11965 SW 79TH AVENUE-1 1.1965 SW 79TH AVENUE
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Addreee11965 S.W. 79th Ave. Permit No.
Permit charge
Owner _Ra oh Ausmenn Connection fee
Paid by_13.a1 Wh ji uL,r«1ann
Type of building dancF_ Date connected _
Service rate _ 3. 00 per month Inspec+,ion fee
Contractor , Paid by
date
Size Of connection Assessment Paid
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : 03ERMIT NO. —
DATE?/—ZZ--45--/a' UTE ISSUED*—Z
OWNERS NAME
ADDRESS : Ll`G %
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RESULT.- Appr-;jvtld 0 �ipxpprovell rd
SKETCM
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INSPECTOR DATE
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CITY OF TIGARD
12420 A. W. WHIR prs�e
TIGARD, OREGON 9/2A!
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish ❑ Addition Remodel ❑ Move
ZONING R_7 DATE ISSUED 10-29!173 BUILD?NG PERMIT
DATE RECEIVED 3UTLDING FEE $ 41.00_ No. 7 3. 2,1 5
BY PLAN CHECK $ 20.50 --
OTHER $ XIX X41 state VALUATION $
TOTALS RECDIPT No._� _
/ 9-7
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT M MAP N CENSUS TRACT - JOB #
Architect or Engineer �� A-mann
Address z ■i[ itab5SSW_-29Lb _ - Phone
Owner Same --- --- —
Address _ -_. _—Phone- -
Builder ------
Address _Phone_
BUILDING [ISE Single Res. Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP I No. of Stories 1 Total Height__ Area of Lot_
Type of Construction I II III IV V Floor Area B-— 1_ __ - 2`
Set. Backs: 1 vont- Back,__ L.Side - R.Side—
Private Sewer Pipe Size 4" Sewer us's JA_ a deptic Tank ❑
Water Service Pipe Size a44j Storm Sewer ❑ Ditch ❑ Dryw^.1IF]
Street and Curb Requirements AKS1111 Exi3ting _ ,^
Driveway Width existing-_ __ No. of Parkina Sp.cesJ
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED_ 11965 S.W. 79th Avs.
FTI;LD CHECK BY JB - -�- V -- DA1'f; 10-29-73 _
PERMIT APPROVED BY LLL.-41
It is understood that all work will conform with applicable
Ooesand ordinances
of the State of Oregon and the City of Tigard, Orfr.on, and that the building will
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector.
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S gnature of Applicant
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COY of Tigard
I
INSPECTION REQUEST
for
1 INSPECTION TI h1E : ��� PERMIT NO : ._
DATE : L6' _lV DATE ISSUED". . .LL.
OWNERS NAME : )PP-x*1-F'�ss
AD DRESS : �� -'� _
CONTRACTOR :_-d5p— ----
TEST . A r J, Water Lr] , wisucix, La" .rafory p
RESULT: Approved, Disapproved 1 , Poinding �1
SKETCH:
INSPECTOR DATE
COTE : Attach supplemental test data heretJ
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UNIFIED SEWERAGE AGENCY NO. - 4902
WASHINGTON COUNTY DATE nrt2ber 15, 1973 _
CITY ---
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: ...---- - --Relph-_.gu�ann
OWNER'S ADDRE:)S: ---__1196579th Ave. �—
STREET
_Tigard_, Ore gan 97223
CITY STATE -- --- _ 'if'
BUILDING SITE: LOT__---_--__-- BLOCK __— ADDITION __Tcain-ski--
TAX LOT NO. -TYPE OF OCCUPANCY Residence
ADDRESS _ 11965 S.W, i9th Ave.
DWELLING UNITS —� _ FIXTURE UNITS
SURCHARGE IF APPLICABLE -- ----
PERMIT
PPLICABLE _ __PERMIT FEE -- 4513 INSPECTION FEE 25 TOTAL DEPOSITE=D 475
(NEW) C�E IN0)IN0) BUILDINC SEWER SYSTEM Tigard
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
ADPL ICANT4
[�
SEWER PERMIT
THIS PE" v1lT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE: 4" INSTALLER --Ld F-""All
RECEIVED BY _ LI
*(AY OR ITS A E I
COMMENTS V�"f!L 9
V
This Application and permit expires in ninety (90) days. The amount paid will he 1r)rfeited
should expiration occur.
CITY OF TIGARD
12440 S. W. Main Street
TIGARD, OREGON 97443
A.'PLICATION FOR BUILDING E IT
New Construction ❑ Demolish F. Addition Remodel ❑ Move❑
ZONING DATE ISSUED BUILDING PERMIT
DATE RECEIVED
BUILDING FEE S O No.
��—
BY PLAN CHECK $ .70' s 0 ---
OTHER $ .�-f/ $j�j/g VALUATION $ �J9•
TOTAL S �s l.9 RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N MAP N CENSUS TRACT JOB N
Architect or Engineer 4
spa�vt.vl�
Address W Phone ',jq e'e
Owner
2e—
Address. , S` GCJ�f _ Phone_ � __y _
Builder
Address _Phone_
BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP_ No. of Stories_ Total Height`– Area of I-nt
Type of Construction I II III IV V Floor Area B2 2!
Set Backs: Front Back– L.Side R.Side
Private Sewer Pipe Size_ Sewer•� A} Septic 'rank ❑
Water Service Pipe Size_ 11 Storm Sewer ❑ Ditch ❑ DryweIl❑
Street. and :urb Requirements Sf IN
Driveway Width C;-, <i/, No. of Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIRL INFORMATION
ADDRESS ASSIGNED f'������✓G �__�,___�________ _
FIELD CHECK BY DATE
PERt4I'r APPROVED BY
It is understood that a?.1 work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector. /"
S n kure of Applicant