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12625 SW 128TH AVENUE
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BUILDING PERMIT APPLICATION 1 Y TIGARD DATE ,9 7 4 4 r o
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICA"-ED 13UILDERPHONW 632 01438
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. 11WNERPHONEL44 ' '_;2y
LOT NO.
OWNER ion Taylor JOB ADDRESS 12625 SW 128tho HOME ADDRESS
ARCHITECT
BUILDER June ENGINEER
ADDRESS DESIGNER
STRUCTURE ❑NEW ❑REMODEL_ QADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE []DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑NOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
GCCUPANCY r LANE USE ZONE i 7 _BLDG_TYPE_kL4 FIRE ZONE PLAN CHECK BY W HEAT
Story 12 x 22 addition to VxiSting dwelling as per plane
Ana L:vde, and wand deck
QQD_LQAR FLOOR LOAD _ HEIGHT 2Imo^ e__ g(3EA 122E3 NO��E_DROOMS VALUE
- -
Iluxt
BUILDING DEPARTMENT SETBACKS FRONi1CJU8U REAR .3U+-- LEFT SIDE I RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check ' REGULATIONS AND ALL. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 1080 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total
By
–"– — APPLICANT OR AGENT
Approved t" Receipt No
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UATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
�---- Permit No.
Rough-in
Fixture
_ Final
HEATING
Contractor
Permit No.
Gas or Oil
------- .— --- Fina I
-- — SEWER ---- – -
- Final
DRIVEWAY
Final
-- ----- — – ----- StorrTi Drainage
-- — —_--� (Rain Drain) Final
—_ _ ----_ ___------_--- Sidewalk
Curb&Street Final
BLDG DEPT. FINAL r A roach
TEMPORARY OCC CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping _
Zoning Final
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City of Tigard
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INSPECTION REQUEST
for
I INSPECTION TIME : PERMIT NO. : ZL2 7
DATE : 4t'11'0/Z3 DATE ISSUED: 7
OWNERS NAME ,&./ n /\-�Y�
ADDRESS : _5"
I CONTRACTOR : __ ---- ---..-------- --- ---- --
TEST. Air 0, Water U ,TVisual a-Labaratory p
I RESULT. Approved Bf, Disapproved ❑ pending [] I
SKETCH: `
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INSPECTOR DATE
ICNOTE Attach supplemental test data hereto
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CITY OF TIGARD
17420 S. W. Main StroO
TIGARD, OREGON 17127
APPLICATION FOR BUILDING PERMIT
New Construction I1 Demolish Addition KI Remodel L J Move
ZONING g:7 DATE ISSUED 4_12_73 BUILDING PERMIT
DATE RECEIVED 4-11-73 BUILDING FEE $ 9 00_ No. a! ^ 73
BY PLAN CHECK $ lam_ ---—
- — -- OTHER $ VALUATION $ y00.Q0 t
TOTAL $ 13.50 RECEIPT No.
TWO SET'S of PLANS AND PLOT
PLANS MUST BE FURNISHED WITH APPLICATION
LOT M MAP N �5/ rIF CENSUS TRACT (�1�_ JOB #—
Architect or Engineer_____
Address—----------- ---- --- Phone_
Owner_,_ -Taylor _ — ------------ —
Address— 12625--S.W__128th —_ -- -.—Phone
BuilderDM
---_ y���„a
Address_ 51327 S.W. Dickinson. PortLaR 97219 , __—Phone
BUILDING USE Single Res. Multi Res. Comm. Industrial.
OCCUpi--Y .ROUP _ No. of Stories Total Height--- Area o Lot
Type of Const tion i II III IV V F1 r Area B 1, - 2—
Set Backs: Front_ _ Back- L.Side R.Side— __
Private Sewer Pipe Size Sewer.----—— Septic Tank \
Water Service Pipe Size---.-- Storm Sewer F1 Ditch 1)rywe1.1 ❑ 1
Street and Curb Requirements
Driveway width ______,No. of Parking Spares-- ___
SEPAPATF: PERMITS REQUIRED FOR SEWER AND PLUMHING
SPECIAL INFORMATION
C C4C Fireplace
ADDRESS ASSIGNEDQ6e`rS.W. twbh —'
FIELD CHECK
PERMIT APPROVED BY
it is understood that all work will conform with applicable codes anc ordinances
of the State of Oregon and the City of Ti d, Oreg r'andllat the building will
not be occupied until a Certificate of cu cy Ila been i sued by the City of
Tigard Building Inspector.
Ir -
Slgnature of Appl ca
Address x,15 ,�,,��i,9S Permit No. 1.2.7
Permit charge
Owner Connection fee
Paid by
Type of building Date connected
Service rate L 3oc�- '"v Inspection fee /ep
Contractor Paid by _ Date_
Size of connection Leif, _ Assessment _Pai.dy____�
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? `' 4. 7 DATE'7
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MUST BE POSTED ON THE DE9CRIBFD P!"EMISES UNTIL.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
lE1ImT P= PAw ...............TIGARD SANITARY DISTRICT
3 B .-M t
L
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CONNECTION INSPECTED AND APPRO JED
Date -� Superintendent
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