9940 SW PEMBROOK STREET 9940 SW PEMBROOK STREET
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INSPECTION NOTICE
City of Tigard Building Department
1247.0 S.W Main St.
Tigaro Oregon 91223
Phone: 639-4171
Type of Inspection -�- ✓ mss.' --_ �'t '
Date Requested___ Time A.M. ' _P.M.
Address ��,i `mac`? -r c ..J ter ., .li _, = Permit #_
Owner �_ ___� —. -- Lot #_
Builder _ -- ---The following Building Code deficiencies are required to he corrected:
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Presented to __..�___v __- - -- Approved
Inspector ��_ -!���� �_- - ❑ Disapproved
Date
CALL FOR REINSPECTION
C) YES lP NO j
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INSPECTION NOTICE
City of Tigard B-Alding Department
12.4217 S.W.Main St.
'F;ydrd,Oregon 97223
Phone: 639-4171
Type of Inspection ----------_.------------__-__—
Date Requested--&—f=�s'S � Time _..- A.M. P.M-
Address �'�� --�'�!.f��* yC�-� %� Permit #•S'_, s
Owner �a_� -�. . --- Lot #---
BuilderThe following Building Code deficiencies are required to be corrected.
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Presented to _- -__ �_ Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
❑ YES NO
�. SEWER PERMIT
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Unified Sewerage. ,Encs
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of Washington County CITY OF _ DATE
WI►� , �v4�' ��-� �t�►�� PHONE t�►3 _�..
OWNER: ---- —(------
OWNER 'S ADDRESS:
TYPE OF INSTALLATIONt
g-
SIDE SEWER ❑ LINE TAP AND SIDE SEWER El LINE TAP
TYPE OF OCCIIPANCY:
❑ NEW
EXI ING ' N SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7- 1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 0
ADDRESS OF STRUCTURE : _
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for Inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be lorfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. It the sewer is not located at
the measurement given, the Installer shall prospect three feel In all directions from the distance and depth given.
If not so located, the installer shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency
will Install a lateral at the location specified by the installer.
FEESt ,• .•'
PEkMIT FEE s
CONNECTION CHARGE `''a'
LINE TAP INSTALLATION ISSUED BY
OTHER --
TOTAL
APPLICANT DATE
SEWER PERMIT
e2 of
ADDRESS OF STRUCTURE I( / (-)
TAX MAP 2 g TAX LOT SYSTEM �'AAhe
LOT BLOCK OF _-
APPROVED BY DATE ISSUED BY DATE
D.U. 'S h(L-,. REf4AR KS Vv*` ' tf ► t1t Se '`�t`C �A►+ �'f1 0,4Q4E ��u 4" /Ae