13795 SW 114TH AVENUE 13795 SW 114TH AVENUE
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�;ifiy of Tigard
INSPECTION REQUEST
for
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INSPECTION TIME : .� PERIVIJ NCI. :_tl
DATE: `/ � DATE ISSUED
OWNERS NAME �1��k• � l�,� -.-�.�
ADDRESS'. ?`'�S
Cor-T R A C T 0 R
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TEST : Air ❑ , Water(:] 7VisuuA Laboratory []
RESULT: Approved/< Disapproved 0 , Pending
SKETCH:
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INSPECTOR DATE
COTE . Attach supplernentcl !eet data heretol
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Address 13722 S.W. 114th Ave. Permit No. 4749
Permit charge
Owner Mike Benner Connection fee 425
Paid by Columbia Custom Home,
Type of building Residence Dote connected ._._ 11-23-72
Service rate 3.00 per month Inspection fee - 25.00
Contractor '.;olumbia Custom homes Paid by same Date
Size of connection 4" Assessment Paid
Ciiy ;f Tigard
INSPECTION REQUEST
(� for
INSPECTIONTiME:, ,c-=' PERMIT N0.: 411
DATE: /,-k3bJ-%} DATE ISSUED:
OWNERS NAME :
ADDRESS:
CONTRACTOR : ---
TEST:Air D, Water [] , Visual C} , Laboratory Ll
RESULT: Approved 0 , Disapproved O , Pending []
SKETCH:
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INSPEC li*0R DATE
E:NOTE*. At!-.sA supplementul test data heroic
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C.r r`Y OF TICARD, ORMW '`` t t Na_ )Vo 7,
mil Ltavest __L
- City H&U
AWcatim Approved Building Depar'tnwM Coat of batimadoa_..___
�_ _.__ Ao�tntera • � �� Fee for
I Applicant shall fill in cost of installation only,
nate 41 yd ?. ---�- _- I a?hr,ve this double line. Street Saw•er
� - g to di
Fixtures Pi
Plumbing Pipes or xures accorn
Application is hereby mode to Pl4,.ans and specifications and
Install description as given below:
Location of building—Number and Street—��3
Addition__.
Name and Address of Owner� G��_��-,,Frh�'.__ .4.-t
Name and Address of Plumber
04,
Building
�p"�' ! -
Building (Old or New)__ Heigbt in Stories— _.. __ Occupied aa__
SCHEDULE OF WORK
NUMBER NUMBER _
- FIXTURES-- -- NowI Move R'pl'co A'�IX"MRE.S- - Nfew Moire R Pas
Water Closeto _-- I Fountains, Drinking__I__
Rath Shower_ Fountains, Yard-
Both
ard_Bath Tuh Fountains, Soda-.. .
I /
Basins —_r.---,-__—._I��-----I� Hot. Water Tank
Sinks, Ordin"1h_ Sinks, Bar___
Sinks, Dishwashing —� Sinks, S-lo�,�0'
Automatic Dishwasher._I�_ I .� Drains,
I�
Laundry Trays i`_I—_—_�._- _ Drains, ice Bo= --
Drains, Floor-- Urinals I� _
Drains. Ana__- Catch-Basins, Yard
Rain Drains-- -- _I s` --._�5 __ Catch-Basins, Garage -
I i
Automatic Washer Catch-Basins, Sub
Water Permit No _- - - - -- ----- BIdg. Permit No. -Is--11? —_
RFMARKS:
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IMPORTANI!---Plumbing shall not be installed In any building, (either new, altered, or repaired 1, euucept as shown rr designated
on the corresponding building plans as flied with, or reauiroa 61, ti.- Building Department In accordance with "w
provisions of the Building Code and Ordinance 62-?? at the City of Tigat a.
I agree to plumbing system according to this description, pans and specihcaticns and tta,Plumhing Code of the
inctall City o igard. `
- �*a-s-_
Plumbing Firm . _ _ ._ _ ._—.--- - - - -. �—._
—. Superviso
SHE
tt-
VNIPIED
SEWERAGEEelf ,� �7�9
O. _-.._......_.._...�..
WASH NCT'ON COUNTY DATE
CITY OF-
APPLICATION
FAPPLICATION FOR SEWER CON"ACTION PERMIT
OWNER:
OWNER'S ADDRESS: _., :.-_+ l1141�._ >�4!_-_-----_.
STREET
34
TE -- --- r ZIP
-- - - ---
BUILDING SITE: L7TBLOCK ADDITION
TAX LOT NO. _.�__... _ TYPE OF OCCUPANCY
ADDRESS ..-----------------. �"l�_�:Ka U4
h_
DWELLING UNITS_____..__l. FIXTURE: UNITSSURCHARGE IF IF APPLICAf;LE ___.___Q,Qft- rAr27 joffiUi
PERMIT FEE . ._d ,AQ_._.._-_._. INSPECTION FEE ___--2.S.Qp TOTAL DEPOSITED ._..—=
(�VEW (EXISTING) BUILDING SEWER SYSTEM T
The Applicant agrees to comply with all rules and rr..yulations of the Unified Sewerage Agency
SEWER PERMI,r
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEIN,
40 Ck�r Mg.
LINE SIZE INSTALLER
RECEIVED BY - _ *-
(A 11 ITB A NT) -- -
COMMENTS:
This Application and pprrrit expires in ninety (901 days The amount imid will he !orfeiteil
should expiration occur
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BUILDER eL 't VAL -E .1 `W FEE /Sly Jv DATE
LOCATION
J'�' i Ow1tER
-�,� < O7 't TYPEPLUMBE, PERMIT � �,—
F i i:,LYd FEE 's
SEWER ehtft FEE _�5 r � �ECHANTCArL PERMIT
DAME BY ?3y
FILL J
EXCAVATION i
L .ATR CONDITIONTNG
_ FOOTINGSIFtIUNDATION _ VENTILATION__
FORMS � SPRINKLER SYS'T'EM yi
SLABS MASONRY'/FLUES
REINFORCING STEEL � FIRE DOORS EXITS ^
STRUCTURAL STEEL GARAGE FLOOR_
/zj� PLUMBING R, T .
DRIVEWAY�__�
ROOF FLASHING _ SEWER_�______..��__
' FRAME ,r; _ STORM DRAIN
LATH WALLBOARD _ PARKING
_ HEATING � i�ENCE SCRLGN
_ WATER HEATER �^ - �� FINAL
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CITY OF TIGA,RD
12420 S. W, Main ftrxN
TIGARD, ORESON 972271
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Denol.ish ❑ Addition ❑ Remodel f❑ Move C�
ZONING_- DATE ISSUED l0-3.J-72__ BUILDING PERMIT
DATE RECEIVED 10-5-72 BUILDING FEE $ No. •7M�
PLAN CHECK $ '"'� AW
BY--- SS ---- OTHER $ VALUATION $ 28,248.00_
TOTAL $ —1 0 RECEIPT No. (5 J/ 7
7- �
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N 32 -_� MAP N 281 3DC CE14SUS TRAc,r W-19 a .JOB N_-_
Architect or Engineer__ _ �91i+�4b�ASt4IDpW4__—___.__
Address—.----_.— -- -- - -- -- --- —Phone—,-----
Owner Mike Benner —_---------.---- - —
Address 13795 a•W. 44th _ -_ -- - - Phone
Builder (Yfluiebi. f`ucfnm Hmeea -----
Address
BUILDING USE Single Rees. Cj Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP I No. of Stories—1 Total Height 21 Area of Lot.---
Type of Construction V Floor Area B 724- 1. 1536 2 1480
Set Backs: Front 22 Bark_ 55 L.Side 8 R.Side_6-6
Private Sewer Pipe Size 4" — Sewer U.S.A_TiNLi9eptic 'rank
water Seri-ice Pipe Size _3, '0 Storm sewer 51 Ditch ❑ 1)rywe11
Street and Curb
Driveway Width No. of Parking Spaces Z
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL 7173RMATION
No occupancy until moratorium lifted
ADURESS ASSIGNED 13?Q5Q•1f. 114th Aw.
FIELD CHECK BY DA'rfJ3-T.2
PERMIT APPROVED BY —
It is unders;.00d that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of11gard, Oregon, and that the building will
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard I,uiidinj Inspector.
S nature of Applicant