11340 SW TIGARD STREET 1.1340 SW TIGARD STREET
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BUILDING PERMIT APPLICATION cUiv TIG ARD DATE- '-``(l-7' 19_._—
iHE- UNDERSIGNED HERCBY FPPL4ES FOR APERMIT F )R 1, c WORK HEREIN INDICATED BUILDER PHONE.—
OR AS SHOWN Al. D APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER SHONE_.._—_--
LOT NO.--—.._..__
OWNER! I,, a f IL,i4, aarett L JOB ADDR►SS 113413 SIJ Tigol d AVfc;HOME ADDRESS
ARCHITECT
ENG 0NEER
BUILDER ^ ❑ []RENEWALU
ADDRF—SS _ DF-�'GNF_R
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STRUCTURE ONEW REMODEL J CIACIDITION I EMAIR
RENEWAL ❑FIRE DAMAGE DCMOLITION
R--ESIDENCE ❑COMM ❑EDUCAT;^NA'_ ❑GOV-T ❑RELI,IOL'SOPATIO []CARPORT ❑GARAGE ❑STORAGE QSLAB I,JFENL,°
ChOND ❑MOVI.YG CUCONDITIONA'_USE 0DESIGN q:VIEW QCOUNCIL APPROVED []SIGNS
OCCUPANCY LAND USE ZONE_ — BLDG.TYPE—I-IRE ZONE--- PLAN CHECK BY- — NEATA=---__
4GC J.LOAD _�L4S2B1.!?AlizHEIGHT —_NO 4LQHI.E.S AREA__NQ,8EQROOM6VALUE-
BUILDINGDEPARTMENT SET BACKS FRONT REAR LEFT SIDE R GHT SID!
Permit
THIS PERMIT IS ISSUED SUBJECT TO T'HE REGULATIONS CONTAINED IN THE IIUILDING CODE, ZONING
Plan Check REGULATIONS AND AL3. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGITEI'D THAT THE
WORK WILL BE DONT IN ACC09DANCE WITH THE PIANS ANU SPECIFICATIONS AND IN COMPLIANCE WITH
SLIb•total ALL APPLICABLE CODES AiID ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTNICTIVE COVENANTS CONTRACTOR AND SUR CONTRACTORS TO HAVE r URRENT C11 Y BUSINESS
State Tax •Eli LICENSE, SEPARr,TE PERMITS REOUIREO FOR SEWER, PLUMBING AND HEATON(.
TotalBV «
APIY WT OR AGF N1
Approved u---- RI f-pihl No
6
UAfE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
_—_ _ _ --- - ----- — _ IP
ontractor
ermitt No.
----- – — — --- —� Rough in —
Fixture
— Final
– -- ---- ---- _--. — HEATING --
Contractor
Permit No.
Gas or Oil _
Rou h-in __-
Final
— — ----- ------_— SEWER
Final
DRIVEWAY
Final _
Storm
— (Rain Drain) Final
Sidewalk 6-3-77 L G
Curb&Street F, lal
A� Lca-n _ w3 ) �G
BLDG DEPT. FINAL TEMPORARY — CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY --
Landscaping
Zoning Final
to-
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Address / �/ _� Permit No.
Permit charge t?.
Owner Connection fee
P a i d b y`_. 2
Type of building _ Date connected
Service rate ��� Inspection fee S l d 5 _
Contractor _ Paid by _ date
Size of connection Assessment Paid
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i City of Tigard
INSPECTION REQUEST
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I INSPECTION TIME : PERMIT NO �—.__
DATE : ,_ '�� DATE ISSUED.__ ' L_
OWNERS NAME . f?�1e- --
IADDRESS : 113 ��: _ �ti• %Gh = ST
I CONTRACTOR :-------
TEST' Air 0, Water, Visuab6 , Laboratory []
RESULT. Approved , Disapproved ❑ Pendiriq X11
7_1_1 _ . . .
SKETCH.
I /A8kCT0R DATE
ICOTE Attach supplemental test data hereto)
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City of Tigard
INSPECTION REQUEST
f
INSPECTION TIME: PERMIT NO. :—
DATE :
O. :____DATE : -.,Z-4LIZY DATE ISSUED .--Z-J-.-
OWNERS
SSUED .._J___L._OWNERS NAME :
ADDRESS: _ 4Z a � ,scV
CONTRACTOR : = .�► —_,L'�'fG ,
TEST *. Air p, Woter P_.,.-Vleualq3-;Laboratory p
'RESULT: Approved G-, Disapproved C Pending p
SKETCH:
I
I
SPECTOR DATE I
NOTE: Attach supplemental test data beret a] I
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,,CAL
-3
UN11FIED SEWERAGE AGF:" [\1CY NO.
Vvk"aSIIIINGTON COUNTY DATE __1_-_1a_-_2_7_
CITY OF .__Tir)ard
APPLICA FION FOR SEWER CONNECTION PERMIT
OWNER: ___Mr. E. C. Jensen
___---
OWNER'SADDH .-S: _____j1340 SW Tigard
STREET
CITY STATE 21P
BUILDING SITE: BLOCK ADDITION
TAX LOT NO. TYPE OF OCCUPANCY rasidence
ADDRESS 11?40 5W 7: St..
DWELLING UNlTS____-..--__ FIXTURE UNITS .
SURCHARGE IF APPLICABLE
PERMIT FEE 575s — INSPECTION FEE 25- TOTAL DEPOSITED .. 600.
(NEW) (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regol atioris of the Unified Sewerage 'Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AIJ,"HORIZ-fS CONNECTION 10 THE SL\,'V'ER SYSI EM.
LINE Sll- E INSTALLER
RFCEIVED BY
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1:,r"fN1C11 UR ITS AFNTI
COMMENTS:_ Paid to Lerzin Heights,
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.