15266 SW ALDERBROOK PLACE-1 1
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—15266 SW ALDERBROOK FLAKE —_
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.,... �. �� CITY OF TIGARD
G OREGON
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i.ot 415
1203 �1• <•�
' 0wner:........... ................ .................. .. _ Permit No. _.
. .
Building Address........ ......S.W...Al.de-l:.b.r.�-ok...Pl. i • ,;
. 19... ..
Certificate is hereby gi"-,n this.. 24 .. day of .. ray 77
that said building may be occupied and
that it complies with all requirements of
i the Building Code for the City of Tigard, V
as approved by the Tigard City Council.
t Building Inspector
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City of Tigard
INSPECTION REOUEST
for
INSPECTION TIME ' PERMIT NO. :
DATEDATE ISSUED:ZL
OWNERS NAME ' —
ADDRESS :
AME :ADDRESS .
!'ONTRACTOR : —_
TEST. Air I3, Water p Visual ❑ , Laboratory L7
RESULT: Approved )isapproved LQ n
:KETCH:
r
i SPECTOR ! DATE
NNOTE Attach supplemental test data hereto
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UNIFIED A �� 0 �� K� ����N��� U� �� �� �� AGENCY N�
"�U� oU x �.K� ��� nw � nx~"w � v "= �, ~ ~, , . _____________
VASHxNGTON COUNTY DATE ��------'
CITY
APPLICATION FOR SEWER CONNECTION PERMIT
T°O°C°
OWNER'S AUDRESS: _-___--__-_--_-- --- - ---' --------- '-'--------'-'-------
mnscr U
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BUILDING SITE: LOT -�-_ BLOCK -_-_____ ADDITION
TAX LOT NO. TYPE OF OCCUPANCY -residence-
ADDRESS .
remidenre_
AOORE8S
15266 SW Aldmrbrook -P�.
'-___-
FIXTURE DWELLING UN|TS-___-�-___--------- ' ---
SURCHARGE IF APPLICABLE
"
PERMIT FEE 5T5° O0- _ INSPECTION FEE 25. 00 TOTAL DEPOSITED
(NEVV) (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT \ _--__--.-
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE INSTALLER
/
RECEIVED BY
` <AmEN Yon ITS AGENT)
�
Bldg. �� �0�
COK8N1ENTS: '
This Application ondpennkexpinsinonehundredmndtwent, (12O) doyw
The amount paid will bnforfeited should expiration occur.
BUILDING PERMIT APPLICATION ri F 0 Y TIGARD DATE
THE UNDERSIGNED HEREBY APPLIES FOR APERMI T" FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONE. ---
LOT NO_�
OWNER XMADDREW 15266 Sid AlderbrIJOJ ,HOME•ADDRESS
ARCHITECT
ENGINEER
BUILDER t� ADDRESS DESIGNER_
STRUCTURE ONEW ❑REMODEL El ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
'0 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSQPATIO ❑CAR PORT ❑GARAGE ❑STORAGE Lrr��JSLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY—"' LAND USE ZONE _ BLDG. TYPE________—FIRE ZONE J PLAN CHECK BY
Lot 041;.: Ne, X] r e-inuwwo same as a.:AJGu Su Jumm+art Gidne
F'r000r dwa111ny w/at`achled ger®ge 2 bedroom, 1 beth
9". LOAD—_--- _. _---.- AREA �4 NO.BEDRO0M5 VALUE +� r
111
BUILDING DEPARTMENT SET BACKS FRONT J REAR t �: I FFT SIDE RIGHT SIDE
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check . REGULATIONS AND ALL APPLICABLF CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS ANDSPFCIFICATIONS AND IN COMPLIANCE WITH
SUb total ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DUES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax sC' LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING
Total 125,66
BY __ ------ _-_ - -- - ---- —
APPLICANT OR AGENT
Approved Receipt No.
...-.-..+IIwMu�...v...w`.�..-......�.r+�riurr...h.u..«...W.....r......,N....r.._...ii.4iWA.a..._....wY�/.-..w...r.,...r.... ....... ........�..w...wtlO.aYW►1.i1Was....... .0 v..�.,...a .MW[JII.Vw .,....,-�..fl..
UATE INSP, TYPE INSPECTION '— REMARK—S
-- PLUMBING FDATEL(o.,/Ed. Contractor
-- —
Rough-in
ZzLY-77ki 6c--ll 12 x
Fixture
Final _
HEA71NGLIP _ --
Contractor
Permit tJo. 1,43 ,
a Gas or Oil
Rcugh•in
Final
SEWER
— Final
DRIVEWAY
Final
Storm Drains e _
_ _ (Rain Drain) Final
Sidewalk
M Curb&Street Final
SLUG UEPT, FINAL TEMPORARY A�proaCh
CERTIFICATE OCCUPANCY CERTIFICATE OCCUPANCY
Final
l Landscaping
�--' Zoning Final `v%
3
,U
I�/ / Permit No.
Address -
Permit charge
oe
Owner
t Connection fee oLy-5—
Paid by1Z
Type of building Date connected _
v v.
Service rate (�.• Inspection fee �s
Contractor Paid by Date
Size of connection Assessment _ paid