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11630 SW (,'AlRV1EW LANE
City of Tigard
INSPECTION REOUEST
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INSPECTION TIME :! PERMIT NO. :
DATF Z. �I� DATE. ISSUED:OWNERS NAME :
NAME : � � 4r
ADDRESS : _.� � rvJ•�.•. ,�. •- -__
C 0 N T R A C T 0 R :
TEST. Air O, �,ater [J , Visualp(, Laboratory p
RESULT: Approved , Disapproved ❑ , Pending J
SKETCH:
INSPECTOR DATE
FTE Attach supplemental test dato he+etol
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City of Tigard
IiNSPECTION IREOUEST
for
INSPECTION TIME PERMIT NO. :
DATE: L�C. DATE ISSUED'.--.LL
OWNERS NAME :
ADDRESS : - -
CONTRACTOR :_ 1 __
1 EST' Air O, Water Visual 0 , Laboratory []
RESULT: App►oved J , Disapproved 0 , Pending r;
SKETCH', NN
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INSPECTOR DATE
[NOTE A!Icch eupplementoI fast doto herefol
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PER['IIT N0
ADDRESS
PERMIT CHARGE none
OWNER CONNECTION FEES f� "
PAID BY \... ---C- �
I
TYPE OF BUILDING r� �.<;_ ._._ DATE CONNECTED _
SERVICE RATE ✓";, INSPECTION FEE .�✓ '""�
CONTRACTOR __ _____ PAID BY DATE
SIZE OF CONNECTION _ ASSESSMENT PAID
►2-�3„
V/ 6 - s- 0
�VI
Uit\.1111T_ f1 S WL- 1AGE AGENCY NO. _ 9581
ul
vA1/ ✓I 1 1 NGTON COUNTY DATE _j__(.1,_ 1975
Tigard
CITY OF _-, - ------ --- --
APPLICA-1-ION FOR SEWER CONN[-CTION PERMIT
OWNER:
Per 0._.Ber Stro^m --
--- 9---_. . - -
OWNER'S ADDRESS: 11275_ SWTimterline Or. -- --
STREET
Beaverton OR 9'1005 ZIP
-- -- __-_ ._.- -- - ---
CITY STATE
BUILDING SITE: LOT_-_- BLOCK __ ADDITION -- —
Tax Map 2S1-3CD
TAX LOT NO. _ _ .�'800 -_ TYPE OF OCCUPANCY ._. residence____.___
ADDRESS - 11630 5W Fairvicw Lane -
DWELLING UNITS-_ ...__ 1 _.___-- FIXTURE UNITS
SURCHARGE IF APPLICABLE --
PERMIT FEE __.._._550.00 _ _ INSPECTION FEE . 25.00rOTAL DEPOSITED __._ 576.Ilf1. _ -.-
(NEW) (EXISTING) BUILDING SEWER SYSTEM __Faaoo Creek
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT _—
SEWER P;-RMIT
THIS PERMIT AUT14OR17_ES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE 411 INSTALLER
RECEIVED BY E (AGENCY OR S AGENT)
Bldg. permit A 0901
COMMENTS: .
This Application and permit expires in ninety (90) days. The amount paid will be forfeits,!
should expiration occur.
CITY OF No 0901
BUILDING PERMIT APPLICATION TIGARD► DATCTHE
---
THE UNDERSIGNED HEREBY APPLIES FOP APERMIT FOR THE WORK HEREIN INDICATED CA4-5701
OR AS SHOWN AND APPROVEC IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER PHONE
---
Per P Cp. 1163U !jW Fairv.oww L.Stiet
OWNER ADO[,E�;ntQa BUILDER PHONE
ENGINEER
BUILDER _ __ARCHITECT �-1 DESIGNER r-t
�SLT,RUCTURE bNEW ❑REMODEL ----11 ❑ADDITION _ ❑REPAIR _ ❑RENEWAL ❑FIRE DAMAGE _ ❑DEMOLITION
bRESIDENCE ❑COMM ❑EDUCATIONAL IJGOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCF-
Q-SONO ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW [:]COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE BLDG.TYPE FIRE 20NE_ PLAN CHECK dY HEAT
Tax L,ot :,9i7O Tax, Map 251-3CO
A yadroomi
OCC.LOAD FLOOR LOAD HEIGI{T -_ NO.STORIES AREA 1461 VALUE 310 26e.
,1 201 70 So
BUILDING DEPARTMENT SET BACKS FRONT _- REAR LEFT SIOE RIGHT SIDE
Permit 13 3. —
y �� - - THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
.
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
146 State `y.97 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total 204,97
By APC AIJT OR AGENI
Approved Receipt No
ADDRESS °NON
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
-
Contractor
/ Permit No.
Rough-in
T Fixture _
S - Final
!D HEATING
Contractor
Permit No. ,.5—oV7
Gas or Oil
Rou h-in
Final
SEWER p-VA ✓G
Final
DRIVEWAY
Final
Storm Drainage
_ (Rain Drain) Final
Sidewalk GL /0—P-7g
rna
Street Final
hBLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY CERTIFICATE OCCUPANCY ping
inal
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