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eitp of Tigard Building pa.partawnt
13125 9% Ball ltivd. Tigard, Oregon 97223
Inspection Line (Rec-O-phone): 639-4175 Busineen Phone -4171
Inepection:_ r---- --
Footing
plbg. Ondorelab Mech. Rough--in Appr/Sdwlk
Found. Plbq. Top Out
Gas Line FINAL:
poet/Beam Struct(�-_ San. Sewer
Framing --Bldg.
post/Beam Mech. Rain rrain
Insulation -Plumb.
Plbq Underfloor
Water Line Gyp. Bd. -Mech.
TimetAM YM
Dato Reyu .sted:_- _1- - —
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Builder• -------' '— ��
TYE FOLLOWING WRA CIONS ARE REQUIREDS
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J_ APPROVED DISAPPROVED APPROVED SU TO ABOVE
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-e call For Reinsp.
SEWER CONNECTION ✓
Ce-, !TYCSF TIGARD PERMIT
PERMIT #, . . , . . , : c JWR9.s-0534
COMMUNITY DEVELOPMENT DPRpaR`fk&T DATE ISSUED: 12/;,0/93
1;1125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)839-4571
PARCEL: 2511 :BC-01800
SI IE AI)DRE:;')S. . . : 14525 SW 1001-H AVE
SUBDIVISION. . . . : TIGARDVILLE HEIGHTS ZONING: R-3. 5
BL.00K. . . . . . . . . . . LOT. . . . , . . . . . . . . :20
TENANT NAME.. . . . . :
USA NO. . . . , . . . . . . FIXTURE UIJ.' TS. . . .
CLASS OF WORT:. . . :ADD I)W'--'-.LING UNITS. . : 1
TYPE OF USE. . . . . :SF NO. OF BU I l_D I NGS: 1
INSTALL_ TYPE. . . . :f_;USWIR IMPERV . : : sf`
Remarks : CONNECT EXISTING HOUSE TO SEWER —• HAVE F'AID SHARE FOR REIMBURSEMENT
DISTRICT
Owner: --_...____._._.___---._...__._._._.._._____._.___._________________—__.__.___. FEES --- --- --------
ROBERT TIGARU type arloi-int by date rei_pt
14525 SW 100TH AVE PRMT $ 300. 00 JH 12/30/93 —
INSP $ 35. 1L)Q1 J11 12/30/93 -
TIGARD OR 97223
Phone #:
Contractor:
WILDER DEVELOPMENT CO
16204 SW 104TH AVE
TIGF'RD OR 97224 ---------------------------------------
Phone
--------------------------•-----------
Phone #. 64,2-27B7 $ 335. 00 TOTAL
Req *. . : 76860
— --- -- REQUIRED INSPECTIONS ----- __.
This Applicant agrees to comply with all the rules and regulations Se�4er Inspection
of the Unified Sewage Agency. The pe,.it P,dires i80 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installer shall prospect 3 feet in all dire tions fr.,
the distance given. If not so located, the installer shall purchase -
a "Tap and Side Sewer" permit and the Agency will install a lateral.
Permittee S i IJ n q t 1_i r e • -
Issi-ted BY :
Call for inspection — 639-4175
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t_:I.1 Y C11,. 1'I GARD - P :C E I F'T OF "AYM"-I RE',"I F''T NO. :93-.F.147 i 4':+
C HE LK AMC1l.IN C n 3673. 35
AMP n MAI..I;CIhI!il.11J, I'ANYA I:.A'aH AMC:II_IN n (A. 0101
11)DREF;�;• a 14`Wft, SW tA01N F'AYMF-:N1 1'1411- n 1 '_/30 93
:31..;BDIVF.-IIIN n
1'II.iAHI)� OR 14 /;,2ic 44938
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vll- VAYW N T olvICI11N'1 PAID F•'l IFlF'1.1;-;f lit F-'H Y MI-•N 1 E Ii iin.iN l Pt1.1 l)
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00
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A .WF.R PERMI T 14 R[:.IMC.1F�i
IF:MF:NT 01131rdCT FEE FOR
4525, SW 1OV"I'l AVF: �_'Si] 1 I E11:' -1f3C�1N
GI1 Al_ AMOUNT RAID 3673. 35
_Residential Building Permit Application
City of Tigard
131Y5 SW Hall Elvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:_ S� o
Office Use Only
Subdivision: Lot#
Valuation: Planck/Rec#
/' Pe,mh#
Owner: R4,flj K Reissue of
Address: /� Y���:? -
Approvals Required
Phone: —3 y.z Planning
� -----. —.--._._.
J engineering
Contractor: � ��' ���'�'n tither
Address:
)-2
3 itomc Required
Subcontractors
Phone: /
Contractor's License# 6 I I Truss Details
(attach copy of ct,►rent Oregon license) Other
Subcontractors:
Plumbing.
Mechanical:
(attach copy of current OR Contractor's License)
Architect/Engineer: i —
Address:
Phone:
COMMENTS:
Applicant Signature & Phone number
Received by: _ Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
Bldg Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (M.ECH)
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK) _
Bldg: _
Plumb-
Mach:
Sewer Connect;on (SWUSA)
Sewer Inspection (SWINSP)
Paris Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC) _
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT) _
Commercial TIF (TIF-(,)
Industrial TIF (TJF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire District (FIRE)
TOTALS: