIGNED HEREBr APPLIES FOR APERMIT FOR FHE WORK HEREIN INDICAI ED euu s,&28
OR AS SHOWN AND APPROVED IN THE ACCT)IPANYIN(- P! ANS ANSI !'YFCIFICATI;,NS C.0"NEr'• ,'/"' Q D I
f�WNER `�VV��T� Q 1('JB GpRESS 102023— 54) z� '♦
gUII_DCR �a�� ADDHESS�J W /�V IV� 14• �—
I STRUCTURE_ NEW l_1REMnOEL OAUOITION ❑REPAIR CJRE'.;V,AL
RESIDENCE ❑COMM COEDUCATIONAL 0GOV'T ❑RELIr10U5OPA110 LUCAH IOHr ; JcARAGE r]STORA11E COSI
l Cqi,' ANCY RAJ LAND USE ' R"7 m nG TYPE J FIRE Tnlo ;'t A�.r
SEWER PERMIT -'-' (��e, • -34L
IIL1C N� /bos 3
� �.
UIIDIN; UE1 6ACKS FRONT 20 REAP
Permit__ _.. 43 :. -
-IIS PERMIT IS ISSUED SUBJECT TO THE. REGULATICINS CONrAINf-D IN ;'
Plrn Check �'� .� T:t1LATIONS AND ALL APPLICABLE (J)DES ANLL ORDINANCES. AND IT ISHE"EUY
r RK WILL 5E DONE IN ACCURDANCE WITH THE PLANS AND SPECIFICATION, n,;; IN ,
Suh�tota!- �dt• .gyp L APPLICABLE CODES AND ORDINANCES. THE ISSUANCL U'' THIS +;n-+IT
VV 77 STRICTIVE COVENANTS CONTRACTOR AND SUR CONTRACTORS tO HA\,E GtiA'Ii N
State Tax 7.
A.N5E SEPARATE FIFEIMITS REQUIRED FOR SF•VVER, PLUMBING AND HEALING
- ------ •
Dc
Total • 0 � -
7 �
Ueffl�.t 1?445
[Ar,ptuvPd ------ pi No
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SDC - $ _ .41r,0
PDC - $ I. /• v
SOWER CONNECTION $ G.fo
SEWER INSPECTION .2r
SEWER SURCHARGE 9 V
Comments: hD+'f - !'"�_. ..4•0•t1-
____ ._ �CNy . Q•20
SSV
3&4
�s n Z6 q-Zo
2 $ 3* 70& Z
Roll
F P A 9 x .Sr
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h�ectcricalNerrI Permit OT i ioar� I �� Fee_ _ �� I
_
New Installation Cl ReplaCe ❑ Relocation Cl Addition 0 Alteration
HEATIVC (��� r . n TOTAL_
CONT RAC TOfi `►�K �M L� ._-_--- 011., JE11 W G7C _
f..)DR24.as � _S�"_,�Zv►�''.._.. 'b.il7�l� `J�;OAK A0DHESS 02�- --`Jw I Z 2 hN.
PHONE APPLI(;A(V
heat Input Rating (BTU Per Hou►1 r_W _ _. _. Vivit Slo ._ __. Flue -
i
r UEL OIL CJ GAS tj2-- ELECT C7 OTHER
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ITEM NO. FEE ITEM NO. FEE +y
n=or Issuance of Permit EE A OVE _ Air Condition Compressor 15 to 30 IIP 10,00 r
Naw-up to Air Handling 10,000 CFM_
New-100X001 BTUTs & over _ A_Q_ _Air11artdling_Over10,000CFM 6.00
Floor Furnace _r 4.00 Evaporative Cooler
0jall.Floor .Suspended � 4.00 Range Vent Fen }.00 '4.
Install Vents Only — 2.00� Vent System
Fleoair Hzat& Cooling -W_Fload Co_m_marcial — 3.00
Air Condition Compressor Unde_;1 QIP 4.00 _ Cn_tn_mtircial Duct System _ _ 10.00
Air Condition Compressor 3 to 15 HP— ~7.60—
:-r--.=-rs-x=.-Wia_-:.�—���-c.:-=-.�—�� --'r*__:.�:: —r:sxnL•a-n. .r- _---xzm�-�.a--•:r�_�._ .--'.r..�___ I
INbPECTOR'S COMMENTS
CITY BUSINESS,LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTRACTORS _
i.PPROVED SY ')ATE ISM)ED RY DATE
FI F.C L I P r NO, .._.. .___._. ----____-
"" Signature of Applicant
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