16648 SW JORDAN WAY iA��•',r • ;r;••sa•pwW',IMtl•npll� __ Q,� ,,d,I y� ,.{�y� rMP%.. Y,yy �.j r
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` INSPECTION NOTICE ^
Cit-f of Tigard Building Department /
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O- hones 639-4175 8ueinser Phone: 639 f
Inspections
Footing Plbg. 3nderelab Mach. Rough-in Appr/Sdwlk i
found. Plbg. Top Oak Gas Line. �lINALsI
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Lnoulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Sd. -Mach,
Qu w Times AM PM I k
` • Date Ra est,W s_� � -� _�� � �
Ad
dreass �1C7Y�l�.VL 1 Permit f► ��
Guilder:
THE f'OLLO4iINn CORf.BCTi(.NR ARE REQUIREDs � ,n
140'
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Inspector: / i 7
Date: �
_APPROVEV DISAPPROVED --- APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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CTY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT C( RT I F I COTE OF ;
1.':125 SW hall Blvd.Tigard,Oregon 97223.8199 (503)830-4171 OCCUPANCY
(XXX PERMIT #. , . . . . . f MaT��3 -4b18a
y ,�3 4171 DATE: IESUEI)f 08/27/9�s
PARCEL- 2$116AD'•-BED32
SITE ADDRESS. . . r 16646 SW JORDAN WY
SUBDIVISION— . # BEDFORD BLCN ZONINGe
BLOCK. . . . . . . . . . f LOT. . . . . . . . . . . . f 32
CLASS (If-WORK. :NEW
TYPE OF I]SE. . . f SF I
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OCCUPANCY ORP. a R3 �
[OCCUPANCY LOA6f118 4 �
TENANT NAME. . . a
Remarks .- PATH I
BEACON HOMES
DO Box 13613
3CAVF RTON OR 9707
Phone #: 524-1999
Contractors
BEACON HOMES
9500 SW 125TH
I
BEAVE.RTON OR 97005
Phone #f 324- 1999 j
Reg #. . 1 70782 S
i
Occupancy of the Above referenced buila•1ng is hereby given, and certifiers
the compliance with the Stam, Of Oregon -wvr.ialty C:odeq far- the group,
occupancy$ and use under which the r eferers,.ed permit was i m-cotted.
FIRE DEPARTMENT BU�j IDI PG INS CTC)P
OFFC. -._...._..._.._._._..
P037 IN C'UNSP I CUOUS PLACE
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INSPECTION N01IC'¢ 4K
City of Tigard Building [cpnrinnt
1.3125 6W Ball Blvd. Tigard, ore= 97223 � �• '; tti� tl�(
Inspw , '.an Lina (Roc-O-Phons)s 639-4175 Business Phon , 639-4171
c'+r
Inspections _
Footing Plug. Underslab Mach. Rougt-in Appr/Sdwlk
round. Plbg. Top Out -v Lina FINALS
Post/Beam +tract. San. Sewer Framing -Bldg.
r
Post/Beam Hoch. Rain Drain Ineuletion -Plumb. �
Plbg. Underfloor Nater Lino Gyp. Pd. -Noah.
Date Requesteds "> L' _Times AN —PN
Address• I (/(y^�( (� c:r�c'Ir)- �'' �Jai, Pelmit is
Builders 'f 4 c"Ty� rT+w�. f1tCLa j i 1 _
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THE FOLLOWING CORRECTIONS ARE QUIREDs y
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✓"3- C5 �,�, C�r� ?_ 6y L<- yr�r
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Inspector•— (/�//i Dates �
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APPROVED _ DTR%!2PROVED APPROVED SUBJECT TO ABOVE
---- — `_--ee11/for Reinap.
? rnv " rnus '' .rekima sl.ti -i� y�l+; dii ,fir^ rvlilfiiNstlilffid1
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I>1sPECTIo��c�
CLt! of Tigard Building DePas<twent B
13125 BR Hall Blvd. Tigard, Oregon 97223 ll-t A -----
Inepection Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspections -
r
looting Plbg. Underslab Mech. R„m.igh-in Appr/Sdwlk
i
Pound. Plbg. Top Out Gas Line FINALS
Post/Beam Struct. San. sows_ Framing -Bldg.
^ost/Berm Hoch. Rain Drain insulation •Plumb.
Plbq. Underrloor Water _.;.ra oyp. Bd. } -Hoch.
Datr Requeetsdt L✓ ^'_ _Times ___AM PN
Address 1, 6 —+ :?Q /Lv Kermit I: / 3__QZ q
Build,ar: _PG C
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THE 1'GLI.0WING CORRECTIONS ARE REQUIRED:
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Instpscto�t_ —�-�--� Dat --
APPROVED DIDAPPROIYED -� APPROVED SUBJECT TO ABUV2
Call For Reirzp.
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INSPECTION NOTIt.E
City of Tigard Building Dspartaent
13125 6R Ball Blvd. Tigard# Oregon 972
Inspection !Yne (Rec-o-Phone)t 639-4175 9u8ineas Phone: 639-4171
Inspections _ — --
t Sooting Plbq• Underslab mech. R xtgh-in Appr./Sdwlk
Pound. Plbg. Top Out Cas Line TINALt
�
W } l+t{�d a�_� Pa qt/Baae1 /!tact. San. Sewer Framing -Bldg.
ti I .
h fCr , ,M1e 1. Port/bvam Neoh. Rain Drain 1. Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. -Noch.
7 i
Date ReTtesteds_, z / �� —.--- // Timet _AN PH
Addresse� !� � ���-,� % ( . .Permit
Builder: —
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THE POIJAYAINO CORRECTIONS ARE REQUIRED:
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Inspectors ---- --- Datee�� ���
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE rv{A
Call For Ralnep.
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j"PECTION NOTICE
City of Tigard Building Department
13125 99W Hall Blvd. Tigard, Oregon 972
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4172
Inspection:
Footing Plbg. Undermlab1. Rough-Ln Appr/Sdwlk
round. P.1bq. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer naming) -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
?lbq. Underfloor Nater Lined Gyp. Rd. --Neth.
Dwte Requested: S �/ Time: _ AM PH •
Address:&7 Q -'tc C-� Permit
Builder:
THE FOLLOWING CORr-ACTIONS ARE REQUIRED:
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Inspectors__ �` _ Date:_
APPROVED _ DISAPPROVED - APPROVED SUBJECT To
Call For Rdincp.
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-7—UR--04-'93 FRI' 13:58 u I D?C I Tq`bF KING CITY FAX IAO:503 ,?•-3771 tf800 F'07 ,
KING CITY sr � - e� �o
�11e�e 1'x300 SW116th Avenue,fi:rq City,Oregon 972'1 Phone:639.1082
COMMUNITY DEVELOPMENT
APPLICATION FCR. BUILDING PERMIT
(Instruiticas ac reverse)
DATE_ 5'�
1. NAME OF APPL I CANT: - eLfiyt_ k-,'" LPhone No. 5c:A W /9c9 9
ADDRESS: o 6ex I3 L- TY--�
ADDRESS OF PftOPOSED IM0ROVIIK9T k.0 7^ X-1 ! r
2. TY-FE OF CHANCE, IMPROVII-fEVT OR CDiV=UCTION FOR WftICH PERMIT IS REQUESTED. i
DESCRIBE BRIEFLY - ATTAC'i TWO COPIES OF PLANS OR ERAWINGS OF
PROPOSM PROJECT:
1 3. NAME AND ADDRESS OF CONTRACTOR I
PHONE NO. 179 9 L I CENSE NO. -7 -7 I—
4. NEIGHBORS WHO MAY BE M7-= BY THIS P'ROJEC'T WILL BE NOTIFIED BY THE CITY.
5. APPLICANT OR HER/HIS ,RF—'7RE-'x1MTIVE MGST BE PRESENT AT THE PLANNING CCMMISSION
MEFfING NEXT HELD ON _
RFPRESI MTIVES NAt _ PHONE NG.
(The (ling City Planning cou salan r'll wider cal, those ayplications received at toast five (5) days
Prior to a teetiog,)
SIGNATURE
*******�*�r*•,tir*#****:*�*,�**t**,t� *******s*************#****�***�**�yht**�iric*****st�t:rx
APPLICATION RECZIVED HY ,—
APPLICABLE FEE RffiCF.TVT.-D $— r `iL9 TC:I -
FLAMING MWISSION DECISION: Approved X Cvnied
WNDITIONS
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(loved appjications ere valid for sit tooth$ only
T
Si utur• 1 Date
NOTE: 0 en Sanebuilden 6x4 re Hires that all persous oho cantract for torr an their residence be
registered Lith the Benders Board which Reins the contractor is bonded sad insured an the job site.
Por your protection, be eertain your contractor is registered by calliaq City Sall Ph: 639-4081.
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KTE: A permit must also be obtained frau the City of Tigard Department of �
Crpmnnnity Developnent ye-S
No�
CITY OF TIGARD INSPECTIONE�___POP,T
The above listed project has been inspected and Approved _—genie ,
Date _ C nments_
Signature
(&Li -na nApec trt pPpaAe, ngtunn arta. ( I} wp y to K-ing9 City)
CD 2-81
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INSPECTION N(rICE r
Citi of Tigard Building Depertaeot
13125 SR Hall Blvd. Tigard, Oregon 9722;
" Inspection Line (Rec-O-Phone): 639-4175 Business l'honet 6394171 r
Inspection: -- -- —
Footing Plbg. Underslab Mach. Rough-in Appr./Sdwl.k
Found. Plbg Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date Requested: _Times AM PM K
i
v' Permit f s � � U� �
�Wdrese:
B•ailders_ 7 ` ■
THE FOLLOWING CORRECTIdlf8 ARE Rr.QUIREDt
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Inspector: Date:_
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ROVED DISRPPROVED _-- APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department I/
13125 RN hall Blvd. Tigard, Oregon 97223
Inspection Line (Fec-O-Phone)s 639-4175 Business Phones('09-4171
9-4171
Inspection# _
i
Footing Plbg. Underelab Appr/Sdwlk 1
i
found. Plbg. Top Out Gas-wL1,941FINAL#
prtilseam strut. San. Sewer -Bldg.
PnM Rain Drain Insulation -Plumb. ■
}b Qn26a
oe1 Nater Line Oyp. Bd. -Meeh. J
Dato s' C. 7 Time: _AM PM
Address# .�T� ��-- ��1�1_ � Purmit
Bulldar:
THE FOLLOWiVO COPRECTIONS ARE REQUIRED#
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C <_/ �/SrJ/�?�' �C�/i �G�'lil.�lrit�
U C"�✓ j M1��"�y J.i.
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InapocLor:_ A�--- -- Oate: C T��
APPROVED DISAPPROVED APPROVED SUBJECT To ABOVEf'$1t}
Call For Rei nap.
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:NSPECTION NOT—
City
OT—City of Tigard Building Department
13125 SK Ball Blvd. Tigard, Oregon 97223 �
Inspection Line Ilec-O-Phone): 639-4175 Buninese Phone: 639-4171
Inspection v__
1�
Footing Plbg. Underslab Mech. Rough-in Appr!Sdwlk
Found. Plbg. Tor Out Gas Line FINALs !
f
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
bg Underflaaf' Water Line Gyp. 9d. -Mech. ■
Uat:e•Regaeeteds TL,,o- �
�T AM PM
11 p
Address: lerm:.t #: c) Q ��
Builder.--
THE
uilder:THF FOLLOWING CORRECTIONS ARI* REQUIRED:
Inepector:,e!� - 7
Date: ��^•
APPROVED DISAIsPROVED -�APPROVED SUBJECT TO ABOVE
----
--Call For Reinsp.
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INSPECTION NM ICE p �'
CiLy of Tigard Building Department
1312- SW Ball Blvd. Tigard, dragon 972
Inspection Line (Rec-O-Phone): 639-4175 Business Ph.n 39-4171
Inapect Lon.-__.___--_�- - -
Footing Plbg. Underalab Mech. Rough-in Appr,1 lk
Found. Plbg. Top Out Gaa Line FINAL:
Pont/Beam struct. Win. Seylet• Fram!ng -Bldg.
�C .
t+� y Pcst/Beram Mech. �R8 1.1?Y Insulation -Plumb.
P)'.,g Underfloor `■4:L�tJ+iu►' Gyp. B -Hoch. .
Datt Requested: Z h Time,
Addrea¢+ I �. Permit 1 s
Builder.:
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THE FOLLOWING CORRECTIONS ARE KEQUIRED: 5
'allN1 e1P�w
r �r 71,171I
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InspecLora —�"'^ Dates
1111111.110111111 IMF,
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Orogon 97223
Inspection Line (Rec-o-Phone): 639-4175 Buoiness Phone: 639-4171
Inspection: —
Footing Plbg. Unde�ilab Mech. Rough-in Appr/Sdwlk —
nd.M, Plbg. Top O+r Cas Line FINAL:
1
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underflocr Water Line Gyp. Bd. -Mech.
i
Date Requested: �/ � � Time: _ AM ��t 0 PM
Address:�J _� �__- �L
C/
Buil.dar: —T ` -�, � �` U ■
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THE FOLLOWING CURAE(.TION3 ARE REQUIRED:
3,56 i°Y
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Inspector
- ----- ---_ Data: �0'
—`APPROVED DISAPPROVED APPROVFD SURJFCP TO ABOVE
Call. For Reinap.
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CITY ®F TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
F-,I_I ISI.: 1 -1.. . . .
13125 SW Hall Blvd.Tigard,Oregon 47223.9169 (503)839.4171
DATE L��jULD: 04/ 0V/9-
l7,Z',ML)ORL._.... t664 b "iW UN 11146
11 TVIfaI�i4 . . • . BE..'.tF•LJHU GL_.(.N ..UN11146
11 IGl3UL :hl ("9c _+�143ty� 00JL-1.L1Nk-- trf=tL,L r,e.i'.;. . . . . . . . :41 -
i-AS6 01: WL)RK. :NE:W f%E 1)RM.13; krF•11 Fla . « . . . . . . . .
t'�•' u+- L�t�,l_ « » «, (.. 1=I,r1Ut� i+ftl`i+ REOUlItr~L' �7 ks c.►;., _.,
4'G�1• F'i
r'PL UF GOIN;�-A :Div F=1 F al . » . , : d=i f LEFT. - 5 1`i f2iUF•T. ;U f't,
CC:1:1PANG'r L ki- . ;•i;:.:; 3ELUNU. . « :lZ+ i'' 1 Rl�l�fl'» :.`+�� fi REAR. « ."20 ft
rbkIES. . . . . . 1 1 HI RD. . . ..0 f RLukJ 2 kr:D _.... .....,_ ....,.._.... _ . ......_ _.._... �
"IGH I . . . « . . . . : 1 f; 1:L 0 ; Al- ' .:;i'iC)KF- Dl..l Lf:'1 URS. :Y
Katt L' '41.). . . . :4 + F%' I Vf•l_i_IC . . « , . 9t : 9 a 3 1 E, PARKING SPACL6. . :0
L.L►017 li4)il`•I3 (Ai f k1-VN f k{L. . .0
WATER HEA'1 LRB. » . : 1 TRAPS.. . . . . , . . . . . . . . ..k►
LAUNUPY l fif1 1G. . . •li`i CGl"rl`;FI F?IllyYl�l:i. . . . « :, . :0
.�"1"ka it L;L C)fil 75. . a ,E WE R,, ,_•1 l'wL. (•f t ) . :0 URE.AUL I nf�1PS. . . . . . , :0
100 UTHE'R F .L X i"URE S. . . . . : ►�
,41RBAGE: DI:P- - , : 1 RAIN DRAIiw (ft ) . L71 I
r-i tt1TNL+ M(lLll . : 1
GF CSF"lily Dl OIP15 ; ►
FLES
UNI IT rl'l Rs. . :t'� L ype aM0,., by date
VENl'U . . . . :r+ E11-11 ! € 430. QI4?f JFi 041071'13
IaX ii'i''i�1 i,.. tr, i ?F'Ll, r �1V.r. 4n] ,?L_W V��.! 113/1)3 93..,
�1 C. ..1 4► 1 r41d,a.
tJrt('w ( 1 4'►!' « . : :L HUt 1)S. . . . . . : 1 ks5PL 21. 54) JF' 0-4/07/9.3
UIRN i :1 1V+1. , . � WOUD:: iU:%E :,. 4: !Ill RT 1, 40. 50 .rri 4"►k!►117f
I.C)LJt1 f URN. . . . :► GLU DR'YE-k'`,, 1 {I.i='l.0 5t 10. 1:i JM 04/►u7/''
1�Z►..iC:)'"I. .SI IH ; f� XJ 1-1 i:.l U 11 1,j
DAL-, OU+LL F;a; 1 r-i)R T I i. c.. "bib JH Q14/01
C.. 6.3 JH 04/0i
/I :FIGUlt1 Fli)INi�:.:, «!C'31 t. 00 l-i 04/114,
—�x
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riune P)
0t►.1,r^aL.t0r: _..-- _........,_.._._.._ _......... -
14:- 1GON 11CAYIL::.7
0 BUX 1366
�EAVLRIU'4 UP
flwle 14 .
'his pera)t is issued subjtct to the iqu,acions ccnta.r'ee it r I'1 1�!Lili{r.1! INE I=L:L'1'1G:N` •_...w.__
igard Municipal Cade, Stale of Gra. .par:,alty Codes am-1 a , c:rat./t t►+_tr:r.l 1 n's I:) F :i r e l:)1 ace .Ln s V
aplicabli laws. Ali work o+ii) be acne in accordance %Ari apr,..:.• a _ t %1+r.+id)r+ 1.;t bas s L..rie l rrsra
cans. This permit w:11 ahpir•e if wort i5 t� ust e.�atm 'fisc h�trr tlt5+al�i't i.c,n LrtsP
!f 155UdPCw, v if Wo'r'th is 5ucic�: r.,: � / yq}/1.I1+CJS+ t.Ei l7 InE(7 Gyp boat-d sr'iRiP
iUI1Jc.-1,f luur a,a.r: rir ir) lr)tal:)
C i,.r.'I,J:tr, i.C:jA 1si+5F: ila'l:ei Line Irl5i.)
LJ+_i t Ata r�r/.:ci w l k is n u
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1312SSWIiallBtW. PLNCK/RECT #
CITY OT TIGARD 110 T�
Box PERMIT #
COMMUNITY DEVELOPMENT DEPARTMENT Tigard.Omgo"97M
(wl)6394171 DATE ISSUED
JOB ADDRESS: tZ"S-SW Jordan Way _ TAX MAP/LOT �2 5/ - 14d
SUB: Bedford Glen LOT: 32 LAND USE: _
VALUATION: �� Z
OWNER SPECIAL NOTES
NAME: Beacon Hanes, Inc. REISSUE OF:
ADDRESS: 9500 sW 125th Ave. — LAST REISSUE:
Beaverton, OR 97005 FLOOD PLAIN/
PHONE: 524-1999 SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: Beacon Hanes, Inc. PLANNING: w _
ADDRESS: __ ENGINEERING:
FIRE DEPT: —
PHONE: _ OTHER:
70782 EXP DATE: 12/1'7/93
CONTR. -BOARD #: _ _
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: can Plumbinq LIST/SUBCONTRACTORS:
MECH: Muehe Quality Heating BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME: Prgo Architect/AIA TRUSS DETAILS:
ADDRESS: •16325 sW Boones Ferry Rd. OTHER:
Lake Oswego, OR 97035
PHONE: 636-0755
PROPOSED BLDG. USE: Residential
COMMENTS:
APPLICANT SIGNATURE
iReceived By: _ _ Date Received:
a. «.w•sir.yw.`rr,.sv.. J�9CNlFNINP.IN�M.MAFMM�eN$„'oh'Y;?idf�.��pFatbl i93'lf�li!V ��"! Y�tAE9�M"r"'u«»ewwewoy�pyp,r.r .
,......•K+mNYVN^l7.(. i .'.X ,?'' ,r1t"�, ,+�, ..4F•''���it4w.`".ai.cv,.pi y ,•..• ............ ...,,. ..._.,..w..,w....«n...,.w,..... ..,»....,......
PERMIT # ACCT DESCRIPTION AMOUNT AMOUNT PD. PAL. DUE
shy -041J 10-432 00 Building Permit Fees -
10-431 00 Plumbing Permit Fees ` - -5c1
_ 10-431 01 Mechanical Permit Fees
10-230 01 State Bufiding Tax (5%) .�
Building
Plumbing
.�.0
Mechanical .�
■
10-433 00 Plans Check Fee
Building m
Plumbing
Mechanical
10-230 06 Fire -
30-202 00 Sewer Connection
30-444 00 Sewer Inspection J-5
25-448-02 Commercial TIF Fees
25-448-04 Iadustrial TIF Fees
25-448-06 Institutional TI.= Fees
25•-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees _ _ —
25-448--05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
f
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) �—
TOTAL
nm/3587F.WPF
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I CITY OF' T I BARD RE CE I FST OF PAYMENT RECEIPT NO. :93--238740
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CHECK AMOUNT 678. 29
i NAME a BEACON HOMeS CASH AMOUNT o 0. 00
ADDRESS o PAYMENT GATE: s 04/0'7/93
SUBDIVISION s
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PURPOSE OF PAYME=NT AMOUNT RA 10 PURPOSE" OF PAYMENT AMOUNT PAID
Bi.1I L.'.:�I NCS PERM 430. 00 PLUMBING PERM 132. 50
1ILCHAN I CAL. PEz. 40. FPO aT. UU I E_.11 Per 301. 16
PLAN (:HECK FE 10. 13 SEWER INSPECT 3.5. 00
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I...E.IOT 32 E3f:E:,F7( RD OL.EN
16648 5W JORDAN WAY
TOTAL AMOUNT PAID 678. P9
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wr unifled SANITARY•
sewer0 NTH sewerage
155 N. First Ave.,VAWal�eflCy 270,Hillsboro,Or..97124 SURFACE WATER
503 648-8621
CI N f''F' I'M I i' ►
< /9 3 EXPIRATION L1A l"111 100193 PT 111T i.03
-3'fF;l1C1 URE:, AI:ILIRESC1 16640 PR01ii::G 1' 11/139 �
STRUCTURE !VTI'21;.FT 5W JORDAN WAY
L0 1 "' BLOCK
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C;t]NDII"C'T'1:I:1N E W nr w.:.D{`f1E2 C1 111..G:N F'NA'aC: 2p
1'YPF TN! 'T'ALL_ATION- ( 19) 11LE1 SWR!E"RL1 CON/SDC
1 '1'F`E. [)1.;C;1.1 I'';11•!C;Y ( 1. ) a 11'!Li L.L. f-A 1111 Y
P0RC,rL :?i1 1!) AD 26600
CITI; GEL V/16 MFI 1.0109:. ■
11W11ER DF:AC'ON 1-1111-ICS
,,UI RE SS F'C) T:OX 1368 TREATM!"NT F'1 ANT 1111 '11(,fl
DEAVERT'nN OR 9707
! PHONE: 524 -.199y .1lII(1�,I7 K7N(,, CITY
I Ti;TUR E: E,CIUTVALE'NT I11�!f"1 ..TNG RVIl,IC1r'NT1AL_
UidT: l ! 11r::RVTCE LINT 1 S 0 ,0 (jHIT 9 i fir"!'�V'CCI: UNI Ili I
CUNNECTTCIN F17FS SIJI'o :,rlcr b!A•1•F,F, L117,Vf"I,.'.,)PMFN1 F F"F5
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SE41F.R C[0MNr:CTF0N ''1.100 >0V WAT'1'R I:1UAL, 1:'T'Y 1.80 .00
CREDIT 1.430 .00::.
WA T'I:Q l:)1.1At411 '1'Y 1.00 . 00
L.E S)S CRI"VI'T
VRC1::iT1)N C1)N CRUI._
1 NI.."I:,EC.;T 10N 40 , 00
PLAN ('IIi'r;K 26.00
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I Stl^) I•)'CAL 2100 ,00 :3 LIfiT0 1 AL. 166 . 00
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TO T'AL 2266 . 00
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REMARKS E'RU,If 1939- HELIFURT1 01 EN-1 CJI' ,1
I k11 {10111.1 N011:C;17 rLlrt I.R . 1I' N CONTRO1. TIJ:iF'E:f.;'1'1:QN;.i REQUT.F,EC,1
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Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency. When calling
for an inspection, please refer to the Pernit Number. The Permit expires one hundred eighty (180) days from the date of
Issuance. The total amount paid (permit fee, connection charge, line tap fee and/or other charge) will be forfeited if the
permit expires.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer 1s not located at the
measurement given, the installer shall prospect three feet in all directions from the distance given. If not so located, the
Installer shall purchase a "lap and Side Sewer" Permit at the current charge and the Agency will Install a lateral.
6/90 WHITE — USA, BLUE — Accounting, GREEN —Inspection, YELLOW — Customer
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