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flu ilding 11ermiL No.
L o c a t i o n
Date
Certification of Registration
With the Builders Board
1, k) it V—) � �� �1rG�,/ doing business as Wba) ,
am registered under the provision,,
of ORS Chapter 101 Oregon Homebuilders Law) .
Fly Builders Board Registration Number is _ / y /—7
Fly registration is in full force and effect and expires on
gnature
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspection
Date Requested Time A.M.-,.Z0U P.M.
Address aK-2 Permit
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
4
Presented to 11Approved
Inspector Disapproved
Date 'V
CALL FOR REINSPECTION
YES n- NO
BUILDING RECEIPT
NAME: DA-E:
ACCT. # DESCRIPTION AMOUNT
13-432 Building Permit Fees
10-431--600 Plumbing Permit Fees $
10-431-601 Mechanical Permit Fees $
10-230-501 State Building Tax $
10-433 Plans Check Fee $
30-443 Sewer Connection (20X) $
30-202 Sewer Connection (80X) $
30-444 Sewer Inspection $
51-448 Street System Dev. Charge (SDC) $
52-449-610 Parks I System Dev. Charge (PDC) $
52-449-620 Parks II System Dev. Charge (PDC) $
31-450 Storm Drainage System Dev. Chrg (SSDC) $
10-230-505 TRFD (95x)
10-435 TRFD (5x) t
10-230-506 Washington County Fire #1 (95x) $
10-478 Washington County rir•e #1 (5x) $
10-220 Ainart/Wedgewood $ _
_OTAL
(bs/1214P)
THE UN:D�RSIGNED HEREBY APFLIF-S f 01 APEANII1 I.ON IllL W010K I,JLIIcIN IND IuAILU UUlLULItI"ILNC'�k2-�662-
6A AS SHOWN t%ND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. oviricn;-I-0rIE_;1_S�. �
LOT N6_
7
r -"—i �GLftw�y-
_7tiVNEP �-
�,, ARCHITECT
R
OESIGNER
SwnUCTt)RE — tJ•VEW ❑RtmnOEL 0AOOI•IO-N ❑nEP:,ln CIRENEVIAL ❑FIRE OAMAGE ❑OE:dOLIT
0"hESILIENCE ❑CO►!,M CJEDUCATIONAL CIGOV'T ❑RLIAGIOUS[]PATIO L� . = OGARAGE C1 STORAGE C1 SLAG CIFEI
t,Par:•,vim=3�t ANO USE 20NF ��, OIOG TYPE 5 _. PLAN CH 'K
CONSTRUCT_s NGI FAMT . hWELLING WIATTACHF.D GABA .l
__ -- -- --r, BATHR4.4i'— BEDROOM
y !W.a PERf1I7GaraQe.__11
_,
ELQSJ-1L04D f.� HEIGHT_
I� SIAL01R:G OEPARTMENP SFT BACKS FRONT `'f! REARS! LEFT SIDE / i RIGHT SIDE
S — _
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZO►,
:;-:,in Check REGULAT90NS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT
r-- WORK WILL BE DONE IN ACCORDANCE WITH THE P?AI13 AND SPECIFICATIONS AND IN CGJ.IPLIANCE V
Sx)-taul 412 7C ALL APPLICABLE CODES AND ORDINANCES. 1.1E ISSUANCE OF THIS PERMIT r'rES NOT We
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CUPP .fCITY BUSY
ata Tix I �� LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING,
TotalI SGC -
r— - PDC#
�4L ANT OR AGENT
Approvm ., Receipt No.
nnAFSS � NON
SVC (Storm] �- r
SDC - $ �'-
PDC -
SEWER CONNECTION
SEWER INSPECTION $
SEWER SURCHARGE $ �...
Comments :
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Bari illSiMCLiOns call 669-4l. S
5681
BUILDING PERMIT APPLICATION tog TIGARD DATE__-_'""'- I,°'�' �,19___ ._
THE UNDERSIGNt_D HEREBY APPL IES FOR A PE^MIT FOF,THL WOI?K HEREIN !NDICATED RUILDER PHONE -ZU--jAL;L _
ORAS SHOWN AIJD APPROVED IN THE ACCOMPANYING PLANS AND 0PE1,:IFICATIONS. OWNER PHONE
/\ LOT NO.
I OWNER (:.arson Guri&L. JOB ADDRESS 9A'b i :int cia rth;i
- _-_ _
ARCHITECT
96.-A4 HE Gana P11:111 9 i 226,ENGINEER
sante
BUILDER ADDRESS _ DESIGNER k gk2� :1
STRUCTURE Q,NEW ❑ REMODEL ❑ ADDITION Lj REPAIR ❑ RENEWAL L7 FIRE DAMAGE CJ DEMOLITION
C] RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT J GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY __KJ--LAND USE ZONE BLDG.TYPE yIi .FIRE ZONE-- CHECK BY 'it
'A3 ` HEAT
- Construct tringle fe,nily awel .inl: wiattached xeragc
WE PERMITM 28599 t,Arage 231
SEWER
lb
OCC.LOAD FLOOR LOAD HEIGHT _ N0.STORIES _ AREA_ NO.BEDROOMS VALUE
_BUILDING DEPART N SET BACKS FRONT 2U REAR 64 LEFT SIDE 1 RIGHT SIDE
Permit _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
1 ,ai. REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
1,91 0/U WITH ALL APPLICABLE CODES AIJD ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal RESTRICTIVE COVENANTS. CONTFACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
, E.SEPARATE PERMITS REOUIR�D FOR SEWER,PLUMBING AND H ATING.IM
State Tax 11.92 C-:3t:.(iU
PP `^J`
SDC— .500.00
:3.
Total , , ., 4U3.()24U3.()2 ..
PDCR T.1 150.01 A LICANTORAGENT
B4 _
Receipt No.
Approved ADDRESS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
�� Pentractor
rmit Na`
19
Rough•in
Fixture —
Final
HEATING
Contractors
Permit No, ���� It s LTJ
_ Gat or Oil
Final
SEWER
Final ---
I���/6 DRIVEWAY _
Final
Storm Drainage _.._
(Rain Drain)Final
- - - - Sidewalk -----__.._
- ---- --- r---—---
- Curb&Street Final
Approach
BLDG. DEPT )-0141.'.. TEMPORARY — CERTIRICAT� OCCUPANCY
ICGRT'f-,CATE OCCUP4NCr j Final_ T__y
Londscaping
2oninq Final
S�
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arfOFWARD No. 8288
12755 S.W. ASH
P.O.BOX 23397 Date ((J- - �� l
TIGARD,OR 97223
Name - - -- - -_ ---- --
Address --- ----- -_T._
Lot BlocklMap Subdivision!'Address
Permit N's Bldg. Plumb __]_ Cash Check
Sewer - ( c�
ther { 1 on
ether Rec. A-
_._
y
—I ____ /-
Acct. No.- _Description Amount
10-432 _ Building Permit Fees
10-431.600 Plumbin_ Permit Fres
10-431-601 Mechanical Permit Fees _-
10.230.501 State Bldg Tax_ - --
10-433- Plans Check Fee
30.443 Sewer Connection
3_0.444 Sewer Inspectlon
51.448 Street Syst__Dev. Charge _
1 52-449-610 Parks I Syst. Dev. Charge
52.449-620 Parks II :)yst. Dev. Charge , �-
31.450 Storm D•ainage Syst. Dev. Charge -'—
t0-430 Business Tax -
10-434 Alarm f ermi—t ----
10-227
- -10-227 _Bail - "
10-455• - Fines -TrafficlMisd,'Parking
10.230CPTA TrafficlMisdlV_ic. Asst.
1U-_45_6____. Indigent Defense --
30-122.401 Sewer ServiceIUSA -��-
30-7122.40?. Sewer ServicelClt_y 30% -�
30-_123 Sewer. evlcelCity al'uTint.
30125 -`- Unmbfched
31124 - - Storm Drainage --
40.47 -- - Bancroft Prin. Pymt.
47 -gancro t 11 nt. Pymt. - -- -
TOTAL UO
1 J
Off I,
F
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W.IMdin St.
Tigard,Oregon 97123
Phone: 639-4171
Type of Inspection
Date Requested__--,L/ — / 0
Time A.M. P.M.
Address d11- Pcrmit # ),-A
Owner Lot #
Builder
The following Building Code deficiencies aro required to be corrected:
Presented to Al-A-pproved
Inspector
Disapproved
Data
CALL FOR REINSMXTION
r J YES 0 NO