16700 SW 108TH AVENUE-1MIIIIIIII�KIIIFLW 4!LTjLW WIII W
16700 SW 108TH AVENUE
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested_ Time A.M Q P.M.
Ado rens __�)S ._� 1 _ Permit
Owner ._� y�
Builder_ _ t
Thv following Building Code deficiencies are required to be corrected:
--1 -
2
6
Presented to y� Approved
Inspector ❑ Disapproved
--s
Date
CALL FOR REINSPECTION
❑ YES 4!�!] NO
--� SEWER PERMIT 33476
UUnifisdSawora"Ag*my CITY OF T9s� _ DATE 6-12-87
of Washington County
OWNER: Waverly Construction _ PHONE : _ 629-8729
OWNER' S ADDRESS: 10185 SW Riverwood Lane Tigard 97224
TYPE OF INSTALLATION:
® BUILDING SEWER ❑ LINE TAP AND BUILDING SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
❑ NEW ® EXISTING E SINGLE FAMILY ❑ COMMERCIAL
❑ MULT . RES. ❑ INDUSTRIAL
FIXTURE UNITS ._ _ DWELLING UNITS 1
ADDN-Mk"K6W1XXXXXX 16700 SW 108th AVe. 97224
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified
Sewerage Agency. When calling for an inspection, please refer to the Permit Number. The Permit
expires one hundred twenty (120) days from the date of issuance. The total amount paid (permit
fee, connection charge, line tap fee and/or other charge) will be forfeited if the permit expires.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer
is not located at thr vasurement given, the installer shall prospect three feet in all directions
from the distance 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.
FEESt
3`) . 00
PERMIT FEE
CONNECTION CHARGE 300 . 00
LINE TAP INSTALLATION''
ISED BY
OTHER
TOTAL s 335.00 — 6-
DATE OF ISSUANCE
PLICANT DATE OF EXPIRATION
SEWER PERMIT
ADDRESS OF STRUCTURE 16700 SW 108th Ave. 97224
TAX MAP 2S-15AD TAX LOT 4800 QUARTER
— SECTION
LUT 31 BLOCK OF Dover Landing
BCR 6412-87
APPROVED BY SEE '- r—IS ED BY DATE OF ISSUANCE.
D . l) . ' S 1 REMARKS 4° pipe t (,quired . Septic tank to be pumped
& filled and nspected by ry