11065 SW COTTONWOOD LANE 'e
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11055 SW COTTONWOOD LANE
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,Y OF TIGARD C'�
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OREGON1
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y O��ner.............. .................................................. --__Permit No.... 1233 . .. ..
11065 SW Cotton Wood Lane
...............
i Blll](iln(� Address
................................. ...................
Certi+'i,c:a ,, is hereby given thl;.r.....30..... day of ....l....un..e..._•_ 1 7.7. ,•�`��
' that -,aid building may he occupied and
that it complies NN-ith all requirements of K. .
j�
the Building Code for the City of Tigard,
r` s a> proved by the Tigard City Council. p :
Building inspector
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City of Tigard
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INSPECTION REOU'EST
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INSPECTION TIME : PERMIT NO. : —
DATE:4--_�1^L �DATE ISSUED: LL
OWNERS
ADDRESS
TEST' Air ❑, Water � viaualffl , Laboratory ❑
RESULT.' Approved 31 Disapproved ❑ , �Perdinq ❑
SKETCH:
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INf EC OR DATE
CNOTE: Attach supplemental toot dote horet-
UNIF= IED SEWERAGE AGENCY NO. _____ 11648
WASHINGTON COUNTY DATE 2-9--77 _
CITY
APPLICATION FOR SEWER CONNECTION PERMIT
O W N E R: —�T.a --------___----
OWNER'S ADDRESS:
STREET
zip
BUILDING SITE: LOT_._192 BLOCK ADDITION
TAX LOT N0. TYPE OF OCCUPANCY _ reside-nce _
ADDRESS _ 110655,1 Cott_anwood ane
DWELLING UNITS__1__..__________ ___.__ - __ FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE _._...57Sy INSPECTION FEE ._25-__ TOTAL DEPOSITED _ -,nn-
iNtIEW) (EXISTING) BUILDING SEWER SYSTEM - Eannr,_Craek_--_-__-`___._____
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
(AGENCY CSA ITS AGENT) /
COMMENTS: Bldg. #1293
This Application and permit expires in one hundred and twenty (170) days.
The amount paid will be forfeited should expiration occur.
BUILDING PERMIT APPLICATION cOF TIGARD DATE a-- -7 +^ 3
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHON
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONF "�, '� —
LOT NO._.---
OW,":`^ I TGI]ISMEiLK LIUITIQ,u JJB ADDRESS .110uiJ J)W Lott Jnwuu,.J HOPli.ADDRESS
ARCHITECT
Lit3M0 6270 5I.:I H1.TTt)LJs; ENGINEER
BUILDER ADDRESS _ DESIGNER
STRUCTURE ❑'NEW ❑REMODEL ❑ADDITION C3 REPAIR ❑_RENEWAL [:]FIRE DAMAGE ❑DEMOLITION
O RESIDENCL ❑COMNI ❑EDUCATIONAL. ❑GOV'T ❑RELIGIOUS[:]PATIO ❑CAN PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOV ING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED [:]SIGNS
OCCUPANCY_ LAND USE LONE BLDG.TYPE_ FIRE ZONE— PLAN CHECK BY HEAT _
c ,nrit. esingla family daellin , w/att eched Ijarsija_pur plana 3 bscr :t_Im bath —
lot , 1�)2 garage 472 sq. l t.. -
1 -- 1741 'r 38,Cl C{tj.
NO,STQRI __-AMA= NO.BE�1$QQbIS VALUE
BUILDING DEPARTMENT SET BACKS FRONT 2O REAR JLI LEFT SIDE 0 FLIGHT SIDE 11
PermitTHIS REPMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 77.00 REGULATIONS AND ALL APPLICABLE CODES AND ORE INANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLAN',AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF 'THIS PERMIT DOES NOT WAIVE
— — RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 6.93 LICENSE. SEPARATE PERMITS REOUIPED FOR SEWER, PL.UMRING AND HEATING.
Total 217.93
By
APp' 1C ANT OR AGiNI
Approved � �— Receipt No. ..
ADORES5
J .,.,.r...........�,;,.............,a..,:,..�....,....d..r......,....r.,,.,. ....,........ww...w...:.,.w..,. ....,..W..,.,... ...,. rai.w..rw..e+.,..a.�..wmr.ru....w.__:,............:.....x.:..:.....,..._ ....,.....,...�.wWwo..u.........
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No. ' -71-7
Rough-in
Fixture
/ �.f-tA-g Final
HEATING
Contractor
Permit No.
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
\_ Zoning Final
i
1
ADDRESS 4 PERMIT N0.
PERMIT CHARGE none
OWNER CONNECTION FEE
�.
PAID BY c:..t'e-L ..� ` I E
TYPE OF BUILDING DATE CONNECTED
SERVICE. RATE C INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT _ PAID
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