11715 SW FAIRVIEW LANE-1 11715 SW FAIRVIEW LANE
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.P, :�W CITY OF TIGARDD C._ ,
OREGON
.j4,; Gene Clayton
Owner:................. ............................................... ..... .......Permit No. .
`
Building A.ddress.......1..1715............SW............Fairview.................La.....n..e...... .. ..... .. . ....................
....�
'(a 1 Certificate is hereby given this.......?A....day of...N Y.... . ....... ..... 19..7.7..
:.y that said building may be occupied and
that it complies with all requirements of
i; r the Building Code for the City of Tigard, f
as approved by the Tigard City Council. !
...........................
Building Inspector
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1-1-014 U!A
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City of "r igard
INSPECTION REOUEST
for
INSPECTION TIME: : PERMIT NO. :
j DATE: /�' P7 DATE. ISSUED:_J_L..
OWNERS NAME: --
ADDRtrSS :� � '� , > Ol
rONTRAC'TOR
TEST: Air p, MJoferp ,�lisual 0 , Laboratory E]
RESULT* Approved W/, Disapproved U , Pend,,iq
SKETCH:
I
I
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I PECTOR DATE
IEMOTE Attach supplemental tae• dato herell�l
i
1-v
7.6
UNIFIED SEWERAGE AGENCY NO. --__-10694
WASHINGTON COUNTY DATE
CITY O F-----T i j='s - -- --- - - -- ---- -- -- - -- —
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Gene Clayton
OWNER'S ADDRESS:. - - ----
STREET
CITY STATE I�r'
BUILDING SITE: LOT— BLOCK ^—_.__—_ ADDITION
TAX i..0'T NO. _ TYPE OF OCCUPANCY ____ residence
ADDRESS __-1171 '- S1.1 ---
DWELLING UNITS -1------ --- FIXTURE UNITS -
SURCHARGE IF APPLICABLE _._50. 00 Derry Dell----
PERMIT FEE 575.00 _ INSPECTION FEE 25.00 TOTAL DEPOSITED 600. 00
(NEW) (EXISTING) BUILDING SEWER SYSTEM _—Fano Creek
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT-
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE --- --...`---�INSTALL.ER -------- -_. - -- ---- - --
RECEIVED BY — — - - ---- - -
IAGENCV OMS AGENT)
COMMENTS:- .Bldg.-- 1;'1160
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.
BUILDING PERMIT APPLICATION 1OFY T:CARD DATE__` ~°'7�__ . I9 i '6Q
THE UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE
e3��89rL
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER PHONE _
±
OWNER JOB ADDRESS 1 _
Ilb SW Fa:irveiw L&:, LOT NO.
HOME ADDRESS _
4RCHtTECT �— —'
BUILDERENGINEER
,,+.LL�� ADDRESS _ DESICNER
�STRUCTURE b NEW ❑REMODEL ._ ❑ADDITION C1 REPAIR ❑RENEWAL. _❑FIREDAM_AG9 _❑DEMOLITION
!J RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO GCAR PORT ❑GARAGE ^❑STORAGE❑SLAB ❑FENCE
_❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL A�P—F-A-O-�VrED TA USIGNS
Y 1f t I IHI i t tl
OCCUPANCY--LAND USE ZONE— BLDG.TYPE FIRE ZONE____ PLAN CHECK BY _ HEAT
Lone ,, a ory way a>ty L: ec ® T094A. Idroom le —
'IF pprb- ales r cede u e usFi3q 1170fMan -51ari anG (jGaq'R I�or .,,Tjprovn
QCS—IDA.Q
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit ----
- — THIS PERMIT IS ISSUED SUBJECT TO THE REGULA7IONS 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 ANn IN COMPLIANCE WI1 H
Sub-total ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
—� RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax ' LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total JV809;'
By -
Ag�--kCANT Op AGENT _-- --- __
Approved Receipt No, //ll
i
ADDRESS --
H(1'1€a—
---
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Ir r �1 Ir r r r
DATE INSP. TYPE INSPECTION REMARKS PLUMBING OATF
Contractor
Permit No. 'S� /1 7-
Rough-in Rou h-in
-- G
✓� _ Fixture
- of Final T `
HEATING
Contractor
Permit No. G'G 7
Gas or Oil _
-- - -------- �.�
Rough-in `
Final
SEWER
-- ---�-- Final _
---- DRIVEWAY
-- _— _—_ Final
— — -- __-_ Storm Drainage y
(ficin Drain) Final
Sidewalk
Curb&Street Final
_
Approach _
BLt]G.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
( Landscaping
C Zoning Final .
r{ ADDRESS_,,,, (/:713 fL�.ct- -;4L
— PERMIT N0.
r PERMIT CHARGE none
' CONNECTION FEE
U OWNER
PAID BY
TYPE or BUILDING , _______�y.__ DATE CONNECTED
SERVICE RATE dd �°, INSPECTION FEE
CONTRACTOR y 16, v PAID BY DATE
ASSESSMENT PAID
SIZE OF CONNECTION r _ _