12522 SW 123RD AVENUE 12522 SW 123RD AVENUE
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CITY OF TIGARD
i OREGON
D.W.D. Contractors �b
Owner:. __... ...-....—J.2 ...................23--.-............................Permit No.........1�+68
Building Address...2.522 .SW...1:2:ird..................................................... .
Certificate is hereby given tVs... i clay of.D.oc.emh.er............. 11..7.7..
that said building may be occupied and
that it complies with all requirements of
the Building Code for the City of Tigard,
as approved by the Tigard City Council. 1r '
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,.jildinR Inspector
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Permit No.
per.tn.it chirgE:
Connection f fi c
Paid by
.ryI-jF) of building �� ._..w_...._ Date ronnacted
5orvicri rata y i' ?nupoction fee S��G
ContracLor _._._._-.__.r.�._._. .. _. Paid by _. _ Da-1;n
Si.zc,, rjf connect inn _. __.. ... Aor4nss,ment
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�- SEWER PERMIT ��, -
12174
Unified Sewerage Agi:ncy
of Washington County CITY OF Ti as rd DATE 5-27-77
OWNER : D.W.D. PHONE : f.39-6881
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
Q BUILDING SEWER ❑BUILDSNG SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
Q NEW Q SINGLE FAMILY u COMMERCIAL
❑EXIST . (PRIOR TO 7-1--70 ) ❑ MULT . RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
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 .
FEESt
PERMIT FEE $ ?5•
CONNECTION CHARGE 575.
SIDE SEWER INSTALLATION '
ISSUED BY
OTHER _
T L $ 600.
APPLICANT DATE
SEWER PERMIT yU 12174
ADDRESS OF STRUCTURE 1.2522 SW 123rd-------
TAX
23rd __—__TAX MAP_ 251-388 _ TAX LOT 7400 . SYSiLM Fann4 Creek
LOT 2 BLOCK _ OF
APPROVED BY DATE r ISSUED BY DATE
REMARKS Rlda. . 1468
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y BUILDING PERMIT APPLICATION 11T TIG,ARD DATE 5-27-77 -. 19- 'A F j
OF
THE UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDERPHONF
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
LOT NO,
OWNER Li OLI•Lj• Jnst.JOB ADDRESS .L LL SCJ 123rd HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER !3c'1!?1G."' ADDRESS - r-1 DESIGNER _
STRUCTURE mw ❑REMODEL ❑ADDITION ❑ D
►;
REPAIR RENEWAL ❑FIRE DAMAGE ❑DEMr—OLITION
�RE',IDENCE ❑COMM DEDLICATIONAL OGOV'T DRELIGIOLIS PATIO LJCAR PORT ❑GARAGE D STORAGE DSL.AB GFENCE
_ DBOND GMOVING DCONDITIONAL USE 0DESIGN REVIEW ]COUNCIL APPROVED ❑SIGNS
OCCUPANCY Z LAND USE ZONE_ 1(+ / BLDG.TYPE FIRE ZONE PLAN CHECK BY� HEAT-__
�:on8ti a your bodroom 3 bath .single family dwellin4 wjattactied garaya 1.l i --
_ basamant. Lot x I gku TUrract, Tax Lo L' Bann TAY Man 2S1_:%RH
H E19±fT- NO.STQR ES _AREA 1344 ND.H=QMS_A VALUE=98 9QQIL
BUILDING DEPARTMENT SET BACKS FRnN t om( _ REAR 4U LEFT SIDE 1� RIGHT SIDE 1L
Permit _ ap"l.dt) -�_—�.---- -
-- T41S PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN 1HE BUILDING CODE, ZONING
Plan Check ln��;,l•1 REGULATIONS AND All_ APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORN WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPEf'IFICATIONS AND IN COMPLIANCE WITH
Sub total ALL. APPLICOBLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITIBUSINESS
State Tax t LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
jyatwM ULvalopMwF1t Lnoryu y4LJ!J. )i_;
Total c
By AP CANT OR AGENT
Approved �(3 Receipt No.
_
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No. 0
o J 13 SEA1iFr "L.00IZ Cs = Rough-in
]Fixture
"�2- ➢ c Final -
20-`l e4l HEATING
9 Contractor
-16-'l7 '� Gc►t�'l V,�i Permit No. /,y3 3� //7j
Gas or Oil Ct7,�
Rough-in
Final _
SEWER
Firal
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
C Zoning Final
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CITY OF TI GARD
ORDINANCE h77-26
STREET SYSTEM DEVELOPMENT CHARGE
DATE : ZZ _ ESTIMATED SALES PRICES C]v.�
APPLICANT NAME � Gl> � C.�R/�i�c�,f'� TELEPHONE � 639-6881 _
SS-;c;2 Rn BLDG. PERMIT #
J06 ADDRESS cS'(�' l� 3 "— —
AMOUNT OF FEE FOR S. D. C. $400.00
DESCRIPTION OF IMPROVEMENT ,A)a2 lca
EXEMPTI)NS -PER ORDINANCE n77-26
FEE RATES:
A. Single family dwelling unit under $60, 000. --------- $3DO. 00
B. Single family dwelling unit over $60, 000.--------- $400. 00
C. Mobile Home Court Space (New Development)---------- $150. 00
D. Multi-Family Dewllings--per unit------------------- $240.00
E. Commercial , Industrial & Institutional(Park. Space) $ 50. 00 each
F. Single family unit under $40, 000. ----------------- $250. 00