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is eeords\rnicroflmUargels\building.doc
INSPECTION NOTICE.
City of Tigard Building Department
13125 SSI Ball Blvd. Tigard, Oregon 97223Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 539--4171
Inspection:_
Footing Plbg. Underslab Mech. Rough--in Appr/Sdu.-lk
Found. Mg. Top Out Gas Line FINAL:
Post/Beam Struct. ` San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested:_ 1/)�,� _ Timet - AMT�-- PM
Address: CJ� d /C/ ( permit /:�i�
Builder- J ' ®it J
THE FOLLOWINNGG CORRECTIONS ARE REQUIRED:
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LD
111
Inspectort
APPR9VED DISAPPROVED APPRO"D SUBJRCT To ABOVE
Cal) For Reinep.
cvry OF TIGUARD RECEIPT OF P(lYMEENT REOFIPT NO. :92—P2,6902
CHECII AMOUNT a 6,71A. 00
NAME- MIL.L.K11, Tom C ASI--i AMOUNT s 0. 00
ADDR696 a PAYMENT DATE a ft. 2
7UB01VIGrON
PURPOSI-7 OF PAYMENT AMOUNT PAID PURPOSP: OF PAYMENT AMOUNT PAID
n.
Q-IR USA 1,00. lAo SEWER USA 300. 02)
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flROM I NISPETT 35. 00 SEWER INSPECT 00
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t-oTs. 3 AND 6 TAE PKL-EY rsTATEG
TOTAL AMOUNT PAID
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C11YOF TIGARD SEWER CONNECTION
cnyOFTWARD PERMIT
COMMUNrTY DEVELOPMENT DEPARTMENT #. . . . . . . :
13125 SW HWI Blvd. P.O.BOX 23397,T19",Oregon 97223 (6W)0"175
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SITE ADDRESS. . . - 16-*!,r10 SW ' CIS'r;-4 r) [- PARCEL: 2SI15AA--BE3
SUBDIVISION. . . . : � C? lCl ��y �,�� ZONING:
BLULK. . . . . . . . . . L LJ . . . . . . . . . . . . . ..
TENANT NAME. . . . . .
USA NO. . . . . . . . . . . FIXTURE UNITS. . .
CLASS OF WORK. . . :NEW DWELLING UN I TS. . : I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS:
INISTALL TYPE. . . . :BUSWR IMPERV SURFACE. f
Remarks :
Owner: FEES
TOM MILLER V P F., amol.tnt b%/) date
PRMT $ 31410. 00 JLH 06/C'-'5/92
—
TN 73 P f, 35. 00 JLH 06/25/9L
Phone
Cc)ritractar:
CONTRACTOR NOT ON FILL
Phone 1 -35. 00 TOTAL
Reg #. .
PEUUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations 'jPwer Inspection
J the Unified Sewage Agency. The permit expires 18@ days fror
the date issued. The total .1voiInt paid will be forfeited it the ......
permit excires. The Agency does rot guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measur Pent
given, the installer shall prospects
t 3 f in
s.1 1 dir tions -ov
the distance given. If not so located, r-e installe s.all e
c
a "Tao and Side Sewer" Pet-tit and the r,encv wili j I a ate 41.
Permittee qirri-it .,Lre .
e kj B y
CAll for iiispectiort 639 4 175