12198 SW 125TH AVENUE mWWWI"ff
-- 12198 SW 125TH AVENUE
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Address �R$ �� r �� Permit No. U-1�9�•—_�__. __
Permit charge
Owner
Connect ',on fee
Type of building Date connected I- LYS
Service rate x`51' Inspection fee _ 4'jf2_
Contractor '`' Paid by date _
Size of e-onnection tI`� assessment paid
X0 _ 33
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City of Tigard I
INSPECTION REQUEST
for
INSPECTION TIME : 2 00,p" PERMIT NO. :-1-
DAT
O. :
DATE: 1� DATE ISSUED .---/ Z I
OWNERS NAME : 506-1 I
ADDRESS: -.5 /ZS"
CONTRACTOR : _L�-1�� �aH S - -.-
TEST : Air ❑, Water❑ , Visual [3;L.aboratory []
RESULT: Approved EJ , Disapproved ❑ , Pending []
SKETCH:
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INSPECTOR DATE
LNOTE.' Attach supplemental test data beret a]
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thiltnit issued-&L.2-.ZZ OF TIGARD, OREGON Permit No.
Application Approved Building Departmen'� Cost of .Installation—_..____.
By z'ao p4aw'J"51i Fe? for Permlt�
App-lil-ant shall fill in cosi, of installation only.
Date.... above this double line. Street Sewer Permit
Application is hereby made to ilumbin& Pipes or Fixtureq according to plans an( specifications and
eAer--'—
inrtaill description as given below:
UK'atio,n of building---Number and Street--./,?
Loc Block---.- Addition
Name and Address of Own viiw'—e-�
Name and Address of Plumbei_4
Building (Old or Height in Stories Occupied as----
SCHEDULE OF WORK
NUMBER NUMBER
FIXTURES New I Move I R'pl'ce FUCTURES New ur e 'Pl'ce
Water Closets Fountai liTs, Drinking-----
Bath Shower -aflo Fountains, Yard—!
Baih Tub- z A410 Fountains, St)da--.--
flot Water Tank—
Sinks, Ordinar� Sinks, Bar -4—
Sinks, Dishwashing AIM_ Sinks, Slqjl,,t .0
Automatic Dishwasher Draj-'-lia-lem&,r for
Laundry TI
Drains, lee Box
Drains. Floor_ Urinals
Drains, Area_ Catch-Fasiras, Yard--.--
Ut?
Catch-Basins, Garage
Rtin Drains--
Automatic Washer- Cal(IT-Basins, Sub Soil
Water Permit No Bldg Permit No.-7A2_-@V *A__
RFMARKS:
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IMPORTANT!- Plumbing shall not be installed in any building, (either now, altered, or repaired), except as show" or dosignaled
on the corresponding building Plans as filed with or required by, the Building Departmunt In accordance with *0
provisions of the Building Code and Ordinance 67:19 of the City of Tigard.
plumbing system according to this description, plans and specifications and the Plumbing Code of tM
C
install [
I agree to =�+�nity
'# Tigard.
Plumbing Firm-
'o
Supervisor
. �'_sBUILDER CJ ern C.�07,,a;� . VALUE 1-7, I f FEE ��� DATE /'I-7 Z
LOCATION 1 j �; ` c_ f 1. - 1l
l «:S : � UwIv�;R a;rt.w � <<
JOB # DIAP TYPE 4.
FLIM PERMIT FEE rI
SEWER :P�,?I 1 -7S -r .75 MECHANICAL PERMIT
DATE BY DATE
EXCAVATION FILL AIR CONDITIONING
FOOTINGS FOUNDATION 1� VENTILATION
FORMS SPRINKLER SYL_EMw
_ SLABS MASONRYZFLUES
REINFORCING STEEL FIRE DOORS/.EXITS
STFUCTUF.AL :STEEL GARAGE FLOOR
PLUMBING R, I . _ DRIVEWAY � w
ROO e, FLASHING SEWER
FRAME STORM DRAIN
LATH/WALLBOARD _ PARKING
_- HEAT I i6 FENCE SCREEN
WATER HEATER
1■r ! 11! ! ! ! ! ! ! I>0!'
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UNIFIED SEWERAGE AGENCY NO. 4759
WASHINGTON COUNTY DATE _ 11-1-72
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CITY OF ----- --- - -- Tigard
APPLICA-TION FOR SEWER CONNECTION PERMIT }
Y
OWNER: ______y��Qll�_SaEether�olltl Jr.
OWNER'S A[",DRESS: ___._.12198 B.M. 125th Ave.
STREET _ --
_Tigard
_CITY97223 �
STATE .__.----- —.---- 97223
ZIP
BUILDING SITE: LOT 32 _ BLOCK ____ ADDITION BrookwaY
TAX LOT NO TYPE OF OCCUPANCY _ _ -
A00RES:; __ .______12198 S.iw. 125th Ave.
DWELLING UNITS_
FIXTURE UNITS __..__ __._._14__.
SURCHARGE IF APPLICABLE--
PERMIT FEE . 425.;i>a_._._ INSPECTIGN FEE —25-AWTOTAL DEPOSITED
' (NEyidI (EXISTING;) BUILDING SEWER SYSTEM
i The Applicant agrees t.) comply with all rules and regulations of the Unified Sewerage Agency.
APNt_iCANT.__ L
SEWER PERMIT
)'HIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE . . - -- 4"-- ----- INSTALLER
RECEIVED BY--._ - r
fAGEN Y oR ITS AGENT) -
COMMENTS: _
This Ar,)lication and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
7.2
Ole
CITY 0701
;4 tfRNl tle a RAMI
i APPLICATION TOR AUXLDIM POST".'
Constr•Action �y Demolish Addition 0 Remodel
%OWING 1-7 DATE ISSUED-11-1-'M BUILDING PERKIT
�xll'L'8 RECEIi/^:U BUILDING 'PSI $ d P No.
�` PLAN CHRCK _
OTHER $� VAI: ATION $ 1
TOTAL S LbQ.Oq RECEIPT No..�&
TWO SETS OF PLANS AND PLO PLANS MUST as FURNISHEP WITH APPLICATION n"
LOT ice_ MAP # 41 CENSUS TRACT Y•l2JOB M
Architect or Engineer
Addresii 11660 B.Y. Timberliw Dr., Beaverton
Owr_er_T__jft1 i jkal lsess .1.
Address- - U
Builder
Address
BUILDING USE Single Res. 1i] Multi Rea. ❑ Coram. I J Indu.tr °
OCCUPANCY GROUP I No, of Stories l Total Height 16 — Area of Lots
Type c ° Construction aAM V Floor Area B -- 11176 2_ --
Set ear'ks: Front 20-6 Back 7b _ L.Side— 5 R.Side 9
Private Sewer Pipe Size W" _— Sewer_U.B-A._TiWQ?ptic Tank 11
Water Service Pipe Size 3/4, Storm Sewer a Ditch ❑ Drywell
6
Street and Curb Requirements` VdstiO4
Driveway Width_ 16 No. of Parking Spaces_
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SEPARATE PERMI13 REQUIRED FOR SEWER AND PLUMBING
SP°:CIAL INFORMATION
ADDRESS ASS GNED— 12196 6.n._125th,xa.
F IELC CHECK BY _ ._ !!E_ __DATE Il•1.7i!
PERMIT APPROVED BY �
It is understood that all work will conform with applicable codes and ordin&PCOG
of. thn State of Oregon and the City of Tigard Oregon, and that the building vi
mot b* occupied until a Certificate of Occupancy has been RReued by the Citi Ot
ViWt! Building Inspector.
nate e o Applicant
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