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CITE OF TIGARD �- � , �• .
OREGON
Morissette 1198
Owner:. ........... etmo................... ! ,•
11730 5W 113th P1
BuildingAddress................................................................ . ...................................
14th Nllvsmber ?7 '
Certificate is hereby given this....... !j. ...day of. ........... ................., 19.........,
that said building may be occupied and i
} i that it complies with all requirements of 4
I , the Building Code for the City of Tigard,
as approved by the Tigard City Council.
j�F ' i building lnspee,or f
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City of Tigard
INSPECTION REQUEST
for
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INSPECTION TIME: PERMIT NO. :
DATE: 1-21 DATE ISSUED
OWNERS NAME : XO rI�Sr7.►
ADDRESS: 73u 5 ' 113�� --�
CONTRACTOR :
TEST : Air p, Water p , Visual p , Laboratory (3
RESULT: Approved C7 Disapproved C P nding []
SKETCH:
c SPECTOR DATE
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UNIFIED SEWERAGE AGENCY NO. 11021___
WASH I NG'rON COUNTY DATE 12-15-76 _—
CITY OF_ Tigazi -- — - - ---- -
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: ...------
OWNER'S
WNER: ...-----OWNER'S ADDRESS: --------------------_ __--
STREET
------ . _
CITY -S14TE ?IP
BUILDING SITE: LOT._-_.__.—___ BLOCK - ADDITION
TAX LOT NO. TYPE OF OCCUPANCY._ _..___. residence _
ADDRESS ____1J.730 SLI- 11 h-P1v-
DWELLING UNITS--. --_----.--.- 1__----- — FIXTURE UNITS _ -..-.---
SURCHARGE IF APPLICABLE -----
PERMIT
PPLICABLE _— _PERMIT FEE 575.00 _ INSPECTION FEE 25,40_ TOTAL DEPOSITED 600.00__-.__. . _
(NEW) (EXISTING) BUILDING SEWER SYSTEM . ._- .Fenno _C-reek
The Applicant agrees to comply with all rules and regulati ns of the Uoified Sewerage Agency.
2 APPL{CANT ____1�__�S__. � --- ---- -
SEWER PERMIT
THIS PERMIT AUTHORIZFS CONNECTION TO THE SEWER SYSTEM.
LINF SIZE __--- - INSTALLER _.--
RECEIVED BY __
IArLNCY oR S AGEWif
COMMENTS:-.--.-,Bldg_,* #1198 _ paid to Leron Heights $150.00
This Application :,ir1 permit gxpl,es in one hundred and twenty (1201 d;ys. y
The ariount paid wiii be forfeited should -xpirat',on occur.
1
BUILDING PERMIT APPLICATION 1OF
1T TiGARD DATE 1 1 s��
Th': UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN I' `ICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE .ACCOMPANYING PLANS AND SPECIFiI–ATIONS. OWNER PHONE 1i4�C—
LOT NO.
OWNER '-eft Nlaz lis*t*t z JOB ADDRESS 1113(., t:c: U10 HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER warns ADDRESS DESIGNER
STRUCTURE -,UNEW ❑REMODEL ❑ADD��IIT77ION El REPAIR ❑RENEWAL []FIRE DAMAGE_ []DEMOLITION❑RESIDENCE ❑COI,M ❑EDUCATIONAL ❑GOV'T l_IREL IGIOUSLIPATIO ❑CAR PORT UG'RAGE ❑SfORAGE❑SLAB Dr-ENCE
OBOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN RCVIEW ❑COUNCIL APPROVED []SIGN'
OCCUPANCY i LAND USE ZONE 1 BLDG.TYPE JP+ _FIRE ZONE_ _PLAN CHECK BY i. HEAT__�p�:
�,Jrietruc. single I anlily Jwullingy/ettechad rjaregs aaheatag 1-2 --
3 bedroo e 2 bath Type, Morolli
O-CC _.�LQo�a2HEIGb.L
t,QAL?_ ��� _WNO.STQ131�$._-- AREA 1133NQ.1l1QBMS `' VALUE— 0'"•1�•
_ . _ ..� ----
-- BUIL DING DEPARTMENT SETBACKS FRONT 20 REAR a3 LFFT SIDE 6 RIGHT SIDE I bit
Permit 1t.400 -
-— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
Plan Check 10.00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THF
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 BUS'NESS
State Tax 4.02 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 138.02
By
APPLICANT OR AGENT
Approved Receipt No l
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DATE1NSP. TYPE INSPECTION REFMAR01 PLUMBING DATE
n r ;tor _Permit IVa. 57
Rough-in
h•in
Fixture _
Final
HEATING
` Contractor
^`/ 77
Permit No.
Gat or Oil
Rough—!n
Final _
—�—�— r--
SEWER
Final
DRIVEWAY
— Final
Storm Drain
Raln Drain; Final _
_ Sidewalk
Curb&Street Final
A roach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final Y+
CERTIFICATE OCCUPANCY ---
1- o.�apmg
Zoning Fina!
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0ty of Ticard Mechanical Permit �_o •I i Permit X100
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New Installation ADC Replrce CD Relocation ❑ Addition ❑ Alteration ED -�"- -- Foe 4 nit
CONTRACTOR OWNER It erh MorrAssette
A0r)nSS 6469 5" 134th !,,venue WORK ADDRESS 11730SN�113th
PHO10,r,17n _ PoCtIn-nAAPPLICANT L ua reyv Meinig_
I-lent Input RatlnU (FITU Per Hour),84O,Q, htU Vent rite Still r-!ue Size 411R
FUEL OIL ❑ GA& x' ELECT OTHER
ITEM'"`"`"'""" Nn. FFI- ITEM M(1. F!=!-
F_nr I�SvnncrCoi Permit 1 �on I•'.uflers Over .50 1IP '
'Ovw—Under 100.909 DTU 1 �t_4U1) /lir Handiincq -,Pq_O CSU'
�rw Over 10�100(1_fi7U r'_��`ii /lir Ilandllnn —
y
!"nor Furnnce 1 4j(1nrvaporative Cooler
Wal! • F!n�r`SusWnded I4 0�_ Ven Fan
Instal! Vnnls t.rin� Venn_''i�stem
Re,P,.Ir• )-jcn!"_r.no'inn Htood
Domestic Inrineretor
•qx" '"' :' �n 1G 1-�f' 7 0 Cnm . 11cinrrator
�)•':f33��1 to ,`!1 !;'t �t (10 pt4�ttr 'int Ustet.I
110;'ers 11 to ';C t•;
,.\_.,"•�T�'t':' CO's!"Ar1'I'^• ___.
Y ".'_" '\""S LIC7'�SC fTrGUlnr-!) FOl-ALL CONTRACrC1!1S OR SUP-CONTRACTORS
A"licIv" '2Y' DATr- t"S'Jr:7 13y '),^Tr
Fre nnnt!! 7 U� .lit '
Lnurey. J. Meing_"_ ...;..,,.�,..,�,.
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Address Permit No.
Permit charge 22 0 Z
DWnerr- t Connection fee
Paid by
Type of building Date connected
Service rate — �S Inspection fee
Contractor Paid by date
Size of connection Assessment _ Paid