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11695 SW FAIRVIEW LANE
City of Tigard
INSPECTION REQUEST
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INSPECTION TIME : ___ _._-_ PERMIT N0.
DATE: -?1.�_ L2,Z DATE ISSUED .— / Z
OWNERS NAME "-d, `-V , _
ADDRESS:
4:0N rRACTOR -- — ----__
r EST : Air E) , Water [] , Visual D , t aboratory p
`4 SULT: Approved L4'," Disapproved C , Pen:inq []
4 KETCH**
INS ECTOR _ DATE
[OTE: Attach supplemental test data beret]
777
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OF OC
CITY OF TIGARD
OREGON
Owner:.....Q-W._D......... ......... ........ ............... ...............Permit No 66.5...
' Building Add:ess....1J_69.5..SW...E'a.ir.vi_aW_.l_.an.a.... ... . . _. ..... . ......
Certificate is hereby given ,his..- .1.3_.... .day of...Januar.y_.. 1:` ..1.Z.. p
4 that said building may be ocenpied and
that it complies with all requirements of
the Building Code for the City of Tigard,
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as approved by the Tigard City Council.
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City of Tigard
WSPECTION REQUEST
for
1148PECTION TIME:Z� ' PERMIT NO. :
DATE: _�_ DATE ISSUED .- Z I'
OWNERS NAME : .b. 144 .
ADDRESS: ;�� �� P�*- i�,:�,.,« 1•„ �
CONTRACTOR :
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TEST '. Air C-, Woter ❑ , Visual�k, Laboratory ❑
RESULT: Approved , Disapproved !- , Pending ❑
SKE,rCH. t+'� 'R�!"� 10;7 PR,,oX Ta /N.r,PE�T�o u.
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INSPECTOR DATE I
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FILE Copy.4v
City of Tigard
iNSPECTION REQUEST
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INSPECTION TIME: PERMIT NO. :-..-
DATE: --L(-/ / ,/-7L DATE ISSUED .-.. I
OWNERS NAME .
ADDRESS: ZZ�7r,44 ,4--r-
CONTRACTOR *.
Tr .-T Air Fi, Wnter [-) , Vis'jcl 0 , Laboriatinify [3
FJ Pending
SKETCH. rev-
IPJ PMTOR DATE
CN ti�E AI}OPi1 yup r- m o r
City of Tigard
. NSPECTION REQUEST
for
INSPECTION TIME: . PERMIT NO. :_ I
DATE: /'"�/�G DATE ISSUED : z I
OWNERS NAME :
ADDRESS: //fii if ;r Lo
CONTRACTOR : �� err !Z
TEST : Air ❑, Wotertg; visual p , Laboratory ❑
RESULT: Approved Disapproved , Pending ❑
SKETCH:
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INSPECT I OR DATE
1—N016: Attach supplomentol test doltit,,o - ..,
CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE — ars' d N2 0665
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND-SPgGIFLC.ATIONS. OWNER PHONE__
OWNER _� a _ T ADDRESS �x13�J SW t airyiso Lane BUILDER ''HONE
some ENGINEER
BUILDER11�� —_ ARQHITECT -- _ DESIGNER
STRUCTURE. nNEW 1:1 REMODEL ❑ADDITION ❑REPAIR�-t ❑RENEWAL ❑FIRE DAMAGE. ❑DEMOLITION
[3 RESIDENCE ❑COMM ❑EDLICATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO CCAR PORT OGARAGE ❑STORAGE❑SLAB ❑FENCE
OBOND ❑MOV-NG QCONOITIONAL USE ❑DESIGF' REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND_UE ZONE pTM7 BLDG.TYPE--–FIRE ZONE— PLAN CHECK OY HEAT ER
.ruct 1322 sq. fte Split Level fralaa, dwelling with gareel9 in I: ,Isment
urding to approved plane ---- -
LOAD _ FLOOD! LOAD AQ lb HEIGHT NO.STORIES 1 AREA 673 VALUE 34*U00
BU;LDING DEPARTMENT ------------T�--- -------_.1) ---------�----- ---��-- �,.
SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit •uu
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 HEREON' AGREED THAM THE
WORK.WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
"Ai' �W RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CCNTRACTORS TO HAVE CURRENT CITY BUSINESS
196 State LICENSE, SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
T0t31
By
- -- -- APPLICANT OR AGENT
� -- ---_ --------- --
Approved RT' Receipt No.
DATE INSP. TYPE INSPECION �— V—� REMARKS _ _ _PLUMBING DATE
/0 his Contractor
d 76 Permit No.
=.rte -- ---- Rouyh_in
Fixture
13
- 9-76 /� Final -- -
- -
3- HEATING
3 vn al 4..., Contractor
" Permit No. i
�Q+', �6l/S'���%00eJy cl�CP-r e door Gas or Oil
f Rough-in -- —
c Final
_—=' ----------- — -- SEWER
Final
DRIVEWAY
Final
Storm Crainage
-_ jRain Drain) Final — /
-- - ---- ----- Sidewalk 1..� 7 .,.�-7V
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C' rb&Street Final
Apprcach 4 1, �, q--2. 7U
BLDG.DEPT.FINAL —TEMPORARY CERTIFICATE OCCUPANCY Final
CEFiTIFICATE OCCUPANCY
tandscapina
Zoning Final
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ADDR,rSS9
PERMIT 140
PERMIT CHARGE none
OWNER _..aC:L .�. - -- CONNECTION FEE Tc7�J
PAID BY
TYPE OF BUILDING �GZ-� � � DATE CONNECTED
SERVICE RATE r _ -- INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT r, PAID
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