12240 SW 127TH AVENUE 12240 SW 127TH AVENUE
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City of Tigard
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City of Tigard
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C)V,l N F.711.9 NAME -
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City of Tigard
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INSPECTION REOVEST
for
INSPECTION TIME :_,/, , PERMIT NO. :
DATE: /A-'I>> DATE ISSUED:_--'. L_
I OWNERS NAME : --
ADDRESS :
AME :ADDRESS : cc-
ICONTRACTOR :---
ITEST. Air 0, Water ❑ , Visual, Laboratory ❑
RESULT. Approved 0 , Disapprovedfl� Pending ❑
I SKETCW.
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INSPE:.TOR DATE
[OTE : Attach supplemental t&st dato horst]
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�MO1 ��:rc; .,�aE!atrteuts� 7Ott de•o hrt.•.�
CITY OF
BUILDING PERMIT APPLICATION TICARD _ N° 0157
THF_ UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATICNS.T OWNER PHONE —
OWNER Herb M®1Ci CbSt�;G __ ___ADDRESS .x.•40 S.W Ii7th Ave. BUILDER PHONE
ENGINEER
luLuu _ pin 1 ARCHITFC_�T __ DESIGNER
STRUCTURE ❑NEW ❑REMODEL ❑ADDITION ❑REPAIRt—1 ❑RENEWAL ❑FIRE DAMAGE 0DEMOLIT'ION
❑ RESIDENCE [:]COMM ❑EDUCATIONAL [:]COV'-, ❑RELIGIOUS PATIO ❑CAP PORT ❑GARAGE [I STORAGE❑SLAB UFENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW DCOUNCIL APPROVED [:]SIGNS
OCCUPANCY.__`_LAND USE ZONE___ _ __BLDG.TYPE FIRE ZONE.— PLAN CHECK BY. .F A HEA.______-._-___
Cungaj ict 1100 ,:L;. it. ,I itdelling ,jrding to approved
plena no bedltddlmont ---ottech ad garpUs
QCCLOAD FLOOR LOAD 40 1b. HEIGHT NO.STORIES I AREA 110 VALUE 271,9911 7rI,
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BUILDING DEPARTMENT SET BACKS FRON1 .10 REAR 31 LEFT SIDE 1a RIGHT SIDE ... 4
Permit 1.1.a.Li(It
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check c� D" REGULATIONS AND ALL APPLIrABLE CODES AND ORDINANCES, ANO I i IS HEREBY AGREED THAT THE
—� WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPI IAN^F WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF TMS PERMIT DOES NOT WAIVE
-- RESTRICTIVE COVENANTS, CONIRACIOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State L• LICENSE, SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 119.1H
BY
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t.,r ; APvANT OR AGENT
Approved Receipt No. 6
ADDRESS Iii u,r�F
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit NJ
Ruu h-in_
Fixture
2S Final -
/D_l7 —Z/X� POS l— t"� U/LDG�'J HEAPING_
��— 94zk?:2—suOL,GFCCy /4, A..,"L Contractor}
�S D L Paps- _ Permit No. '—UUrJ°—°
Gas or Oil
Hou h in
Final
_--- ---- .2�7SSEWER
—__ Final
----- �_ __ DRIVEWAY
-- --— _ — - Final
- —�� Storm Draina e�_—
(Rain Drain) Final _
Sidewalk `-
-` Curb&Street Final
— _ __
Approach 4 C 3`
BLOC DEPT,FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
�S Landscaping
Zoning Final
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A D D R E S 5 1r.2,;1�o ��tt /,'� 7�� -"�.-...� PERMIT N 0.
PERMIT CHARGE none
OWNER CONNECTION FEE
PAID BY
TYPE OF BUILDING ca��_ DATE CONNECTED
SERVICE RATE ._a�.L��_ INSPECTION FEE
CONTRACTOR
PAID E3 Y :_ i._�.,._c [)'1 T E -
SIZE OF CONNECTION � �� A iSE55MENT PArD
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