12040 SW 122ND COURT . � ate• �
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INSPECTION NOTICE
City of Tigard Building Department
12420 SM . Main St.
Tigard, Oregon 97223
Phcne 639.4171
Address_
Permit 0
Type of Inspection —
'The following Building Code deficiencies are required to be corrected-0
r._ �_ - 0.. a-L•"t.i'4.� _ —.. "�-- t i _ _ mac.. ) � _^At./1...1{i�G�.+c,-`fVtd'..t!..t..GrL�,M
aS.rr:..G•-,� .,-�-�r.�Y3.'r`_ � �. �` .. _ �. _X9i. c�. a,'./ ..G�✓!J �+^.�r..��A-^L.
I
Presented to _ _—�--_� �___ _ Inspector �.
Date _— _ --•
CALL FOR REIAWEMON
U VES El NO
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
T!;ARD, OREGON 97223
PHONE 639-4171
CONTP ACT'OR-
Pursuant to Section(s) of the Uniform Building Code, the
following items) require correcting:
-C>Ir R^ Fes_
- CX I.A i
is
Date:' Permit No. _
Inspector
CALL FOR REINSPECTION
BUILUING DEPARTMENT, TIGARD �Y
��� (� PLUMBING PER1'k41T
holder of a valid plumbing contractors license is hereby
authorizedtoto cause work as 'ierein noted to be installed in accordance -ith the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four _
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors and sub-contractors. a �g y
Owner. _ '�'"-`�'_�__. Address ! J S� _ Q "__ Date__LL/rz _
NUMBER OF TOTAL PERMIT NXS
TYPE OF PERMIT ITEMS FEE ON EACH AMOUNT (Office Use Only)
_Single Family-1 bath--each 25.00 - - �--.-__--- - x
Duplex-Each 1 beth unit 23.00 r
1dd�tionsl 'oathrooms-each __ _ _ _��_�_ 10.00 % �Y �_ _..__ 1•
Mobile Homa Space each _ _ 15.00
INDIVIDUAL FIXTURE FEES
1 to 50 Fixtures in 1 building-each _ 3.00
_51 to 100 Fixture i in 1 building-each 2.50
101 to 200 F?xture in 1 buildinj:�earh`__ 2.00
_201 or more Fixtures in 1 building-each _ _ 1.50
MISCELLANEOUS
Building Sewer-let 50 ft. _ 10.00 T
St,wer-each addiN mal 100 It. _ _ 10.00
Water Service to Wilding ._ 5.00 1
Private Water SY,tems-each 100 ft. ^� .-- 10.00 _
Other (Specify); ?S
PERMIT )a'O O For Plumbing InsperrrQn Phor:e 6.77-4171
3%State �a Plumbiny Contractor By
TOTAL. Va RECEIPT NO. Issued By
I
-.-�-;Yy;P�G',;wTtxsammxraS'M..7�'�? '^"-,i �,'�:'/�,e: ;tH�.;+A'Gael.tw�wvn+uara�,..-a»;'3',i..,wfti:✓gd7.'t+nlR; jlthw'�'!^r" ,,,,�y.�,�..,,�.,.�..ry .� r. -
BUILDING PERMIT APPLICA-I ION " TIGARD DATEOF
•' _._.___. 19 G�� �C?
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE�
OR AS SHOWN AND APPROVED IN THE ACCOMPANY! .G PLANS AND SPECIFICATIONS. OWNERPHONF
LOT NO.
OWNER j L��Li y �1 LJL JOB ADDRESSL 20 Q(I Ik2nd LuUL t HOME ADDRESS
ARCHITECT
r�yy
ENGINEER
BUILDER 9c4m" ADDRESS:,"')05 Sid 182nd,, idahi3 DES!GNF_R
STRUCTURE ❑NEW ❑RI MODEL ❑ADDITION ❑REPAIR ❑RENEWAL— ❑FIRE DAMAGE ❑DEMOLITION
Q RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'- ❑RELIGIOUS❑PA110 L1CAR POET ❑GARAGE ❑STORAGE OSL.AB ❑FENCE
❑BOND C3 MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCl1PANCY__ _LAND USE ZONE. r"" —._BI.DG.TYPE___.__ FIRE ZONE_ PLAN CHECK BY "�1 HEAL'
Corintruct single family dwtrllint, W/attachwt'i garage. 3 bt.rjroums
SEE CORPFCTIUM SHEET ATTACHFU.
svuei Parmit ,-120362 - 71[1'j*()0
Q_ULOAD — FL0_QB_LQA.L?_ 40 HEIGHT 'AREA 1��N2.@.EJm OMS "'_YEILUE"
BUILDING DEPARTMENTYSET BACKS FRONT It REAR `' LEFT SIDE r RIGHT SIDE 6
Permit 1 cq 1.(?C T''TVr'T''_TJT-THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
'Plan Check REGL r '.I IONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT TYF.
--- WORK WILT_ BE DONE IN ACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal .._1st.� ,�� ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE. CURRENT CITY RUSINFf,
State Tax 7♦64 LICENSE. SEPARATE PFaMITS REQUIRED FOR SEWER, PLUMBING AND 14FATING.
Total S Z94*14 --,UL iO4UU0tjw
BY •)DC fr1 $100*00
-- I/f',/ APPI ICANt OR AGFNt
Approved Recclpl No.
DATE INSP. TYPE INSPECTION _REMARKS PLUMBING DATE
— Contractor _
..-----
Parmit No.
Rough-in
, .,P_o..T _—_----------- —_
Fixture
Final
HEATING
rFin
ctor
3.Ia-f� qc
*K -- --
-----------
s+./—w t No. .1 -.-Oil 9 Y-inSEWERf�—(O`DRIVEWAY-- Drainage Drain)Final-- alk
—�— --- JT Curb&Street Final _ -__-
ARY
Approach
BLDG. DEPT.FINAL ClRTIFICATI OCC�1tANCY CERTIFICATE OCCUP CY Final
Landscaping
Zoning Final
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MI I APPI ICA ION 'O"y TIGARD od . S �g 7�' �`
BUILDING P E_R 6 - z
THE UNDERSIGNED HEREBY APPLIES FOR APERMI I FOR THE WORK HEREIN 114 n' I_U eun-o'=rr r!+r. ,•
OR AS SHOWN AND AFPROVED IN THE ACCOMPANYING PLANS AND SF'ECIFICA 11t.INS G:•NLrrrN'',t- g a
LO'r NO,^
Wq/�I JOA ADURES2-S� �-- I
OWNER_ !
9UIF_DCR RLt.. AADO
r� 1
STRUCTURE IAfNEW _ I�ntmnDEL _ ...0,,L)ulIIION L_.JREPAIR (�111':L1vnL Lli Ht.
RESILIENCE1._,ICOMM ❑EDUCATIONAL E3GOV'T DREL.IGIOUSL'PAT10 LICAHPOHT ❑GARAGE [ JSTGRAGEDrL,�3
OCI_UPAfJCV- _ ± I t AI7 nG f�Fr g� FE .' lnlr _ PI tr Lr r .7r ✓'w
----- C� Q,,.,,,,nsc.�h'o�.. s�e��- -�,�a.�•�te� ' .______._.._..._-.___.-..._ --____.__� .3 �cn�ls
SEWER PIE:RMIT�;'-
• E)CC_4.OA�__.__ __- ��Q':,a I ,�,- � , , �� n'�.7_ST9gtlS_/. �F; ��i�T' � 172,000
__- - - - 3�•
REAR f3
_ _ 9UILOiN'; btC�F'�" '• �� + 7 NIL;H't S
Pe It —_.._ ��� ��
PIIS C[HM11 IS ISJUt.0 ;OBJECT TO THE NEGULgI1CF�ti'' 1 LTN1<..+.� �: �. SHE NLII{ DING '
Pl,n Check yo r1IILATIONS AND /LL APPLICABLE CODES AND ORDINANCtS. AND IT IS Ht 1EBY A04 ..
(---- in WILL CE DONE IN ACCURUANCE WITH THE CLANS AND SPECIFICA IION; C.ND IN C.O"'F"
I Su:7_ttJidl Y I �Q/,••SQ APPL1r ABLE CODES AND ORDINANCES. THE ISSUANCE OF ENI; vER.MIT pC`rS 'JOT
F Vwv. IRICTIVE COVENANTS, CONTRALIOR AND SUB COtIiRAC 7ORS TO HAVE CUR PF.•NT r,lf t{l
State Tax H—!—NSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING ANDHF.ATINC
Q t, Dc
Total ,�'-
e, Vs
LAtnu+uvFd –pt Nu _
1
SDC �p
PDC - $ /4>0
SEWER CONNECTION $ Gso
SEWER INSPECTION
SEWER SURCHARGE
Comments:
MIME
2Lx .28- 2 75Z
x 7
3 S o
17 81
#17
1-6 9�
---
19-111--
x2� vvo
t�.. i y O 1 10a�'`� I��eL }�nrrieai Ne+ rrl�i ��� Fee Permit—'3` .00 '
NEw lnizall.,tion Replar_a F( Relocation Addition Alteration i 4%statc
TOTAL---
HEATING
OTAL HEATING l
r..c►vrFs.ncraRQJ�CYI�- Xm o�vNEH _ -
A:'►Df(Ea°i� k11 _-.. RESS WORK ADD1y�s(1u 1 n(k
PHONE Ig �J-1 - _ _.._ ._. __-__ .. _.._� APPL.ICL\N 1'-__ -_---
Heat Input Rating (Ft•1'U Per Hour). _..._ Vint Site ---- ---..._.. Flue Size
'U::L. OIL t"� GAS � ELF CT CJ OTmE.R,_
ITEM NO. FEE ITEM NO. FEE `
.'or Issuance of Permit _ L;R ATIOVE. Air Condition Compressor 15 to 30 HP _ 10.U0_ . t,
New-up to 4 itic�..lU0,000 _B U �''y� A.00 _ Airflandlinr� 1_0,00_0_CF_M 3.00_
Mevv. 1_003001 cver� -6.00_ A_ir Fland ling Over 10000 CF N1
Floor Furnace ___ 4.00 Evaporative Cooler 3. 0 =;
_.. _...__. - -.._ . .._..._ .- . —
Viall • Floor -Suspended 4.00 Range Vent Fan _ 2.00 -''
Install Vents Only 2.00 _Vent System - � 3.00
Repair Heat Er Cooling _ 4.00 w_Hood Commercial- _-w- 3.00
Air Condition Compressor Under 3 FIV__ -_--y� -ti.00 M�Co_mmerciai Duct System —�- 10.00
Air Condition Compressor 3 to 15 HP -
i"SeL_�-==-•�Sa.�'SY.G..:.....1�'�"�Tt..S"=...'__ ..: �Y.ii::..rTs�'.:r.?�:�s.::—_.'.�T.Td�Sc'�[_::1.• x •�.x+_.._.'�...'�.:=Y:.^_._�.�'- --`_._=.. �.
IN:.•PECTOR•S COMMEN'f5.�
CITY BUSINESS LICENSE. REQUIRED FOR ALL CONTRAvonS QR SUB.CON f RACTCI,1S
i.1lF20`'GD 13Y DATE MSUED B DATE
RFCE IPT
w+ Signature of Applicant