11455 SW HAZELWOOD LOOP-1. ...�
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City of Tigard
INSPECTION REQUEST
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INSPECTION TIME: J �.N� PERMIT NO. :_
DATE: 3 -�'f LATE ISSUED .'- ---i—
OWNERS NAME :_.,40Y �,-�;� r/fi ADDRESS:
CONTRACTOR : —
'rE ST : Air C7, Water[3 , Viet-at (( Loharotory ❑
RESULT : Approved, , 1,is4pproved C'' Pending []
SKETCH:
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INSPECTOR DATE
COTE : Attach supplemental tett data beret?'
City of Tigard
INSPECTION REOUEST
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AUDRESS '.
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EST,. ,,ovu�, water Ll viauo Laboratory U
Dieupc)rtived Ll Pending
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INSPECTOR DATIF
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City of T1 Mrd
INSPECTION REQUEST
for
INSPECTION TIME * b"L-2Z_ PERM'T NO. : .____
i DATE: s :CL x DATE ISSUED'.—L1_
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OWNERS NAME :
ADDRESS : —
CONTRACTOR
DDRESS : _CONTRACTOP
TEST. Air ❑, Water [� i�uu [] , LaborutarV [�
RESULT' Approved Disopurowod ❑ Pordinq n
SKETCH.
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LANIVIED OSEWERAGE AGENCY NO.
W\SHINGTON COUNTY DATE 1-25-77
cily 01"-- Tigard
APPI-ICATION F013 SEVVFR CONN[CTION PLRMIT
OWNER: _ �3oh Smith
OWNER'S ADDRESS:
STREET
ZIP
BUILDINGSITE: LOT__9_1__.__ .____ E11_OCK _ /ADDITION ._
TAX LOT �1(). TYPE OF OCCUPANUY
11455 SW Hazelwood Loop
ADDRESS
DWELLING UNITS FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT pEl: INSPFCTION FEE TOTAL DEPOSITED __
(NEW) (EXISTING) BUI1_DING SEWER SYSTEM
'rhe Applicam agrees to comply with all rules and rc W- , .u f the Unified Sewerage Agencv.
.0t) ris 0
APPLIC
SEWER PERMIT
rms PERMIT AUTHORIZES CONNECTION TO THE SEWLR SYSTEM.
LINE SIZE INSTALLER
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4--Cjx
RECEIVED BY.
(AGENCY OR AGENT)
COMrv:FNTS- _Blqlgo__.J,. l264 ___, ..
This Application and pern'lit expires in one hundred and twenty (120) days.
The arnount paid will be forfeited should expiration occur.
WIMMMU
BUILDING PERMIT APPLICATION Coy/ TIGARD DATE � ' �, 19 __- 1?.64
THE LINDER'jIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONT' _
OR AS SHOWN AND APPROVED IN THE ACCON,FIANfING PLANS AND SPECIFICATIONS. OWNER PHONE____—_—.
L.OT NO,__ _r
OWNER jQ J �(Ti.•7:F1 - JOB ADDRESS 114_' 5W HSZO":-__�140ME ADDRESS .-
'%RCHITEr_T
'J m: kNGINE.ER
PILUER _ ADDRESS jESIGNER
_U
5',FtU(JURE •❑NEW ❑REMODEL ❑D,U')ITION ❑REPAIR ❑RENEWAL �❑FIR�E CAMAGE ❑DFMOLI i ION
C.I RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIn'.c❑PAI IC, QCAR PORT ❑GARAGE 1 rJ STORAGE[]SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL 0SE -SIGN REVIEW ❑COUNCIL APPROVED DSIGNS
L 1.
�CCUPANCY..—.—LAND USE _—_ZONE: ! B —_FIRE TYPE FIRE ZONE 1 PLAN CHECK BY—_�C
— at #91 �Lorui t. a.ea tyle f4imily dWellint,,ii W,/;ata.ichad "Qtse ow.
— y'��aame;�t• . o. aub . Pt. _ A badr -nm I bath----- -------
r i C(.`�_,�giZ----F�9S�B1'-��'�--—---h-E I G H T �r.�.�SIQ.�.+�S . tfB.E.9•�19 t,i L1flSZ0�_� Y81.L►€3611,500.6 500•
BUILDING DEPARTMENT SET BACKS FRONT iI' REAR 4L+ LEFT SIDE RIGHT SIDE
Permit 148.n, .---- ----._-------------�__�
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE (BUILDING CODE, ZCNING
Plan Check 4.000 - REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT I� HE 14ERY AGREEO THAT THE
WORK WILL BE DONE IN ACCORDANCE. MATH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Seib-total ALL APPLICABLE CODES AND ORDINANCES. THE ISf;DANCE OF THIS PFRMI; DOES NOT WAIVE
-- — RESTRICTIVE COVENANTS. CONTPAC(OR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINEi5
State ax 4*•1' LICENSE, SEPARATE PERMITS REOUIR1eD FOR SEWER, PLUMBING AND HEATING.
Total , 162.i., , ..,p..__. ..
By
------- -- APP •-ANT OR AGENT
Approved Receipt No
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MUNRO
DATE
INSP TYPE INSPECTION REMARKS
PLUMBING DATE
lContractor
-,..!'r Permit No. • is ' 1l
Za s ,,, ,. ��.� /, Rough in
A3�e�={ � ,' ., cr� Fixture —
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Final
/ S(/�.t_,t.SC' - �►ti� �
/ HEATING
Contractor -�—
JGtsermit No
- or Oilou •ininal
SEW-R-
Final
—— ____— --- - — DRIVEWAY — -?--2 7- 7
Final
-- Storm Drainage
(Rain Drain) Final
JOCCUPANCY
Sidewalk3 23-7?
Curb&Street Final
A •roachBLDG DEPT. FINAL TEMPORARY CCERTIFICATE OCCUPANCYFinal
LandscapingZoning Final `
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ADDRESS // a � a...li� � � PERMIT NO. '% {
PERMIT CHARGE none
OWNER CONNECTION FEE
PAID 9Y
TYPE GF BUILDING r/�_/ _ _ DATE: CONNECTED
INSPECTION FEE o1
SERVILE RATE �-
CONTRACTOR _ _ _ PAID BY _ DATE
SIZE OF CONNFCTION ASSESSMENT PAID
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