11610 SW TERRACE TRAILS DRIVE 11610 SW TERRACE TRAILS DRIVE
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ADDRESS PERMIT NO.��
PERMIT CHARGE none
CONNECTION FEE +-�.��
0 W N E R
PAID BY
I .I PE OF BUILDING ,2,ci, DATE CONNECTED
sem'
INSPECTION FEE 5
NICE RATE ____ rY
CONTRACTOR �� PAID BY _ DATE
SIZE OF CONNECTION ASSESSMENT PAID
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CITY OF
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Larry Kelley 1040,-. . -- ;:
Owner:............................................... ........._. Permit No...
Building Address.....---. ...11610. SLI.. Terrace ..Trails.
1 April 7,7 "lk'
Certificate is hereby given this................day of.. ... ...... . .. . ........., ly..... ya '
that said building may be occupied and
that it complies v ith all requirements of
�.� the Building Code fur the City of Tigard,
as approved by the 'Tigard City Council. * 1
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I City of Tigard
I
INSPECTION REOUEST
for
INSPECTION TIME : ,'x' PERMIT NO. :
DATE: DATE ISSUED:._._Z
OWNERS NAME :
ADDRESS :
I CONTRACTOR '—CL r.0"tL-
TEST: Air ❑, Water Visual Q , Laboratory I]
RESULT: Approved ( , Disapproved O , Pending [j
I SKETCH:
4O l flE,f
�L315._
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INASPECTOR DATE
CHUTE : Attach supplemental fest data herefo0
1
UNIFIED SEVV1_-. RA(_317_- AGE*NCY NO. 10623
WASHINGTON COIJN *I'Y DATE __ 9-8-75
CITY OF_____ Tigard
APPLICATION FOR SEWER CONNECTION PERMIT
Orb'NFR: Larry Kelley
�)WNL R'S ADDRESS:
STREET
CITY
BUILDING SITE: BLOCK ADDITION
TAX LOT NO. TYPE OF OCCUPANCY residence- , ..
ADDRESS 11610 SW Terrace Trails
DWELLING UNITS FIXTURE UNITS
SURCHARGE IF APPLICABLE __.
PERMIT FEE . 575.00 . INSPECTION FEE __25. 9ITOTAL, DEPOSITED -600.00-
(NEW) (EXISTING) BUILDING SEWER SYSTEM Fanno Creek
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Ag,mcy.
APPLICANT
S F W L" R PERMIT"
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE INSTALLER
RECEIVED BY
f,'A'ANCY OR 115 AGENT)
COMMENTS:
This App!;(-,ation and permit expires in one hundred and tvventy (120) days.
1-lie amount paid will be forfeited should expiration occur.
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BUILDING PERMIT APPLICATION 1
1T TIGARD DATE9-6476 ,o 1 ,140
OF
THE UNDERSIGNED HEHEBY APPLIES FON APERMIT FOR THE WORM, HEREIN INDICATED BUILDER PHONE _'45-15645
OR AS SHOWN AND AFPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_
Larry Kellwy 11t,10 Tarr-tice Trails LOT NO.—
OWNER JOB ADDRESS HOME ADDRESS _
ARCHITECT —--
M�+ImIx same ENGINEER
BUILDER ��( �^ ADDRESS --DESIGNER CI
�liT(RUCTURE MEW _❑RLMODEL _ ❑ADDITION ❑RE_PAIR _ ❑ L„J
RENEWAL ❑FIRE DAMAGE DEMOLITION
LJ RESIDENCE ❑COMM OEDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PAT 10 ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND LJMoVING ❑CONDITIONAL L1Sk ❑DESIGN REVIEW _❑COUNCIL >PPFiOVED _ ❑SIGNS
OL,CUPANCY__ Z LAND UU ZONE_ 7 BLDG.TYPE— �y` 5_FIRE ZONE 3 PLAN CHECK BY ETLI _ HEAT ijfiF�v
C:onxt single family dwelling w/attached goroge 5 bodroonl 3 both
-- 2 storit,,q Tax Map ; / Tax Lot
_•
O '2 364 � "� �O�Ci(JCI.
CA.LOAD F�S1t'8.1.9A0 LT�LCiHT �Q ST –9-1U� AR EA NO,BEQBQQMS YALU�,___---
BUILDING DEPARTMENT SET BACKS FRONT REAR 48 LEFT SIDE � NIGHT SIDE 7
Permit 1571011THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, 7ONING
Plan Check 10000 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 CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 5001 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 172,C).
EIV
APS' (CANT OR AOEN1
Approved _._ I R(�(v1 1 No, _
ADD SS _-
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11-5-26
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