10950 SW FAIRHAVEN WAY-1 s �
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10950 SW FAIRHAVEN WAY r
SEWER PERMIT
UUnified Sewerage Agency
of Washington County C I T Y OF _ DATE — l 6` cfl
OWNER: ._ _I 1_ �,. ,_ _ �� ,,. ---- -.._�.. _ PHONE :_, ,
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
W BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
❑ NEW OSINGLE FAMILY ❑ COM"-!ERCIAL
❑ EXIST. (PRIOR TO 7-1-70 ) ❑ MULT. RES. ❑ INL.U',TRIAL
FIXTURE UNITS DWELLING UNITS_
ADDRESS OF STRUCTUPE : _
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND W
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.
FEES:
PERMIT FEE 2�-S�
CONNECTION CHARGE
SIDE .SEWER INSTALLATION
r � � • • - ISSUED 81��
OTHER _
TOTAL
3 n APPLICANT DATE
SEWER PERMIT N4 2
UN
ADDRESj OF STRUCTURE
TAX MAP _ �; ! ' ��,�a TAX LOT ,Z o SYSTFM
LOT BLOCK OF
APPROVED BY DATE ISSUED BY DATF
D. U. 'S _w REMARKS a'Z<.jy '" =-�-
M-02 0
L
BUILDING PERMIT APPLICATION TIGARD DATE 19 --_ 3'*--
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED 1� BUILDER PHOT'E
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. O1, c)aM rITPHONE
Lor NO.
OWNER IlPrt SrhrnitZ JOBADDRESS 10950 561 f airhavon Way - --- - _ �- -
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER_ 1001,
_
STRUCTURE NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR J RENEWAL _IRE DAMAGE ❑ DEMOLITION
❑ RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT S• AGE (7 STORAGE ❑ SLABU FENCE_
OCCUPANCY n-1 LANDUSEZONET I''10 BLDG.TYPE �� FIRE ZONE------- ANCHEC:KBY � bCLKHEAT___
e':a;'I �trl.ict detached accessory garage, 1
SEWER PERMIT# ice_
OCC.LOAD FLOOR LOAD :O _ HEIGHT i <• NO.STORIES 1 AREA 936 NO.BEDROOMS VALUE
BUILDING DEPARTMENT SETBACKS FRONT r'0 RcAR 10+ LEFT SIDE SCI+ RIGHT SIDE_
Permit _ a.04,00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS COMTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICARLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE
Plan Check _ 42.011 WORK WILL BE DONF IN ACCORDANCE WiTH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
Sub-total 1 i G.�0 WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT' DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB C(,NTRPCTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tex . 3 6
SDC
Total X129.,3
PDC# APPLICANT b AGENT
ey P1 �.
Approved bcr Receipt No.
ADDRESS — - - -- - PHONE—
s.
DATEr INSP. TYPZ INSPECTION REMARKS PLUMBING DATE
e—I'le-," let— .11161jr—ri -2tt-LA, e-V Con!rcctor
Permit No.
Rough-in
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Raw Drain)Final
Sidewalk
Curb&Street rinal
I pproach
BLDG.IF EPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
PERMIT N0.��
PERMIT C14ARGE none
1
0 N E R - � + CONNECTION FEE .3bo
PAID BY
TYPE OF BUILDING � DATE CONNECTED
SERVICE RATE /gy4 INSPECTION FEES
l�3
CONTRACTOR PAID ".Y DATE
SIZE OF CONNECTION ASSESSMENT PAID
City of Tigard A
INSPECTION REOUEST
for
"u""ECTION TIME :-.--,. .- PERMIT NO. :
DATE: / / DATE ISSUED:__Y-L_
^WMERS NAME :
TRACT0
C KETCH:
INSPECTOR DATE
CNUTI. : Attach supplemental test dutu hereto