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City of Tigard
INSPECTION REQUEST
for
arJ A
INSPECTION TIME: PERMI'r NO. :
DATE: DATE ISSUED :—,- IIr
OWNERS NAME :
ADDRESS: z
CONTRACTOR : --
TEST : Air ❑, Wote10, vfsual�d, Laboratory 0
RESULT: Approved , Disapproved ❑ Pending p
S*ETCH
r
,ALI
1
y T .......... .... _.. .__._......._._
t
SPE TOR DATE
INOM Attach supplemental test dato herl-t.1
e� 17 en .i i� w w w w w iw
City of Tigard
INSPECTION REQUEST
for
.PERMIT N O.: .-----
INSPECTION TIME : '� 5 DATE ISSUED:_ —L--
1
OWNERS NAME :
ADDRESS :
CONTRACTOR :..
TEST. Air ❑, Water ❑ , Visual)f, Laboratory ❑
RESULT: Approved ,
Disapproved ❑ , Pending ❑
SKETCH:
INSPECTOR DATE
EN OTE'. Attach supplemental telt data hereto,
.,./�"#w^`•..nnarMSNr•msew+r+Ay�ladi:thl�^^""'r''"`°�""aR."''; .,. .......
1 CITY OF ;- 75 N° 0284
BUILDING PERMIT APPLICATION TIGARD DATE- ,g
TrIE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR T!;E WORK HEREIN INDICATED OWNE6I Pf� tyE
')R AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFIC,j0j)N �:,.Qa,wk —
Tusl&jin Dov* Co. .10245 ::',Wo hi( t1j.6nd DrOBUILDER PHONE --
OW VER ADDRESS
ENGINEER
R ILD dame ARCHITECT DESIGNER _
STRUCTURE LJNEW ❑REMODEL ❑ADDITION ❑REPAIR []RENEWAL_ ❑FIREDAMAGF 1 [:]DEMOLITION❑_RESIDENCE []COMM [:]EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑ ❑
STORAGE SLAB ❑FENCE
❑BOND ❑MOVING []CONDITIONAL USE El DESIGN REVIEW [:]COUNCIL APPROVED []SIGNS--- — — x
HEAT gas
N
_
OCCUPA ;Y LAND USE 7_ONE —BLDG.TYPE FIRE ZONE_ PLAN CHECK BY
2. beth
HEIGHT _
QCC. LOAD NO.STORIES AREA VALUE
FLOOR LOAD -`"-�-
��' LEFT SIDE RIGHT SIDE
BUILDING DEPARTMENT SET BACKS FRONT REAR — —
Permit 00 1 at)
THIS PERMIT IS ISSU -D SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check .10.00 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
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVF CURRENT CITY BUSINESS
1%State + LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING,
Total 111.00
By rte+ ---__.�_. ----
APPI ICANT OP AGENT
Approved Receipt No. —,-- --- — __—
ADDRESS PFII7NF
DATE INSP. TYPE INSPECTION REMARI.S i'LUMBING DATE
Contractor _
2 -7S — Permit No. 013V
Sy —
Rough-in _
!� it O� �•.-+-i� Fixture
Final_
HEATING
7 7- Ja�w e !� �c y Contractor
rl� f,,//717 S�
Permit No.�_ 7 `�
vas or Oil
Rough-in
Final
SEWERS �f�1 0*
Final
DRIVEWAY / ZA
-
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final r L�G G`4-7.5 `
Approach
BLDG.DEPT,FINAL TEMPORARY CERTIFICATE OCCUPANCY Final -
/ �� CERTIFICATE OCCUPANCY
Landscaping
y Zoning Final