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INSPECTION NOTICE
;..,
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
no: 639.4171
Type of Inspection
j
Date Requested
' /r0 Time A.M.__ P.M.
Permit
Address
Lot
I Owner —.__ -- --
_ #
Builder ----- ---�— ---
i The following Building Code deficiencies are required to be corrected:
-T=S-t
_� Approved
Presented to
Disapproved
Inspector r
Date
i
CALL FOR REINSPECTION
J YES 0 NO
BUILDING PERMIT APPLICATION TIGARD DATE JOnU&ry 3( .19 84 4721-
THE
( 21-
THE IJNC)F:RSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OFI AS SH")WN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICA TIONS. OWNER PHONE —__ _
." LOTNO._j4_,_.
OWNER 1 Shelbarlm)Vktved08_ADORESS 9400SW ,Millen A. � _ -t aetleivii Rotates
Lake OswegoARCHITECT
ENGINEER
BUILDER ADDRESS 1':r.,_A _ 5f7G4DESIGNER
STRUCTURE _ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR 11 RENEWAL ❑ FIRE DAMAGE_ ❑ DEMOLITION
Ci RESIDENCE ❑ COMM ❑ EDUCATIONAL D GOVT ❑ RELQIOUS ❑ PATIO ❑ CARPORT ❑ 3ARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY �K-3_LAND USE ZONE- R-!WBLDG.TYPE �. S�?FIRE ZONE PLAN CHECK BY HEAT
SanstruCt ainxleisutll ry dwelliLia a/attache
-- __-- 3 Bedroom 2 dadirao,n
SEINERPERMIT# 21155 -- _ Carage 504
OCC.LOAD FLOOR LOAD 40 HEIGHT-20' NO.STORIES 2 AREA 2435E NO,BEDROOMS 3 VALUE13b,0Uii
BUILDING DEPARTMENT SETBACKS FRONT �f: IT 4_AP 42 LEFT SIDE I- RIr3HT SIDE
Permit _ _�y1 uU THIS PERMIT IS ISSUED SUBJECT TO rHE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 2Sti.05 _ WORK WILL BE DONE IN ACCORDANCF WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
Wil"H ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT W141VE
Subtotal 655.[)5 RESTRICTIVE COVENANTS. CONTRACTOR AND SUb CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 15.t38 LICENSE.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
SDC
Total _ _- $%11.!13 t'dt -z-4c.
`L
PDC;# YL �Ul).f,)t) APPLICANT OR AG-E1 -^��-7--/�
BY _i:!I
Receipt No. _ �� !+ U f �C w!'►/����I e'
Approved ____ l3i;M ��� �,t HONE
DATE INSP. TYPE INSPEC'v IC N REMA 'Kb I PLUMBING DATE
Contractor
Z)ve &
Permlt No. 7
Rough-in
Fixture
C.&—.I eL Final HEATING
Contracto
Permlt M1,. 2 r? O� / ��/�/�Y
Gas or Oil
9ough-0i
Finil
SEWER
Fijial
DRIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
DLDG. DEPT.FINAL--T- TEMPORARY CERTIFICATE OCCUPANCY
C17411FICATE OCCUPANCY Ftnol
Land.c.pirg
Zoning Final
BUILDING PEHMI.F APPLICATION TIGARD DATE_THE
---
THE UNDERSIGNED HEREBY APPLIES FOR A PERiAIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOtAPANYING PLANS AND SPECIFICATIONS. OWNER 1-4
LorN kAL
._
Uv,jNER , OB ADDRESSARCHITECT
A•'�n'�',
ENGINEER
ADDRESS DESIGNS;'
13UiLGER est-- , �� _ — —
STRUCTURE NEW Cl REMODEL Cl ADDITIrA ❑ REPAIR Cl RENEWAL._ ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE Cl COMM ❑ EDUCATIONAL. ❑ GOV'T ❑ RELIGIOUS 0 PATIO Cl CAR PORT ❑ GARAGE G STORAGE U SLAB❑ FENCE
0:;CUPANCY �.LAND USE ZONE BLDG.TYPE __ FIREEZZONE PLAN CHECK 13Y HEAT �► _�
SEWER PERMIT N s -'/ !, --- -- �=_ --= o
')CC.LOAD FLOOR LOAD _HEIGHT n NO.STORIES } AREA- "-T NO.BEDROOTS VALU7 r�
BUILDING DEPARTMENT ,t=T BACKS FRONT ,cam r' REAR 4 l LEFT SICE RIGHT SIDE / ry�"�
P^rmtt / i THIS PERMIT IS ISn'lr--O SUBJECT TO THE REGULATIONS CONYAINEU IN THE BUILDING CODE,ZOMNG
REGULATIONS ANL, ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED TKAT THE
Plan Check -�_ - WORK WILL SE DONE ". ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
a t: WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total G' RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CI-7 Y BUSINESS
LICENSE,SEPARATE PERMITS REQUIRED FOR SEWER.PLUMBING AND HEATING.
Slate Tax
SOC--
Total
PLAIN APPUCAN r OR AGENT
By
Receipi No. —------
Approved
----Approved � ADDRESS PHONE
SDC_
PDC
SEWER CONNECTION 5
c " 7 C
SEWER INSPECTION
SEWER SURCHARGE 5 l
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C�nl m o O(_c i _ � -p ��►'] t,� � f 1/1A�a[_,.kY_._ ��.��•�11{ .�
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371 7
MIRUNUM
Building Permit No.
Location
date 3i� /7s, q
Certification of Registration
With the Builders Board
doing business as (dba) ,
am registered under the provisions
of ORS Chapter 701 Oregon Nomek-)�i lders Law) .
My Builders Board Registration Number is _ Z/-."
i
htv registration is in full force and effect and expires on s
ign�aturE
i