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INSPECTION NOTICE
City of Tigard Building Department
12420 SK Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
Date Requested 12- Time A.M. P.M.
Address Permit
Owner Lot
Builder
The following B!cIding Corte deficiencies are required to be corrocted:
Pi esentpd to loved
In Disapproved
Date
CALL FOR REINSPECTION
1-1 YES C NO
BUILDING RECEIPT
C ,
17
DATE:
ACI,'T. N DESCRIPTION AMOUNT
10-432 Building Permit Fees $ �.•
10-•431-600 Plumbing Pennit Fees s _
10-431-601 Mechanical Permit Fees s —
11--230-501 State Building Tax f
.1. 8
10-433 Plans Chuck Fee
30-443 Sewer Connection (20%) f .�
30-202 Sewer Connection (80%) iy, 42-
30-444 ;ewer Inspection $
,z
51-448 Street System Dev. Charge (SDC) $ y "'SUu
52-•449-610 Parks I System Dev. Charge (PDC) $
52-449- X20 Parks II System Dev. Charge (PDC) $ _
31--450 Storm Drainage System Dev. Chrg (SSDC) $
1.0-230-505 TRFD (95X) $
10-476 TROD (5%) $ _------,-
10-230-506 Washington County Fire N1 (95X) $
10-478 6dashirvjton County Fire N1 (5%) $
1U-220 Amart/Wedgek000d
TOTAL =
(bs/12:4P)
BUILDING PERMIT APPLICATION TIGARD DATE.._-- -'�412!_St19 85 5569
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR f HE W'_)ICK HLRf IN INDI-,ATED BUILDER PHONE b54nf,1!U3lI
OR AS SHOWN AND APPRO /ED 114 THE ACCOMPANYING PLANSA ND SPECIFICATIONS. OWNER PHONE
LOT NO.59
—
OWNER Jill hart JOBADDRViS 12220 SW f4;atxr ine, }till Ur. 'wraing hill 11—
Milwakukie, 97720 ARCHITECT
ENGINEER
BUILDER Sam ADDRESS 380 &C, Harrioon - DESIGN-_R
STRUCTURE a NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
a RESIDENCE O COMM ❑ EDUCATIONAL ❑ GOV'T ❑ R_ELIGiOU_R ❑ PATIO ❑ CARPORT ❑ GARAGE C STORAGE ❑ SLAB❑ FENCE
OCCUPANCY —1-7-3 LAND USE ZONE x"7 _BLDG.TYPE J___FIRE ZONE__ PLAN CHECK BY HEAT.—_.,_.-_
C
onstruct single fmi.ly dwelling w/sttach*d garage - -_ —
,: ub ject to ',360.W AtfAR%/'iif3DGZW00D * $150.00 Leron Heights Sewer Surcharge
" bathrpmu 3 ka ro m1a.—
SEWER PERMIT# 28534 _
40 13 f _ t 7 7�ga _ 2
OCC.LOAD FLOOR LOAD _ _HEIGHT NO.STORIES AREA NO.BEDROOMS VALUE
BUILDING DEPARTMENT ` SETBACKS FRONT 20 REAR 39 LEFT SIDE` 13 RIGHT SIDE 6
Permit 340.0!0 THIS 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 224.90 WORT( WILL BE DONE IN ACCORDANCE WITH THE PLANS Al/D SPECIFICATIONS AMD IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub tatal 570.90 _ RESTRICTIVE COVENANTS. CON' IAC1011 AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
I.Iq�� A1,4 PERMITS Rc(JUIRFD FOR SEWER,PLUMBING AND HEATING.
State Tax 13.84
SDC— $ 500.01)
Total 5134.i4
1 150.00 APPLIGANT--6R
By a�J
f3C31 Receipt No.
Approved ADDRESS PHONE
DATE INSP.1 TYPE INSPECTION REMARKS PLUMBING DATIC
Contractor
0_6 -
Int bermirNo.
Flough-in
oug"
fF'xture
F�in.
HEATING
Contractor
Permit No,
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
Main brain)Final
Sidewalk
Curb&Street Final
Approach
&tx-,. DEPT,I'F� Af TEMPORARY 1' OCCUPANCY Final
�.'ERTIFICATIZ OCCUPANCY
011 ,Landscaping
-,imina Final
IluildIny (', rmit t , 5a�'',,�11
I r-ocat_ ion ao .IKJ
rY1 orn . �N rl Dy-
Cert if iCat 10n of R��giSirat ion
With the Tsui Iders floard
doing business as (dba) ,
am registered under 'Lhe pr ov is iunv,
of URS Chapter 101 Oregon tlornebuiiders Law) .
Ply 6!iilders Board Registretion flumSer is __. 13 7 ___�_�_
r
My registration is in full force and effect ar.d expires on
gnat re
I
it
TME UNDERSIGNED HEREBY APPLIES FOR .1PER�IIf FU1+ 111E 411UNi: Nt fIcIN INtaI>ralLu CwrNILPPI'"Ir+k
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. Lal No ,S a
JqB ADDRESS
�� N � C
/� -� CNI7ECT /
y/SCI(�(772cr ENGINEER \
.^�'r \ `L. rVuyl$1� OE4IGNER
RU _ AooRES3 . F 0RePA1t �,RFNEVIALCJ
FIRE DAMAGE CSD£:•
ST1UCTORE 0Rtmnm. rrAOOITIOy
F.(]SIaB
CJGOV'T 11REL41CUSC]PATIO []�;ARPOPIT ClrARAGE ❑ST�
nI laE^ICC ❑CORM EDUCATIONAL
9l UG.TYPE_ PLAN CHECK BY �^4 - HEAT
y`�IPAN�y $-3� LANOUSEIONE%'�...��� —
Y D1elE LINT_IJAI AMU CARAGE
LSV//J'/G Ts
BATHROOM - __�, BEDROOM
.IF_ueR . RQ11f1I_LI'J'
310AD _`�f --f�F-1�tH� -_ NQ STORIES �� Aj a �SNO.B�12$cZi!kls
( 41IfL01NG OEP_ARfMENf ScT BACK$ FRONT c ' PEAR - ; -LEFT SIDE RIGHT SIDE
/
THIS PERMIT IS ISSUED SUBJECT TO THF REGULATIONS CONTAINED IN THE !BUILDING CODE
1.:xn^.deck �� .�/ 4' REGULATIONS AND AL1.APPLICABLE CODES AND ORDINANCES,ANO IT IS HeREBY AGREED
WORK WI' L SE DONE IN ACCOAOANCE WITH THE PLANS ANO SPECIFICATIONS.?ND IN COhSPLIk
$uD•tptrlL� 0 ALL. APPLICABLE CODES ANU ORDINANCES THE ISSIIANCE OF 'PHIS PERMIT DOES N
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY
I!;.&C4 TA , -4� ri�YLICENSE. SEPARATE PERMITS REQUIRED FOR SEWER.PLUMBING AND HEATING.
SDr. -
To ( PO(-#
} �y —
APPL :ANT GEN
OR AT
AI pprovtra— l i Reeewt No. _
mnnPF%S
S)c (Storm))
SOC –
PDC –
SEWER CONNECTION $ _S --
SEWER INSPECTIONS 7
SEWER SURCHARGE