12170 SW 124TH AVENUE 12170 SW 124TH AVSNJS
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Addt sav a.. _121 pS.6i. 124th rtAve,.=.. . . , permit No. r...R1617
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nddner Ralph Oeutz Connem t.fi aaTn foo 400
Paid by
Tvoe or t,gjlding . .rej. Date connevted
Sel vice rate 3.00 per month In,9PAction fes 25
Fantractor same taold Wi date
Size of connection 4" A,;.�se;ssta®tat pair!
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City 0 and g
INSPECTION REQUEST
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INSPECVON TIME : 4_ �` _ PERMIT NO. : 7_,?�`�7�
i DATE : DATE ISSUED:�2
I OWNERS NAME
ADDRESS :CONTRACTOR :_ -ICA-4v-k
TEST'. Air Ll , Watbr [j , visua',0_1_�Laboratory Cl
RESULT . Approved Cl , Dis.pproved Ll Pendmg_er�
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SKETCH:
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INSPECTOR DATE
IOTE : Attach supoememol test data hereto]
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Wpm
` PLl1MHIlPO
Jur!.sdicti m '! ,,p,; s
a. _ype of Fixture Fee Permit No. 7 3 4 r 1
Permit fee w •F
1. Wats Closets Toilets .+ `� Perm i.t Issue �{
Bath Tubs Approved by
- Lavatory e asin Building Perm :
Shower Receipt No.
SMS s� Dishwashing
Sinks. -Kitchen rd
oinks. r na Location of Building 7o ,:: b(/-
-Sinks, Bar
Sinks, So
Aiitomr4tic Mshwasher
1 . Disvosal 'PAW
Laundry Trays Name do ,'tress of Owner
Drains Floor -
Drains Areaj,,3
wins e
rigerator
Rain Drains
Automatic as er y Name & Address cf Plumber
oun a ns inking
Fountains, Soda
Hot ser a -'�
Water Service (Size '
Urinals Bulldin _{..ar New) 0-1
Catch-Basi rsYard
Lawn Svrin ler System
Swimming Pool �� er
__�prinkler System
This permit becomes null and void if work or construction authorized is not
commenced within 60 days, or if construction or work is suspended or abandoned
for a period of 120 days at any time after work is commenced.
All plumbing firms must be licensed by the City of Tigard and post a $1,000 bond.
I hereby certify that I have read and examined this application and know the sw
to be true and correct. All provisions of laws and ordinances governing this type
of work will be complied with whether specified herein or not, the granting of a
permit does not presume to give authority to violate or cancel the provisions
of any other state or local law regulating construction or the performance of
construction.
Signet,
ignet e oApplicarit-
v
J CITY OF TIGAM 7
Al- q-7 3 PERMIT NO. % .3"/5-A RWRIP'S NO.
FEE
Permit shall be obtained prior to commencement of installation.
Permit shall be obtained for all appliances which are to become
% fixture to the building.
3. Relocation, replacements, alterations, or changes to burners and
duct work require permits.
4. All work to be concealed Must be inspected before cover up.
I.nstaliation Replace LJ Relocation E Addition ,❑ Alteration ❑
COMR. OWNER-.
ADMSS WORKADDRESS 70
APPLICANT
TELEPHONE NO.
DUCE - MANUFACTURER _ TELEPHONE NO. --
WAT Input, rating (Btu Per Hour) _ Vent Size F?ue Size _
FIi'EL OIL U GAS❑ ELECT Q OTHER r
TOTAL SO. FT. Top Floor Main Floor Basement
—_ GENERAL
ITEM NO. FEE ITEM NO. Elm
For Issuance of Permit 00 Boil rs Over 50
ow - Under100100-0--- to it an lid 0�u CFM
ew -�Ve'r u c- an�Iliin over000 CFM
Floor Fumace a or ve oo e-
- Suspended
our - en an _
notall ens en sem
Da r Ifeat & Coo n _ .00 oo
ers Qn ermes ic nc neroar
era 3 to I - I Comm. incinerator
ors 1 to - ero s e
o ers o
INSPECTOR'S COMMENTS
APPROVED BY _ _ DATE ISSUED BY DATA: �-
a�c_ �L �-a
Signature of Applicant
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PERMIT TO CONNECT _5197
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Tigard Sanitary District
q
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PERMIT N° 1617 DATE '' At
PERMIT IS GIVEN TO1
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE Drtil'RIBED PREMISES UNTIL.CON
-
NE!_'TION IS MADE AND INSPECTION OF CON14ECTION HAS BEEN COM-
PLETED.
v
PERMIT FEE PAID ..••....T1GAR D SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROVED
?. ititG�i'l> ��+u 701-`✓ 7
DRQ — — _ Bupeciisti tn�eat ---
otr ■s � sir � � �e �r
f
G
J - UTLDER VALUE ��. � FEE DATE
LLOO-C—A--T-ION OWNER n t
iJVD # MAP / ! .LOT # 'j TYPE . y
PLUMBER —
PE MIT # '— -EE
SEER FEE VECHAN CAL PERMIT
DATEBY DATE7 'SY
EXCAVATIOY/FILL AIR CONDITIONING
FOOTINGS FOUNDATION VENTILATION _
FORMS SPRINKLER SYSTEM
SLABS MASONRY FLUES
REINFORCING STEEL FIRE DOORS/EXITS
STRUCTURAL STEEL GARAGE FLOOR
PLUMBING R, I _ DRIVEWAY
ROOF/FLASHING _ SEWER
FRAME ._ STORM DRAIN
LATH/WALLBOARD PARKING
HEATING
WATER HEATER �..� � FINAL . _......._._. __._..._.. ,
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CITY CSF TIGARD
12420 L W. Main E4reN
TIGARD, OROGOW 97227
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish �] Addition ❑ Remodel ❑ Move
ZONING R-7 _ DATE ISSUED 5.12-72 BUILDING PERMIT
DATE RECEIVED_ -8-72 BUILDING FEE $ y1.50 No• "72�
PLAN CHECK $ 45.75
BY — OTHER $-- VALUATION $ ,
TOTAL $ 137.25 RECEIPT No. 9�
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N 54 _ MAP # 281 3B CENSUS TRACT W-19 _ J013 N
Architect or Engineer _
Address Phone
Ownar Ralph Beutz
Address--- 12170 g.w. 124th
Builder same
Address__sawe —`_ ----Phone _
BUILDING USE Single Res. a Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP I _ No. of Stories- ? -_ Total Height 20, Area of Lot s
Type of Construction XX)=XK]A03XX)M V Floor Area B`- _ 1
Set Backs: Front.__ Back`._ L.Siden__ R.Side _❑
Private Sewer Pipe Size 4" Sewer_ Q•gJ• ^ Septic Tank
water Service Pipe Size 4" — Storm Sewer 0 Ditch ❑ Drywe11 ❑
Street and Curb Reyuirem^nts— __ _Fad.st!ng
Driveway Wic:th lb' _— __No. of. Parking Spaces` 2 _ —
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED_`- i2i7D 8.w. 124t1:
FIELD CHECK BY DS - - ---DAT E__
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PERMIT APPROVED BY Z16L l-.e.
It is understood that all work will conform with applicable codes and ornc�es
of the State of oregr,n and the City of Tigard, Oregon, and that the building wZZiC
not be occupied until a Certificate of Occupancy lima been issu,cd by the City of
Tigard Building inspector.
s�gna ure of Applicant