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C,r"FY OF flGARD x Cy
OREGON
.D.c. Permit No.10,6E .. .... ... . r ;
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r , S ummerfield 1 ane .,
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Building Addres. ?
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Certificate is hereby given this....31........day of..�e.nuary yy ,#
that said building
may be occupied and
that it caMplies Nvith all requirements of
the Building Code for the City of 'Tigard,
as approved by the Tiga •d City Council.Ir
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♦ ......... ..._,.�•Hui, ing Inspector y.V................. �� , ry.
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s ,_.,=c' �.- �`.-o. Permit No.
Address ��"�„ .��_____� -
Permit charge
Owner J Oor� �ct i on fee
Paid by
Type of building Date Date connected
Service rate d Iospection fee
Contractor _ _ Paid b / i „ date
size of connection _ Assessment _ id �I-P'r
1-lo - 77 �_ n'- p Q6
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City of Tigard �
INSPECTION REQUEST
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INSPECTION TIME: �� PERMIT NO. :---. I
DATE: ZZ12-1hZ DATE ISSUED _ Z '
OWNERS NAME : ?CZ_-�-------- __-_ _----
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ADDRESS:
CONTRACTOR : —
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rE ST : Air [], Water[],Visual [I , Laboratory p
9ESULT: Approved 9 , Disapproved C Pending []
SKETCH,
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!y P CcT0R DATE
[NOTE Atta h supplemental t"si data bereta�
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City of Tigard I
INSPECTION REQUEST
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:nSPECTICIN TIME: � ' ' PERMIT NO. :--
DATE :
O. :DATE : DATE ISSUI-D —1_L I
OWNERS NAME : 7- l'_ -
ADDRESS: 1-07- �"�5 S - '
IC 0 N T R A C TOR
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FEST : Air ❑, Water El Visual Laboratory
RESULT. Approved DisapProved C � Pending D I
SKETCH.
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INSPECTOR DAATTP/
ENOTF. Attach supplemental t4st data beret]
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City of Tigard
INSPECTION REQUEST
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INSPECTION TIME '—//, ✓" `_ PERMIT NO. : ---.-
DATE :
O. : _____— --_DATE : &LLLZ(. DATE ISSUED: L
OWNERS NAME .' 7'1)
ADDRESS : T_ 15-
C 0 N T R A C T 0 R
5CONTRACTOR ZI
TEST. Air ❑, Water ❑ , Visual Laboratory I]
RESULT : Approved Disapproved i] Pending mi
SKETCH:
INSPECTOR DATE
[_rTF Attach supplem*nlol test data hsreto]
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I City of Tigard
iNSPEC'91-i0w REOUEST
! for
INSPECTION TIME : j' PERMIT�NO.: --.—.—
D A T E
O. -.—.—DATE DATE ISSUED'.--.L'�L
OWNERS NAME .' G' 1 C'-
AD
'-
AD DR E S S :,K r__.:l5
CONTRACTOR :--__
TEST: Air O, Water g4lyisual 1S, La bora torp []
RESULT. Approved Q` Disapproved 0 Pending Ll
I SKETCH:
!
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IN ECTOR DATE
NOTE A I I a c h supplemental feet date @eretO
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UNIFIED SEWERAGE AGENCY N0 10640
WASHINGTON COUNTY DATE 9-16-76
CITY
APPLICATION FOR SEWER CONNECTION PERMIT
OWN E R: _.—Tu al-a. D_e_v_e1_o_p_m_QD_t_C o.
OWNER'S ADDRESS:
STREET
CITY STATE 21P
BUILDING SITE: LOT__155_ BLOCK _ _—_ ______-. ADDITION
TAX LOT NO. TYPE OF OCCUPANCY i— sidence
ADDRESS ___ l5rj65_S_W___5.ummerfi@.1.d Bane
DWELLING UNITS . ___-_ - 1 - ____ FIXTURE UNITS _
SURCHARGE. IF APPLICABLE
PERMIT FEE --s-7-5- 00 INSPECTION FEE TOTAL DEPOSITED 573. 00
(NEW) (EXISTING) BUILDING SEWER SYSTEM Fanno ' Cnegk.---
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-
(AGENCY OR ITS AGE I
COMMENTS: Bldg. _ 1068 -25. 00 Insp. fee paid 9-17-76
-41
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.