11155 SW 115TH AVENUE a
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Address //.S S � /, ` Permit Nlo.
Permit charge 21 D �+
0 w n a r _ �/v,�,Lr-; .rConnection Fee ;
Paid by ) L2ll
Type oP building Lj- nate connected
aRrvice rats LL Incpsction Pee
Cuntractor Paid by data
Size of connection A33essment Paid
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-- SEDER PERMIT M 13809
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Unified Sewerage Agency CITY OF Tzyard DATE 10–1—0–ZZ-
of Washington County
PHONE
OWNER : Nott
OWNER ' S ADDRES_' : —.
TYPE OF INSTALLATION:
X>x BUILDING SEWI FR ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
QXSINGLE FAMILY ❑ COMhtERCIAI_
X x�t9E W
INDUSTRIAL
❑EXIST . (PRIOR TO 7-1-70 ) ❑ MULT . RES.
FIXTURE UNITS __ DWELLING UNITS
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING
POR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION
EXPIRES IN ONE—HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEES
PERMIT FEE $ 7S
CONNECTION CHARGE Ann —
SIDE SEWER INSTALLATION — ISSUED BY
OTHER _-
T O T A L ' $"112
/�`✓ --- DATE
APPL I CANT
e�
SEVIER PERMIT N t3809
ADDRESS OF STRUCTURE
TAX MAP--
AP —
TAX LOT SYSTEM fanrto creek
LOT BLOCK __OF
APPROVED BY
DATE ISSU HY DATE:
REMARKS bldg. #1737 Paid to Leran Hoiahts O.O Q
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CITY OF TIGARD
ORDINANCE #77-26
STREET SYSTEM DEVELOPMENT CHARGE
iaATESTIMATED SALES PRICE esv
APPI.ICANf NAME :.;-�,_e TELEPHONE 7f
JOB ADDRESS ///5`S- s BLDG. PERMIT
AMOUNT OF FEE FOR S. D. C.
DF5CRIPTION OF IMPROVEMENT
EXEMPTIONS -PER ORDINANCE #77-25
F FE HATE,",:
A. Single family dwelling unit under 960,000.---------C ,300.0��
B. Si.nglo family chielling unit over $60, Gf10.---------» yIQO . 00
C. Plabilo Hortic, Court Space (Now Development)------------ y 15D. 00
4
D. Multi--Family Uwellings: por unit-------------------- ;240.00
E. Coinmercia .; Industrial & Institutional(Park. Space) 1 50#UO each
F. Single family unit undor $40, 000. --_ ..... ._ .______..__ Oo250.00
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,
CITY OF TIGARD
ORDINANCE #77-71
PARK SYSTEM DEVELOPMENT CHARGE
DATE . ESTIMATED SALES PRICE
APPLICANT NAME fJc�: i--C ,�..�, �u TELEPHONE
JOB ADDRESS I;/� S' ,Qt,J iiS �� BLDG. PERMIT
AMOUNT OF FEE FOR P. D. C .
DESCRIPTION OF IMPROVEMENT
EXEMPTIONS - PER ORDINANCE #77-71
FEE RATES:
A. Single family dwelling unit uruer $40, 000. - ------------$ 75. 00
B. Single family dwelling unit over $40, 000- ---------------
J070;
C. Mobile Home Court Space (New Development)-------------- , 50. 00
D. Multi-Family dwellings--per unit------ ----------------- 60. 00
CONSTRUCTION___I-L-LOCATED 0k --S.W. t-- N.E . SIDE OF S.W. PACIFIC,
HIGHWAY. A.E , is park District2 . . S.W. is Park District #11 .
-.......�.«�.�,.w� •-..r..w.ww+�n+.a s.x..m.+-r•...�.....wrap+ar+,.'X576+�Tw+"w7rlr�+'.'NwY7Jkvr�f"^.'�^M91++•'°r^'^..+;�,�,.'�.7wn.�1AR�IM T........-..r
1TY
BUILDING PERMIT APPLICATION coy TIGARD DATE_. IQ-10-77 . ts__ 173'
THE UNDERSIGNED HERE11Y APPLIES FOR APERMIT FOR -THE WORK HEREIN INDICAT-D BUILDER PHONE "r
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE--- —
LOT NO. ,
OWNER ..): f'lf-11 anti jIIG• JOB ADDRESS HOME ADDRESS
ARCHITECT
BU LOER Lic^!ti c ENGINEER
ADDRESS DESIGNER_
Sj' RUCTUR, UNEW ❑ L ❑
REMODE ` ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
0RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB [-]FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW CCOUNCIL APPROVED ❑SIGNS
OCCUPANCY —LAND USE -ONE BLDG.TYPE----FIRE ZONE_ PLAN CHECK BY-__ HEAT
alt-ti16 (am,L1 y W/GttaChEad ijurat-, 3 bed doom 2 bath
CGS.LOAD _____FLQQRlQRD 40 _ 4EIGHT_ L . _ NO.STORIESL —ARE)Q ;_Q__M BEDROOMS`„j VALUE31.OLLI.
BUILDING DEPARTMENT SET BACKS FRONT REAR.:1.) i.fa f
LEFT SID[ RIGHT SIDE
Permit 1~.30.L1(J �--_ ---- ------ _,_�_-- __--THIS PERMIT" IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 63.Oil REGULAT ONS AND ALL ArPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
— WORK WILA BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub total l `�.':�.(j CJ ALL APPLCABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- - RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 7,80 LICENSE, SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
.:..r
Total 202.80
By
-- — A IC'.ANT OR AGENT
Approved —� Receipt No,
A RESS --
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DATE INSP. TYPE INSPECTION REMARKS— PLUMBING -` DATE
Contractor o
Permit No.
��l`I-,'I Rough-in-_
/`J� ( _ _ Fixture
4,J -c� ...e-�-� � Final
HEATING
. Contractor
\ -
Permit No. _
Gas or Oil
Rough in
- Final
SEWER
Final
DRIVEWAY
v Final _
_ Storm Drainage
(Rain Drain) Final J
_ Sidewalk
Curb&Street Final
A roach
BLDG DEPT. FINAL TEMPORARY .ERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —
(_ Landscaping
Zoning Final
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