12495 SW 129TH AVENUE U I...l SLI L-1 U U Li i(_.� �.•�'� �...
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12495 SW 129TH AVENUE
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CITY OF TICARD Pf umlb5ng PerOWVIVED
er:iiding Department _ r No.
Residentici! _� Commercial [ ) flAY �t
New Installation ❑ Replace 41 (E t
t p [_) Addition [ ] teration OF T�rgRU
Licen ped
Plum`)er �n� .r So,,. �e �1-� £d_ i�aEy .,� Owner
7- _ 4
Address k-94 ___ _-- - Job Address _ 1 c 5
Phone UU, Y7J.$ --_._ �— A. )Iicant L,
CITY BUSINESS LICENSE REOUIRED FOR ALL CONTRACTOR ND SUR-CONTRACTORS
IITEM _ NO. FEE' -TOTAL M —_ NO. FEE TOTAL -
Fixtures Traps -- 7.50 Sewer:First 0 k — __ 30.00
Dishwasher `_- 7.50 Eac ddit.100 ft. _ 15.00
IGarbage Disposal __ 7.50 ctor Pump 7.50
Water Heater - - 7.5 dter.-irsl 100 ft. 20.00
Backflow Preventer - 7.5 Each Addit.200 ft. 15.00
Storm 8 Rain Drain:First 100 ft. 30.00
Each Addit.200 ft. 15.00
_. Mobile Home Space25.00
Other(Specify); �� �- Y Rain Drain-Single Fam.Dwelling 1500
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PERMIT FEE - 'r Cornments
STATE % I �,. Issued By:_------------ ------ ----
C . Receipt No.- -----._ Applicant--_-'-'-, _7as�
' ITOTAL _ /_� T Signature
For Plumbing Inspection Phone 639.41 'f -
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MARTIN T. M0' J1 J "J 111PLUMBING PERMIT
49920 r!. E. UNICra �:ac. - 234.1111A
-_.., holder of a valid plumbing contractors license is hereby
ajthorized to cause plumbing worL- herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for ell contractors and subcontractors.
Ownerf DN /iG �_ Address -?� y `.�1
_ /
� 9 —
NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT - ITEMS FEE ON EACH A.MOUNT (Office U;e Onlyl
_Single Family-1 bath—each 75.00 ,i
Du lex—Each 1 hath unit4
_25.00 I Q
Additional bathrooms—each 10.00_ 55�
Mobile Home Sp•+ea—each 15.00 — e
INDIVIDUAL FIXTURE FEES
1 to 50 Fixh-res in 1 building—each_ 7,00
51 to 101) Fwures in 1 !Tjilding—each 2.50 _
`101 to 200 Fixtures in 1—budding—each _ 2.00
201 or more Fixtures in 1 building—each 1.50_
thiISCELLi.r+ EQUS ._-
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Building Samar-1st 50 ft 1000
Sewer—each additional 100 ft. ~1000
�V'later service to building 5.00
—Private water Svsrems—each 100 ft. 10.00 _
Other ISoecifyl.
PERMIT For Plumbing Inspection Phone 639 4171 1�
State Q _ Plumbing Contractor
TOTAL RECEIPT NO. Issued By ,
11
213" i;LL'$,!Or...l1: 3903
BUILDING PERMIT APPLICATION TIGARD DATE 1s 1 `•°
THE UNDERSICNEDHEREBY Af'PLIES FOR APERMIT FOR THE WORK HEREIN I:JDICATED BUILDERPHONE 253-11
OR AS SHO'.JN AND APPROVED IN THE P CCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_
LOT N0.
OWNER .J.e";.Rig'Aa1►SC)Tt,b1dr.JOBADDRESS 12495 S11 129th AV<?71up
--�" ARCHITECT 'P.J. F ri T'tc.1
ENGINEER
BUILDER game ADDRESS 11059 Sr 17iViciOn DESIGNER
STRUCTURE L3:NEW ❑ REMODEL 0 ADDITION CJ REPAIR ❑ RENEWAL _ ❑ FIRE DAMAGE-- ❑ DEMOLITION
M RESIDENCE CJ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CAR PORT ❑ GARAGE ❑ STORAGE ❑ SLAB FENCE
OCCUPANCY `�"'3 LANDUSEZONE R-7 BLDG.TYPE ST`' FIRE ZONE_- PLAN CHEICKBY KWh HEAT
ron^tmict single family dwellin:T V.'/attvjc!'te►ct uaranci. 3 Tz&lroon.E� fel ''tth
SEWERPERMITN ------
OCC.LOAD FLOOR LOAD 4 n HEIGHT 13 NO.STORIES 1 _ AREA 1 500 NO.BEDROOMS 3 VALUE
BUILDING DEPARTMENT SETBACKS FRONT REAR 5 % LEFT SIDE RIGHT SIDE ..'
Permit 211 e9fl TH-�S PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 1 PAIL) WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal _ _ F ESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
— 1 I(CENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING. '
State Tax 2, d''
Total
.y1q'Q,, SDC-- k �ll1l?�Zit' i f ! "tr ' `r� !� ✓` rt:L � ' �� �
PDC# 1 %1011.•' PLNTOR AGENT
By �'1 _ -
C}*A} Receipt No. ADDRESS
Approved '
Ito-BEMP
DATF (NSP. T-PE INSPECTION REMARKS PLUMBING DATE
jI Contractor--
Permit No.
Rough-in
✓d
Fixture
Final
HEATING
Contractor k I
Permit No. 42W-0/ )9
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Druinage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
t3LOG. DEPT. FINAL TEMPORARY CERTIFICATE OCZUiiANC'f
Final_
CERTIFICATE OCCUPA14CY Landscaping
IIZoning Final
BUILDING PERMIT APPLICATION TIGARD DATE_____
"THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCON PANYING PLANS AND SPECIFICATIONS. OWNER PHON
�-?.•l*I VY�t O � OB ADDRESS I.Z s �' A _,�,� LOT N0.
_....ER .J s h��31d J 4 �-
ARCHITECT
yENGINEER
BUILDER �QW1e. ADDRESS IIa5q SE N IAh DESIGNER
STRUCTURE Y NEW C3 REMODEL :3 AODIT!0N rJ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEM IOLI-i ION
RESIDENCE C COMM ❑ EDUCATICNAL ❑ GOWT L1 RELIGIOUS ❑ PAT 10 ❑ CAA PORT ❑ GARAGE G STORA E ❑ SLAE❑ FENCE
r4_-t:;UPANCYJ _.LAND -L-G.TYPC N__.''I�E 7uidE-. PLAN CHECK BY HEAR_
J -
--I--- �(,ta 0~ —
SEWER PERMIT I 421 4L- `y Irl
OCC.LOAD FLOOR LOAD HEIGHT 3 NO.STORIES AREA ly OG NO.BEDROOMS 3 VA.LUE(Vk100
BUILDING DEPARTMENT SET BACKS FRONT M?V REAR ,-7 LEFT SICE S.2-4' RIGHT SIDE 5AJ'
Permlt �• GV THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZOW!4a
IEGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
P!.�n Check D�•,� K WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS At:D IN CO.YPLIANCE
T LL APPLICABLE CODS AND ORDINANCES. THE ISSUANCE OF THIS PER7.91T DOES NOT WA,IVZ
I
Sub-total r�.s� RESTRI IV CC
COVENANT Q A�t�' ND SUB CONTRACTORS TO HAVE CURRENT CITY EUSINESS
LICENSE PARAT' ITS REQUI F A SEWER,PLUMBING AND HEATING.
state Tax •
SOC- � y.S'�
Total — - -
--- ppm APPUGA OR AGENT
By � 1,�y�,
Recel No. --
ApprovwJ DRESS PHONE
SDC 400 /I� I n
PDC - $ j— /Dfl__ VA eU,4 a -- I�` /�1PA'sANA
EWER CONNECTION S 7�`� ( I �-l3y sco 9u*."&vtes4 c-Dir. O
5EWER INSPECTION $
SEWER SURCHARGE $
..nmmerl{;b� , 1z� I•I�{/, t�. �-•s • % g6N A-
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. w� 1V_ �t II e�4 ro 11 �cr 4.. 1.29 IVA sk*."ew P1 fkm. I a�
1.2G F�'P I'
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CITY OF TIGARD-12420 S.W.MAIN-TIGARD,OREGON 97223
RECEIPT
DATE: `� - 5- AMOUNT: 0
i I
Tom`- _DC ._ARS
NAME: l _T �t �c�i _ CASH
i 1 i
ADDRESS: y�J _ 4 _/ CHECK,
M.O.:
OF
FOR: ACCT. N PERMITS SURCHARGE AMOUNT
SEWER BILLINGS 4C;,364 _ $
BUSINESS LICENSE 05-331
PLUMBING PERMIT 05-332
MECHANICAL PERMIT 05-332
qp� BUILDING PERMIT 05-333
I SEWER CONNECTION 40-363
SEWER INSPECTION 40-365
{ SYSTEM DEV. CHARGE 25-366
PARK DEV. CHARGE #1 30-367 _
PARK DEV. CHARGE #2 30-368
ZONING ADJUSTMENTS 05-362 ---
I
k
TOI ALS
RECEIVED BY
PERMIT NUMBERS ASSIGNED:
Number Amount Number Amount Number Amount
o � .�_
1241S.
Aona- it Atoo-
1v x z3-1 238
32-G xo�
fn 2 -4x 4 -Y /i..._
I oo @ 3 3• ® �C�, 70 0
�¢•9 x 34-
MEN
cirfOF TIGARD
WASHINGTON COUNTY,OREGON
BUILDING DEPARTMENT
PLAN CHECK APPLICATION Date:�, 2�
This is to certif; that the following plans havo been submitted
for plan check pursuant to the Oregon Structural Code and Fire
& Life Safety Code, 1979 Edition.
n W n e T<,----rte' `[1�v1 �/! t
Job Address 12-!� ,��(,�
II Lot No. _� �G'lt.trOooC .3
Owner/Applicant Address b 03.5- alO
_Phone No.-
Description:.. o Descri tion:
Ci of" Bard, Building Dept.
By :
12420 S.W. MAIN P.O. BOX 23397 TIGARD, OREGON 97223 PH: 639-417) —----_