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FlUILDING PERMIT APPLICATION TIGARD DATE_.—_ ���/ ,9.__ 4022
TF'E UNDERSIGNED F!i'REBY APPLIES FOR A °ERMIT FOR THE WORK HEREIN INDICATED BUILDER PRUNE 620-115V V
OR AS SHOWIJ AND AF PROVED IN THr ACCOMP' ,.I'ING PLANS AND SPECIFICATIONS. OWNER PHONE _
LOT NO.3A_ - Y )1 cl
OWNER �7c11' '?111f r, Cl.ri `JOBADDRE-'3Sj `1r,5 ''1%4 123rd Court _ Windmill
ARCHITECT -- --
ENGINEER
BUILDER SCITIP ADDRESSI'•O• Box 232.91,, TirTarc:DESIGNER 'Ti11Pr
STRUCTURE 3 NEW Il REMODEL _ ❑ ADDITION ❑ REPAIR `❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE ❑ COMM ❑ EDUCATIOI IAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY N-3 LANDUSEZONE t�..� BLDG.TYPE Lf FIRE ZONE PLAN CHECK BY T''h NEAT
C:ongtruct sin,_i.ic family (lwellinc; w/attarhhc:l garr,��e.. 3 } cdroorg 2 llatbr,
_- to=19m12£_ of ?,366 (1210v S: ) Ann )tarn)
SEWERPERMIT# 238g4 — 'L 1�,_nn
COC.LOAD FLOOR LOAD I` HEQHT I i _NO.STORIES_i 1 AREA 1388 NO.BEDROOMS 3 VALUE' `_ r 'D R.
BUILDING DEPARTMENT I SET Bl',CKS FRONT ?'I REAR "` LEFT SIDE RIGHT SIDE
—---- --- _ _ r
Permit $31 o l QA THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
I PEGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 1 r, •rl' IF ORK 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
Sub-total RESTRICTIVE COVENANTS. CON'TPACTOR AND SUB CONTRACTORS TO HAVE CURRENT 'lTY BUSINESS
State Tax
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
'� j ? .?c'
Total 11.1 3"7 4{I SDC--
-- — ' PDCM aPPucANT OR A�lENT'---
BY t'`1
Approved Receipt No. -�-
e_ ADDRESS T Ff10NE
� 1
I —
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
E;j ��� — Contractor = WA.1 (oZ.:-=7L 3c
.(J.�. Permit no Z �} �22,� 2-IZ-6Z2117.1 VV
v / y� —T7 -------- Rough-on —
n 15�' Fixture I - - ---- -
RK cJ-,c. Final
HEATING
Contra,•t,. �J
�G.s
or Oil
Rough
.in
Final
1 _
SEWER
Final
DRIVEWAY
------ Final p•„
�q -- -- --- _Storm Drainage Q ! D -
ti� (Rain Drain)Final wM
App"mch
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY F'cN
CERTIFICATE OCCUPANCY
Lunc wAping
i or i•,4 Final
U il}yr�" :;� k�`(t' r �� ���. r'+If •. �,. S; a- �i�4 r:ryi,'�I{i�u ,
PU?LDING PENiVIIT APPLICATION co TIGARD DaTE�e_�'�- -• ,q�- �°�'t'L
TFIE UNDERSIGNED FIEREBY APPLIES FOR APERN11T FOR THE WORK HEREIN INDICATED BUILOF_RI'!ioNE4?Q-
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNEF'.h!GtiE
L T NU �
" A/kAo RrN� S�J Iz3 C . Y� ale ,,�
—'�'
ARCHITECT
ENGINEER /
�U1�_.0,='� -t'�GJ:• .u A009' 1 Po &Y lej
2?gl I I OESIGNER f"l1 a.—
TRL'CTUP•E �J- HEV/ 11 Flt MnCEL ❑_ AODITION�- ❑REPAIn" C]RENEV,AL _ EIFIRE 0A.`i1AGE `.JDE.'00LIT1.
TiESIL�t"Ir.E I—ICOM"•1 ❑EUUCAT JNAL �GOV'T -O`1ELIi,ICU5 C�?ATIO UCAR POFIT ❑GARAGE ❑STUAAGE CISLAB ❑FEN
CCCUPAft_Yl?.__llLAND USE ZION;: __Q-7____RLDG TYPE y-0 FIRE ZONE PLAN:rHECK BY' _—HEAT—�7�-
Rt A t�C P`anhi�f �l� 12
1,59y) 4m n Rate _ 3 6s_oe_mem#
SEWER PEFf1I1 1L
FLOOa.1 2A� HEI HT NO STORIES AREA 3V Q_2EDROU�IS_ V I S9 00
5111LCIN , DEPAR rmENT SE T BACKS FRONT �T REAR .2C/ LEFT SIDE 8 RIGHT SIDE S.J
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATION% Cl- '-AIMED IN THE BUILDING CODE. 20NI,
j 'r ar, Check I `JIB O0+ REGULATIONS AND ALL APPLICABLE CODES AND OROINAI .5, AND IT IS HEREBY AGREED THAT T
------ — .—K WILL BE DONE IN ACCORDANCE WITH THE i-L.. _. AND SPECIFICATIONS AND IN COMPLIANCE WI
::3:)-rordl II -----^ ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAI
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTC. TO HAVE CU:,RENT CITY BUSINE
'7;at? Tat I 12 ,40 LICENSE. SEPARATE PERMITS REGUIIIED FCR SEWER, PLUMBING AND HEATING.
�----_ O S D C
APPLICANT Oq AGENT
LANUr�,el' - Receipt No
- ��` '1 r•t7FS5 PHONE
SOC - �OO
PDC - - T# 100
SEWER C'JI'NECTI.ON $ 77:l
SEWER INSPECTION $ 36
SEWER SURCHARGE
1 310
Comment,q : Reit. .2-2-9 A54 _ ___--
W
City of Tigard Mel,,:hanical Permit NO.
New Installation 0 Replace U Relocation� Addition 1l Alter-tion C7 DATE:
HEATING
CONTRACTOR --1 �� ��k� �1 { / i )�1/ OWNER
ADDRESS Q(�,, ` /, VIA-) Q -JOB ADDRESS r 1 h
PHONEAPPLICANT
Heat Input Rating(BTU per Hour) �� Vent Size_
�_..—.__— Flue Size.-_/," "
FUEL OIL C.J GAS vQ-'ELECT ❑ OTHER
ITEM �IJO. FEE _ ITEM _ _':V. FEE
For Issuance of Permit SEE BELOW-,----..------ Each Air Handling Unit or Duct System _ 7.50 --
Now-up
.50 _New-up to & incl. 100,000 BTU 6.00 Commercial Hood System 7.50
New Inn nnc '"UT's & over 7.50Other Equipment Each 4.50
'A'ondhurning Stove 4.50_ 1 Trip Im.pection 4.50
Wall-Floor- Suspended 6.00 Air Condition Compressor • up to& incl.3 H.P. -6.00
Vent System w/ran 4.50 Air Condition Compressor•3.1 to 15.H.P.incl. _ 11.00_
Repair•Heat Cooling 6.00
CITY BUSINESS LICENSE REQUIRED BY Al-L CONTRACTORS OR SUB-CONTRACTORS ! I
FEe1MIT ISSUANCE 10.00 Comments:
FIS E�S -- -
%-STATE Issued By--___yam r /J
ILAN4HACK f 1 �3fr: rr.►tF