10470 SW KABLE STREET-1 10470 SW KNBLE STREET
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INSPECTION NOTICE
City of Tigard BuiIO;ng Department
12420 S.W. /Iain St.
Tigard,Oregon 97223
';wi ie: 639.4171
Type of Inspection __—
Date Requested__....__1�_. � -_� Time A.M._ _P.M.
Address -___.__107_ {7�() Permit
ot
Builder
The following Building Coda deficiencies are required to be corrected:
'S.
Presents _ pproved
��
Inspector _ pproved
Date
CAL FOR REINSPECTION
❑ Yss ❑ NO
Receipt #
SEDER PERMIT INV 21159
Unified Sewerage Agency
of Washinq!onCounty CITY OF _ Tigard _ DATE 2�2fl�B0
OWNER : Richard T. Smith _ PHONE: :_ 639-5893
OWNEP 'S ADDRESS: --
TYPE OF INSTALLAIION:
Q BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
❑ NEW ❑X SINGLE FAMILY ❑ COMMERCIAL
[X?
EXIST. (PRIOR TO -7- 1-70 ) ❑ MOLT. RES. ] INQUSI'RIAL
FIXTURE: UNITS DWELLING UNITS 1 _
ADDRESS OF STRUCTURE : 101170 :its Kable Street
PERMIT CONDITIONS: THE APPLICANT' AGREES TO COMPLY WITH ALL. RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR INSPECTION ,
F '.EASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE-
HUNDRED AND TWFNTY ( 120 ) DAYS. THE AMOUNT PAID WILL. BE FORFEITED SHOULD
EXPIRATION OCCUR .
FEES:
PERMIT FEE $�--�_�
CONNECTION CHARGE 300.Od
SIDE SEWER INSTALLATION _r Penny Liebertz
ISSUED BY
OTHER
TC)i AL $ 325.00
2/28/RO
Af- L I CANT - ~r PATE
NOTICE: r tJa�s c i 11E.
A�TJE C.'JE, Si!'ItR SUVICE
BG►., iG, Tf+,s SEWER PERMIT
N.O
PEF,'IST. 2)9159
ADDRESS OF S)'RUCTURE 10<<70 SW Kable Street
TAX MAP r TAX LOT SYSIEM _Fanno Creek
LOF 25 ___BLOC! OF Hoodview Plat 2 _
Frank Currie 2/28/80 2/28/80
APPROVED BY DATE I_ 'UED Ry DATE
D. U. 'S 1. REMARKS Septic tank to be_P-u-Rined and fi11e with Rand
per Sta% c Code. Minimum Aft pipe required.
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CITY OF TIGARD—12420 S.W.MAIN TIOARD,OREGON 97223
RECEIPT
DATE:�..�___ AMOUNT: $ S _.......-.,�.�.....
1 _DOI_t QRS
NAME: ; �^ CASH
ADORES.>: �-
.r COF
HK
FOR: »_ ACCT. i PERMITS SURCNAROE AMOUNT
SEWER BILLING, 40-364
BUSINESS LICENSE- 05-331 -
i PLUMBING PERMI1 05 332 S
MECHANICAL PERMIT 05-332 -
BUILDING PERMIT 05-333
SEWER CONNECTION 40-363
SEWER INSPECTION 40-365 `1
SYSTEM DEV,CHARGE 25-366
PARK DFV. CHARGE *1 30-:361
PARK DEV,CHARGE #2 30-368
ZONING ADJUSTMENTS 05-562
TOTALS
RECEIVED BY: _.
PlRMIT NUMSlRS ASiBIGNlD: ------ _— x
Number Amount Number Amount Number Amount !, +�� '