11005 SW COTTONWOOD LANE A
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11005 SW COTTONWOOD LANE
INSPECTION NOTICE
City of Tigard Building':)apartment
12420 S N. Man 5t.
Tigard,Or. )on 9i223 / V a✓�U v��
Phone: 639-4 i71
Type of Inspectiont
Date Requested_--J/��/�� 11 as A`- A.M. ---P.M.
Addressuldao peh t
I --
j Owner —_—_ v Lot #
j Builder
The following Building Code deficiencies are required to be corrected:
-- I
--+- - --
'Presented toApproved
Inspector _ (_� Disapproved
oft —�
CLL 'O REINSPECTION
[_] YES (7 NO
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1. CITY OF TIGARD 1�11lipTt&e�nt,� 19ejr ➢�
Building Department !
Residential F__'' Commercial ❑ NO.
New Installation ❑ Replace ❑ Addition
.) Alteration [_) Date ,-_—
Licensed - .��
Plumber '- c� _ Owner ,_-
Address i�_'1-�.5� (/i. (� S C..' P -_`------------
---�-�-— Job Address +�_. 1 /�''C'`� S 4>
Phone �_LOY l� `�. '1 — _ -^
Applicant
_�- CIT`'BUSINESS LICENSE REOUIHED FOR ALL CONTRACTORS AND SUB-CONTRACTORS �^ 1
I ITEM NO. FEE TOTAL - ITEM -
NO. FEE TOTAL
Fixtures-Traps — 7.50 ;ewer:First 100 ft. —
_Oishwashor - - ----- 30.00
_ 7.50 Each Addit. 100 ft.
Garbagtt Disposal — _ — - 15.00
7.50 Ejector Pump
Water Neater — _ 7.50
—__ 7.50 — WatE�r.First 100 ft. — --
Back'!jWw Preventer --"- 20.00 —
- 7.50 _ _ Each Addit.200 ft.
_ 15.00
I -----— — — Storm<3 Rain Drain:First 100 ft— _ 30.00
_Each ddit.200ft. _ 15.00
- _ Mobilo Horne Space__'_ _
Other(Specify): 25.00
- _- Rain Drain-Single Fam D Ilinq 1500
PERMIT FEE . _ t ' Comments: _
STATE % Issued BY:
TOTAL Receipt No._-_ - _ Applicant
i Foi Plumbing Inspection Phone 639-4171 f3ipnature —
CITY OF TIGARD Plumbing Permit
Building Department Na.
Residential Commercial ❑
New Installation Replace 0 Addition El Alteration Date
L icensed 0
Plumber q >0 Owner
,LqR20 IOPV% -A 12 0 1, 1
Address Ito 5 Pa-jL- -1)4- -- JobAddress
Phone . 6 4 41 -:9-72 A) OeX-41 4-04f .- Applicant f; o(,L-re
CITY BUSINESS LICENSE REQ.)IRED FOR ALL. CON i RAC TORS AND SUB-CONTRACTORS
ITEM NO. FEE TOTAL ITEM NO. FEE TOTAL
Fixtures-Traps 7.50 Sewer:First 100 ft. 30-00
Dishwasher 7.50 Each Addit.100 ft. 15.00
Garbage Disposal 7.50 Ejector Pump 7.C3 I
Water Heater 7.50 Water:First 100 ft. 20.00
Backflow Preventer 7.5U Each Addit.200 ft. 1�5oo L
-0 1 1 1 �- I --. Storm.%Rain Dain:First 100.11. ----.---3000
v aA Nor /;T Each Addi!,-200ft,----- 15.00 — _—
Mobile Home Space 25.00
Other(Specify): Rain Drain-Single Fam.Dwelling 15.00
Comments io
PERMIT FEE
Issued By.
STATE '� %
Receipt No.
TOTAL Signature
For Plumbing lnepectionll5honbS39-41711
ULPMALMIRLMLm
E S S 11. D ,uG zzt � PERMIT NO
PERMIT CHARGE none
OWNER / CONNECTION FEE
PAID 8Y
TYPE OF BUILDING DATE CONNECTED
SERVICE RATE INSPECTION FEE
CONTRACTOR PAID BY _ DATE
SIZE OF CONNECTION ASSESSMENT PAID _,,,�
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SEWER PERMIT0
E '= 13488
Unified Sewerage Agency
of Wa%hingtonCounty CITY OF Ticar d DATE 8-1-77 _
OWNER : — 'T PHONE : 639-6560
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
BUILDING SEWER BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
®6EW ®kSINGLE FAhILY COMMERCIAL
❑EXIST . (PRIOR TO 7-1-70 ) D MULT . RES. INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1 _
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION
EXPIRES IN ONE AUNDRED AND TWENTY ( 120 ) "AYS . THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FEE $
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATION
OTHER ISSUED BY
TOTAL
• P /
DATE
SEWER PERMIT NV 13488
ADf.)RESS OF 51 RUCTURC 11005 SW COU011000d Lane
TAS' MAP TAX LOT --- SYSTEM--
LOT
YSTEM_LOT _ IqA BLOCK OF
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A P P P n v E D B YDAIE
ISSUED B DATE
REMARKS bldg. T1624
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TIGARD DATE 4[1 �
BUILDING PERMIT APPLICATION SOF 1f-1'77 , 19---
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE ,„3dNVae
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
Lo•r No._�._
OWNER . 11f!n;� SU C ttonwoud Lf t.JOB ADDRESS P HOME ADDRESS
ARCHITECT'
ENGINEER
BUILDER — ADDRESS DESIGNER
STRUCTURE —Ls1.NEW D REMODEL. ❑ADDITION ❑REPAIR DRENEWAL ❑FIRRE DAMAGE []DEMOLITION
RESIDENCE ❑COMM DEDUCATIONAL DGOV'T DRELIGIOUSDPATIO ❑CARPORT ❑GARAGE [I STORAGE OSLA13 OFENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW DCOUNCIL APPROVED DSIGNS
OCCUPANCY__ LAND USE ZONE __.BLDG. TYPE_,_---FIRE ZONE_PLAN CHECK BY HE10.___-
_ru•-iartu� is C: Jnvt• •inwla family dw+illitilu Wsttachad uersus –
Lut 190 4 badruam 2 bath
loam® as 11805 Sid Schnllwodd Lt.
�4�1�Q9A—_—FL49H..1.S?AD
41I HEIGHI—— _. MQATORI€S l._—BBEA 1559 NO.BEDROOMS
BUILDING DEPARTMENT SET BACKS FRONT20 REAR 25+ LEFT SIDE 6 RIGHT SIDE '
Permit 7:,42.00 —_—- -.-- -— —THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 15.17n REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
— WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUb•total ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CON'rRACTORS I'D HAVE CUIRENT CITY BUSINESS
State Tax LICF.N&E $
tf
P�R�7 ,Pj�MITS REgUIREp FOR SEWE[i�IPCl.MBING AND HEATING.
Total 156.1 Oki JT/ ya V ]] 1i
eY
-- - _-- —-
- APPLICANT OR not rvr _- - -- -
Appruved Receipt No.
1
I
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
-j 4 , Contractor pp
' Permit No. d0 0 � -22-77
Rough-in
_ _ 1 Fixture
1 � Final —,
- HEATING
-Ib-1'1 vt Contractor
Permit No. 0 p g�
Gas or Oil
Rough-in
Final
SEWER
Final _
DRIVEWAY
Final _
Storm Draina
(Rain Drain► Final
Sidewalk
Curb&Street Final
A roach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
(•, Zon'ng Final
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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W.Main St.
Tigard,Oregon 97223
Phone: 639-4111
Type of Inspection
Date Requested/ 1 Time A.M. P.M.
Address
[Permit #_z7 Owner---.-_ --- Lot +`
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _- -- --_ f1� Approved
Inspector ! Disapproved
Date
CALL FOR REINSPECTION
L1 YEIt i2� NO
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