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CITY01IFTIGARD
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COiWUNITY DEVELOPMENT DEPARTMENT 011100H EPKIT NO. ME880516
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)639-4175
L DA'T'E Iti5UED :A
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USE 'T*YF,I--.: 51NGL.EFAM11-Y FUMACE.' :1.00K4- AJA 1-11ANDLA 10K
COWAT .TYPE : VN EVAP . C001-FA
CICCUP.GPP . I 173 VENT FAN
VIEN'T k)l::*Nl' . SYSTEM
13LIVCOMP) <31-117 HOOD
NO . STOPUES : F-41-P/ClOmp .3 1.31 H P 1N(.'1NF7.A*1*OP(E)(:)M
OWE-A.,L. .UNIT S 131_.A/ClOmp 1.:1^••301••1 P XNCINEPATWI 11 COM
1:0EX 1 YPE '30-30HP ISE PAIR UNTTS
MAX . :I:Nl:-1UT al P (D.0mr, 304-11-41::, OTHER
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'T•OTAI 11111117 .33
This permit is issued sliblecIta the regulAU ontalned In Title 14
of the TMC, State of or.igon Specialt) Codes,zoning regulations ;*;(:-F:-TPT NO 30720
and all other applicable codes and c,-dinAnces, ane It Is hereby ...................
Agreed that the work will be done Ir,a-cordance with the plans and :EN%Pr-:(::'TT()Wi
specifications and in compliance with all applicable codes and GAS L..TNIc.
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have turrent city PO!4*T 14-KAM
business tax permits. This permit will expire and become null and 14011.110-4-1 N
void If work Is not started within 180 days,or if work Is suspended or V:11:ME.
abandoned for A period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections are requested And approved
--Pe 4rm I It Spntu;e 2
Issued By
SEPARATE PERMITS REOUIRED FOR W64)K dV1AV1A;I`4H`%N1 6AC-016i'
ABOVE
i
BUILDINr PrHMII' APPLICATION TIGARD DATE- 3unr-- I i —,19_t5 5433
THE UNDEHSIGNED HEREBY APPLIES FOR A PERMIT FOR 1 HE WORK HEREIN INDICATED BUILDER PHONC 1539-MO
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHONE
LOT NO
OWNER John Geis JOB ADURESS 12625 Sly 124th
ARCHITECT
am ENGINEER
BUILDER '� ADDRESS —_ _ DESISNER
F I RUCTURE ❑ NEW IJ REMODEL ® ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
1 RESIDENCE ❑ COMM ❑ EDUCATIONAL r7 G_OV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FE I(_,E
OC:UPANCY -_ lt"3 LAND USE ZONE &-7 ._BLDG,TY- PE _—�t __FIRE ZONE PLAN CHECK BY � HEAT
Construct Paito elevated to 2nd Floor all per approved Plains and Code.-
SEWERPERMI_T#
OCC.LOAD FLOOR LOAD HEIGHT 2U - NO.STORIES � AREA NO.BEDROOMS VALUE !96LK).
BUl!
DATE �INSP. TYPE INSPECTION - REMARKS PLUMBING I - DATe
t-
6-j LCont.acto;w� _
Permtt No.
p
----- - -- - --- -. _ 1-&rgh In
- - :Fixtt rr -----�
,nal
-- --- -- -_- —.._ ---------..- _ HEATING
Contrector -
Permit No.
_ -�-. _---- -- -_ -- -- --- Gas or Od -.----- --
-
Rough-in I
_ - --- --- ---------- Final ---- ----r.-.—�--
-�_- --
SEWER
Final
DRIVEWAY
Final
Storm Drainagr -- --
Main Drain'Final
Sioeswlk
Curb&Street Final -+
_
Apps noch
I
ELDG-. DEPT TEMPORARY �:ERTIPICATE OCCUPANCY
n �Flnal -
C C IFI:ATE OCCU PA NC Y
Zoning
L
onfng Fin, _�- � - -----
wow
wM11pItl1gMtelltltb
F
Splr.i4jq��° i�?i'I ' NI ` a :s r k.•r-a ;�
I
I
IIS IF
BUILDING PERMIT APPLICATION rIGAR:) DATE '-� ' 19
THE LINVERSIGNED HEREBY APPLIES FOR A PERMIT FOR TIME WORK HEREIN INDICATED BUILDER F ONE'-
ORS
NE<ORS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. O NOR PHONE
OWNER �'u JOBADDRESS�Z �' �ff/ f j oK]`�tr✓"
ARCHITECT
ENGINEER
I� w ADDRESS DESIGNER _
BUILDER —�
❑ REPAIR ❑ RENEWAL ❑ FlRE DAMAGE ClDEMOLITIC
STRUCTURE ❑ NEW C7 REMODEL {AADOITION
RESIDENCE ❑ COM-M ❑ EDUCATIONAL Cl GOV'T ❑ RELIGIOUS ❑ PATIO Cl CAR PORT ❑ GARAGE Cl STORAGE ❑ SLAB❑ FEN(
O-CC FANCY LAND LISE ZOyE// --2--BLDG.TYPE ' PLAN CHECK BY .`�!>C HEAT -1 -
r,l
— n �f
SEWER PERMIT N ------
OCC.LOAD FLOOR LOAD HEIGHTi4J^ NO.STORIES _ AREA NaaaA00MfJ'�"- VALU
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFTSIDE RIGH :DE
Ppfftltt THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED !N THE BUILDING CODE,7.ON!1
REGULPTIONS AND ALL APPLICABLE CODES AND ORDINANCES. AND FF IS HEREBY AGREED THAT TI
�Plan Check WORK WILL BE DONE IN ACCC'WANCE WITH THE PLANS AND SPECIFICATIONS AND IN COt.!PL1AN1
•� WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIT
Subtotal 3 RESTRICTIVE COVENANTS.CO;ITRACTOR AND SUS CONTRACTORS TO HAVE CURRENT CITY BUSINH
UCENSE.SEPARATE PERMITS REOUIRED FOR SEWER.PLUMBING AND HEATING.
StStu Tax •
SDC-
-- -- -- - — --- -- -- --- --- -- ---..
.�
Total APPLICANT OR AGE N i
By
Ro.
ecelpt N --------- .
Approved � AooRfss
SSDC ---
SDC
PDC
SEWER CONNECYION S -
SEWCR,'fNZPECTION S_
SEWt fl SURCHARGE S
- S�
iw �■r s>t ea► a: �
BUILDING RECEIPT
— -
NAME' ...�L� DATE: _ � _--
ACCT. M DESCRIPTION AMOUNT
10-432 Building Permit Fees
10-431-600 Plumbing Permit Fees s
10-431-601 Mechanicai Permit Fees
10-230-501 State Building Tax
10-433 Plans Check Fee
30-443 Sewer Connection (20X) S _.
30-202 Sewer Connection (80%) S __
30-444 Sewer Iwispection s -
51-448 Street System Dev. Charge (SOC)
52-46�0-610 Parks I System Dev. Charge (PDG)
52-449-620 Parks II System Dev. Charge (PDC)
31-450 Storm Drainage System Dev. Chrg (SSDC)
10-2.30-505 TRFD (95%) S _�
10-479 TRFD (5%)
10•430-506 Washington County Fire 41 (95%)
10-478 Washington County Fire 01 (5%)
10-220 Amort/Wedgewood
i
TOTAL s • ---- - - ---
(be/1214P)
I
INSPECTION NOTICE '
City of Tigard Building Department '
12420 S.W. Main St.
Tig:lyd,Oregon 97223
Phone: 639.4171
Type of In•jectiun
Date Requested-___.__-___.__. /_ TimeA.M. P.M.
Address �_ ��' } �� �L— Permit
Owner---_-- _ _ — Lot #_-------_-__
Builder e d:::'1 e je -----
The following Building Code deficiencies are required to be corrected:
-----�i+ //— / ---- --
All tm
Presented to
Inspector —_ �_ Disapproved
Date _ _--nk, .e"
CALL FOR REINSPECTION
El Yta LJ NO
Address /�(r�S� �j �� /�?�� Permit No. /Z�,,�._.__.___�
Permit charge___.
,
Owner , � ���� Connection fee
Paid by
Type of building_ Date connected `e7l A4'�4
Service rateInspection fee_ A4
Contractor Paid by 4Date_�
Size of connection_ _ Assessment --Paid
PER.MTT TO CONNECT R 2 ;+
Tigard Sanitary District ✓m "
PERMIT N° 12073 DATE J - Le
PERMIT IS GIVEN TO
OF'
:O CONNF(T A
TG T TIE SYSTEM OF TIGARD SANITARY DISTRICT
AT d4
THIS PERMIT MUST BE POSTED ON THE DE9CRIBED PREMISES UNTIL CON-
NECTION 1S MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT EEE PAID a. . .....:.'..`!.............TIGARD SANITARY DISTRICT
C'41NNECHON INSPECTED AND APPROVED
Date Superinten�c elft