11765 SW SPRINGWOOD DRIVE 11765 'SW SPRINGWOOD DPIVE
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' IN OF TIGARD
G OREGON
> Z' Wayne Hellickson.... .......... ............. .Permit No........... ..
..............
11765 SW Springwood Dr.
Building Addre . 76
I r 5 .................. ......is..... 20......da of.eU9ust...........
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Certificate ;s hereby given th ... y
that said building may be occupied and
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t that it complies with all requirements 01
the Building Code for the City t)f Tigard,
}` as approved by the Tigard City Council. .!`_ )•;f
.151
Building Inspector
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! City of Tigard
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INSPECTION REQUEST
for
INSPECTION TIME :_4. 5 ,,'� PERMIT NO. :
i DATE: DATE ISSUED:-
OWNERS NAME .
ADDRESS : /i 7 G} �S�. _S,y�.; � �.�r,/ tol,
CON r -ACTOR :--.---. _
iTES . . Air ❑, Water ❑ , Visual,g , Laboratory ❑
1317S1°L T: .pproved,R , Disapprovsd ❑ , PendlnQ 0
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SKETCH.'
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INSPECTOR DATE
! [OTE '. Attach eupplementol toot date hereto
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City of ► igard
I NEOP' PTCTION RECe"i�J ES
for
0
INSPECTION TIME: -� ,.L- PERVIT NO. I
DATE : .�r1 y1?� DATE ISSU ) .. ..1 .! I
OWNERS NAME : 'l.k '�';��"• l
ADDRESS: /��3`�
'TEST : A r j, Water[] , Visual 0 , LOQ' , I
I�ESIILT: Approved Disapproved
SKETCH,
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INSPENIT'E I
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CITY OF April 19 7( No 0758
RUILDIN01 PERMIT APPLICATION TIGARD DATE---_ 19
THE UNDERSIGP ED HEREBY APPLIES FOR APEi.MIT FOR THE WORK HEREIN INDICATED y
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. —
waytia Hellickson 1J 16 "grinpr��,..1c9 nr. .
OWNER ADDRESS._, BUILDER PHONE
ENGINEER
QUILDER )Gln » -- ARCHITEIJ ^ rr-��DESIGNER _
STRUCTURE EINEW _REMODEL DADDITION _ ❑FIEPAIR []FIENEWAL L,.IFIRE DAMAGE [:]DEMOLITION
RESIDENCE ❑COMM ❑EDUCATIONAL- ❑GOV'T ❑RELIGIONS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑rF:NCE
— ❑BOND [I MOVING ❑CONDITIONAL USE _ ❑DESIGN RE'V;EW ❑COUNCIL APPROVED _ ❑SIGNS
OCCUPANCY- LAND USE ZONE BLDG.TYPE——FIRE ZONE_— PIAN CHECK BY��
Constru d 1450 sq. ft. fraena dwelling With stbilll,ChUd yuraga
— No 8assmsnt. Ra..ssus 11313 " r . Irunwood Luup -- ----
cs x
191- 3
40 M
OCC LOAD FLOOR LOAD HEIGHT NO,3,TVRIES AREA VALUE
BUILDING DEPARTMENT SET BACKS MONT 71) REAR LEFTSIDE Ibq RIGHT SIDE
Permit $13E�.�:0 -- - --_----- -- —.. ---- --r.---- - �
if). 4- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AN' AL'_ APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT TNF
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICAR _E CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
---er" RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
96Stete LICENSE. SEPARATE PERMITS REGU1RED FOR SEWER, PLUMBING AND HEATING,
Total
BY ------- -- -- --- -- _--
APPLICANT OR AGENT
Approved Receipt No.
ADDRESS ^^ _ SON
]ATE INSP. TYPE INSPECTION REMARKS P.LU�MBI�N.i ��oDATE
- __T------ --
� rY — �Q/�G•
Contractor
�. �� e.•�..� �: Permit No.
Rough-in --
- - G Fixture — —
(� ,b ---------- Final
HEATING
Contractor —
l�a�_,' Permit No. CA' S`
-Y4
Rough-in
_
Fina!
--- -- ------ - — SEWER
Final _
Final
Storm Drainage
(Rain Drain) Finn!
Sidewalk
Curb&Street Final
tkoDroach
BLDG.DEPT.FINAL TEMPDRARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Finial
C j 1• (�- 6 Landscaping -- -- - -
�' �1j Zoning Final
ADDRESS_ PERMIT NO.. i��AL�
PERMIT CHARGE none
CONNECTION FEE
OUNER PAID BY
DATE CONNECTED
TYPE OF BUILDING
SERVICE RATE INSPECTION FEE
CONTRACTOR PAID BY D A T C
SIZE OF CONNECTION ASSE55MENT PAID
• 3 ISO - 31,
G
Z.I V 0i tearci Mcclhanicaj Permii J�" Permit $3.00
/
FeeGd
New Instailation '►`' rTeptace CJ Relocation i_: Addition alteration —
TOTAL -
CONTRACTO
ADDRMS US / WORK ADDRESS/
PHONE yrr— 7/..%.�G APPUCAIV_
Heat input Rating (BTU Per Kim-,,/L) Ivr-?) m Size _ �Iue Size S
FUEL OIL Ci GAS E ELECT OTIiER_ -
MMM N0. FcITE,,f NO. FEE
For ;m. zce of Pe^nitT 3 00 ��i hailers Over 50 uP T 257CC
"".der 100 000 BTU ; 4.00 li Air Hand'ina 10,000 OPM + 1 3.0{
- Over 100.G00 BTU 5.00 Air Handling Over 10,00-1 CFM 5.0{
Floor Furnace 4.00 i Evaporative Cooler 3.0{
'Nall - 'aor- Suspended 4.00 ' Vent Fan _ l 2.0{
F-700,
Install Vents i 2.00 Vent System 3.0{
Repair- Heat & Ccalin 4.0' Hood 3.G�
Boilers Under 3 HP l 4.00 Domestic Incinerator 10{
30:1ers 3 to 1-3 HP 7.50 Comm. Incivera:or _ 20.0{
Boi!er s j 5 to 30 X`2 10.00 Other Not Liszad i 3.C:
Boil-r. 30 tc 50 H? 1x.00
INSPECTOR'S COMMENTS. _
CITY BUSINESS LICENSE; REGUIRED FOR-ALL CONTRACTORS OR SUB-CONT RACTORS
APPROVED BY DATE ISSUED BY DATE
RECEIPT NO. _
9
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