11860 SW 113TH PLACE 11860 SW 113TH PLACE
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>� CITY OF TIGARD Ale
OREGON
>� Owner:.........Nerb..... . .. . ssette......113th
.. �...Pi...........Pe►mit N��.._.... .1.73 t
t Building Address... ...11860".SW.... 3
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y 29 y Jun�.... ..n �d and �t\
Certificate is hereby given this.. . ........ da of
that said building may be ceupie r'
that it complies with all requirements of �3 <t
the Building Code for the City of Tigard,
l ( as approved by the Tigard City Council. I
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r,jiidinp 'Inspector 0 \
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City of Tigard
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INSPECTION REO L1 E ST
for
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INSPECTION TIME :. PERMIT NO. :
DATE: 31222-2. DATE ISSUED:-
OWNERS
SSUED:OWNERS NAME .
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ADDRESS : 1/���' /� .�
CONTRACTOR : ----- ---
TES I ' Air O, Water Q � Visual , Laboratory Q
I RESUL'r: Approved Disapproved ❑ Pending 0
i SKETCH:
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I INSPF CTOR DATE
C01 Attach supplemental test Petc 'terc�o
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City of Tigard
INSPECTION REQUEST
for,
INSPECTION TIME: J l PERMIT NO. :
DATE : L-7Z DATE ISSUED .-- Z
OWNERS NAME : srTE
ADDRESS:
CONTRACTOR :
TEST : Air Ll, Water❑ , Visual , Labnratoryp
RESULT: Approved Disapproved C Pending p
SKETCH.
C4
INSPECTOR DATE
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COTE Attach suoalemental test data bereta]
City i of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PLRMIT NO. ' .�_
I DATE: .g-J— DATE ISSUED*-J--/
OWNERS NAME . _ ------
ADDRESS . _'/ b ��
CONTRACTOR :_
TEST' Air ❑, Water ❑ , visual D , Laboratory C]
IRESULT: Approved 13 Disapproved ❑ Pending !'
SKETCH:
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" INSPECTOR DATE
ICOTE . Attach supplemental test data hereluJ
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UNIFIED SEWERAGE AGENCY NO.
WASHINGTON COUNTY DATE 11-22-76—
CITY OF Tigard
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: ._ .. - Herb Morisse 11 te_'____
OWNER'S ADDRESS:
STREET
CITY— _ STATE ZIP
BUILDING SITE: LOT__ 16 BLOCK ADDITION
TAX LOT NO. TYPE OF OCCUPANCY —_—residence
ADDRESS
DWELLING UNITS--,.--- - -1 FIXTURE UNITS
SURCHARGE IF APPLICABLE . —.—------
PERMIT FEE -- . INSPECTION
57500 FEE __25. 00 TOTAL DEPOSITED r7 00 00
(NEW) (EXISTING) BUILDING SEWER SYSTEM Fenno Creek
The Applicant agrees to comply with all rules and regbilail ns of the Unified Sewerage Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE INSTALLER ------—
RECEIVED BY_
_%GENCY OR i7S AJI,
COMMENTS:_ p1dq._:'1173 Leron lieirhts
This Application and permit expires in one hundred and twenty ;120) days.
The amount paid will be forfeited should expiration occur,
°"®"Wf`7A t'-• F.. 1"w�.*3""'yZ9`.,;k"�M,�}D'Q!`T*yj7`1Y}!M'A�`c"'..... `"'"pMe" _�.r �+�^%:+irw...y,
BUILDING PERMIT APPLICATION 11TTIGARD DATE 11-22-76 ,s 1173
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILOERPHON., 246-6en3
OR AS SHOW14 AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNS:PHONE_
LOT NCI.
OWNER Herb Plorissettu JOB ADDRESS 11860 •ALJ 113th I S.n HOME ADDRESS
_ ARCHITECT
BUILDER O!>!MO ADDRESS ENGINEER DESIGNER I•L6 _t+�11['h
STRUCTURE NEW LREMODEL CIADDITION C1 REPAIR _ ❑RENEWAL ❑FIRE DAMAGE _❑DEMOLITION
ST
`,1 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO [:]CARPORT ❑GARAGE 1_1STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONnITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY—I—.LAND USE 20NE m2--BLDG.TYPE---aPL—FIRE ZONE PLAN CHECK BY HEAT_-
Const,—:.ngu fenily owallint,, +/; ttacbed garsg� 3 t:adroam 2 both —_
garage 510 w-,. Pt.
9",L29 ____—FLOQ13 LOAD _ - HEIGHT- . -gym —o—ST RID._ AREA 100NO. 1 FjQQ�n-� 3 VALUJLMZ =
-
BUILDING DEPARTMENT SETBACKS F H01NT REAR 39 LEFT SIDF RIGHT SIDE 10
Pe.rmit 1 12 4.OC) -- -- —
TI-41S PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE PUILDING CODE, ZONING
Plan Check 62.00 kFGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED TMP r 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 CONTPACTORS TO HAVE CURRENT CITY BUSINESS
State Tax Jg LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
T�tal
L�ppm,ecl
ApPI-CANT OR AGENt
Receipt No.
ADDRESS
W IAC
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE—
Contractor _
Permit No. ( •'3,1 36 76
Rough-in
�j - Fixture _
- 7�� Final
HEATAO
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Contractor
1 Permit No.
6 a�
-- — - Gas or Oil
--- Rough-in
Final
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SEWER
- — - -- DRIVEWAY �G ,��'/-�7
Final
— - — 'Storm Drainage
(Rain Drain) Final
_-_-- Sidewalk („e- 3-jJ-7 7
Cvrh&Street Final
_ np roach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICA—E OCCUPANCY F inel
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G 4 // .�._ Permit 'Jo.
Permit charge 22
C2 6" L
Owner Connection fee 5 `
Paid by
Type of building
Date connected
Inspection fee �.="
Service rate A� -
�� Paid by Date
Contractor
Size of connection Assessment paid _