13735 SW 116TH PLACE T-r ,
_. 13735 SW 116TH PLACE
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City of Tigard
I NbPECTI ON REQUEST
for
INSPECTION TIME: PERMIT NO. :---
DATE:
O. :—_DATE: r, //Z /? a DATE ISSUED
OWNERS NAME .*
ADDRESS: --
C D N'r R A(,'TO `Z : --- -- — - --- ----
'i EST ' Al f u, Watery , V;sual f7 , I_cboratory I-J
RESULT: Ap,�roved )iiapprovad G rendinq [�
SKETCH.'
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INSPECTOR_ DATE
-NOTE Attocn supplemental test data her"t01
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City of Tigard
INSPECTION REQUEST
for
'oQo%e cep
INSPECTION TIME : --L-1�0 tom,-PERMIT NO. :
DATE: 20 %? DATE ISSUED:
OWNERS NAME : L2uaiko,
---------_.-----
ADDRESS : ►3��s ��� ; '�_ — – —
CONTRACTOR : -----
iTEST. Air 0, Water p , Visual Q Laboratory p
RESULT'. Approved FJ', Disapproved ❑ , Pending ❑
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SKETCH*
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INSPECTOR DATE
ICOTE : Attach supplemental test data hereto
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Lit issued 49-4 7.2. Czff OF ?I+<A", C1x110014 � Pnrmit Pia__
city]Full '4
APPlicatian Approved Building Deparbmt C'M4 of InitsIlrtlou-. zW..=- ~
Ry�lt�t--�dE�- - ---- ''�plrLoar.µ"a fr`' 1�raa�, ID�ia�at� lnoNriidL�ifih�
Fee for Permit.._._-
Applicant shall fill in cost of installation oilly,
above this double line. street Sewer Perri&____._.____.
Application is hereby made to Plumbing Pipes or Fixtures according to plane and specifications and
11 description as given below:
Lavation of building---Number and Street_...- 13735 SWj.�1li p��F
-----------_---
Lot--- _-___ _ Block_ -
_ !
AdditionHOLLYTREE
Name and Address of owner_ -Qu�ANr CORP 1750 SM SKYLINE BLVD P'ORTLA 97221
IMPERIAL PBLH 9 HT6 , INC. P 0 BOX 106327 PORTLAND 97206
Name and Addre" of Plumber.__ ------
Building (Old or New) _. _ Height in storing ONE Occupied as RE39W CE
SCHEDULE OF WORK
-__--NUN = _ NUMBZRR
_ FIXTURES New Move R'pl'ce FI][TURES Nowllcne R'pl'a
Wfte:`Closets __II. Fountains, Drinking___
Ba(A Shower-__-- — i I_ _--. � Fotmtains, Yard_ _
Bath Tub_.__ _s___L Fountains, SSoda
I _
Basins _ _.— 2 Hot Wats Tank._._ i
Sinks, Orlin 1
ary__ __ � 1 �..__.—I sinks, Bar_
Sinks, DishwashingSinks, Sit 1) —_ I
I
Aulom,ntk Dishwasheri------
__.__ Drains, Refrigerator
Laundry Trays _--_I __ Drains, fee noir
Drains, Floor___ —� _ _ fnrwals y_
Drains, Areas o _ `— r atrh Racing, Yard__r I I�
.9_!Rain Drains—- .I,-- ('atch•Bastns, Garage---___
Automatic Washer _I_, Catcb•Buins, Sub Soil` �
Water Permit No.---- Bldg. Permit No.__ 72-�Y-L-
REMARRiI:
IMFORTANTI—P'utnbing shall net be installed in any building, (either now, altered, or repaired), except as shown or designated
en the corresponding building plans as filed with, or repaired by, the Building Department Ih eeterdapee with the
ptnvisions of the Building Code and Ordinance 62.19 e/the City of Tigard.
fiftr
I agree to a the plumbing system according to thin desert ane and specifications and Plumbing Code of the
Pity of Tigard.
leg
Plumbing Firm W'St & PBL6-4 R;6,- INC. -- -_
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UNIFIED SEWERAGE AGENCY NO 4708 _
WASHINGTON COUNTY DATE 8-Z-72
CITY OF ------_----xi
APPLICATION FOR SEWER CONNECTION PERMIT
Quedrsnt Oorporation
OWNER: -_- _..__---- _-----------.___-_._. ._.. . _._._. . _ _- ---_._ .
OWNER'S ADDRESS: 1750 S.W. 3kyliw.# Suite 20 297-3721
STREET
Portland _ ---..QxvgD
CITY STATE ZIP
BUILDING SITE: LOT---9-- -.-.---_ BLOCK _-. . _ ADDITION _.__._----_-_---
TAX LOT N0. _ ___._ TYPE OF OCCUPANCY Reaideaoe
ADDRESS . 13735 S.M. 116thPism
DWELLING UNITS 1 _. _...._ _ ._ FIXTURE UNITS 16__
SURCHARGE IF APPLICABLE __. 50.00 Lo Derry Dell _
PERMIT FEE 425+04 INSPECTION FEE 25.00 TOTAL DEPOSITED
(NEW) (EXISTING) BUILDING SEWER SYSTEM ._ ?isatt'd
1'he Applicant afli-cos to comply with all rules and regulations of the Unified Sewerage Agency;.
APPLICANT l 1` " C.:,C/c� 4s, / C � �•j►1•
SEWER PERMIT
THIS, PERMIT AU'l HORIZES CONNECTION TO THE SEWER SYSI EM,
LINE SIZE 4" INSTALLER Lloyd Iran
RECEIVED BY c1 fit ► �c -f
/( 1 ENCY OR ITS 40ENT1
COMMENTS:
i
This Anoliration ,ind permit expires In ninety (90) days. The aniuunt (,,lid vvill he fo Ovited
should exl;iratlan occur.
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BUILDER VALUE FEE , DATE t
LOCATION
10.8 N1AN # LOT
LUMBER 4 PERMIT
SEWER PE-HM F ,E �i� , ,� ,.yo MECHANICAL PERMIT
DATE BY DATE
EXC_AVATION/FILL AIR CONDITIONING i
s ?' FOOTINGS FOUNDATION VENTILATION
.?
FORMS T- SPRINKLER SYSTEM 7
SLABS _ MASONT RY/FLUES
REINFORCING STEEL FIRE DOORS EXITS _
STRUCTURAL STEEL GARAGE FLOOR
77 ' PLUMBING R, I . _ DRIVEWAY
ROOF FLASHINGa�W�•��� ~�~
ER
FRAME %•, ST_OR14 DRAIN _
LATH WALLBOARD PARKING
HEATING FENUE SCREEN ..
WESTER HEATER FINAL .
CITY OF TIGARD
INS L W. Main drew y
TIGAM OftrG M "227
APPLICATION FOR BUIL3ING PERMIT
New Construction Demolish ❑ Addition ❑ Remodel 1__J Move❑
ZONING R-T DATE. ISSUED 7.0-72 BUILDING PERMIT
DATE RECEIVED 7-18-7'L
BUILDING FEE $ _ No. a I^1 t�
BY
BE PLAN CHECK $ 701
OTHER $� 10.00 VALUATION $ ��
TOTAL $ 00 RECEIPT No.�G
`—' Q-x-72
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
j LOT A_ 9 MAP A W 3C CENSUS TRACT :OB A�
Architect or Engineer Jack Woodma i Asr..alates ArcUteats
Address Bell.vus, V"Mngton —Phone
Owner
1750 3-W. U711= Blvd.
Address --- ------- Phone`—
Builder serge
Address sews _ _ Phone_
BUILDING USE Single Rer 511 Multi Res. ❑ Comm. ❑ Industrial,
OCCUPANCY GROUP I No. of Stories 1 Total Height 16' Area of Lot W&V
Type of Construction ] - §F0 ff V Floor Area B .. 1_ ]_.435__ 2
Set Backs: Front 22_ Back 30 L.Side_ 5 R.Side V _
Private Sewer Pipe Size Y`4" SewerU.B_A. TilpxdSeptic Tank ❑
Water Service Pipe Size_"(1A•_— Storm Sewer 1;1 Ditch ❑ Drywell❑
Street and Curb Requirements egetlng
Driveway Width �jb! No. of Parkinq Spaces_ _ _
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED 13735 8. IA"Maas
FIELD CHECK BY — _ _ —_ DATE_��-�
PERMIT APPROVED BY
It is understood that all work will conform with applicable codes and ordinances
of the State of Dragon and the City of Tigard, Oregon, and that the building will '
not be occupied until a Certificate of OccupAncy has been issued by the City of.
Tigard Building Inspector. ��
S gnature of Applicant
�.c�t�./..�„t�,.' USO ''� �'/'.✓ �,
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Address 13735 S.W. 116th Place w Permit No.
Permit chargeowner --
quadrant corp. Connection fee
Paid by qur.,,drant
residence Date co:u.ected
Service rate
Type of building
3.00 per month Inspection fee �5 ,
Paid by Late
Contractor auadrr�nt rnr-��_ ----
��
Size of connection Assessment Paid----
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