11605 SW HAZELWOOD LOOP 11605 !TG' HAZELWOOD LOOP
"1
J
Nl
s Permit No.
Addrcs �z;
Permit charge
Owner Connection fee
Plaid by
Type of buiJdil-Ir, Date connected
Inspection fee
")ervice rate
Contractor P,lid by Date
uunnection A!isessment paid
3 - 7 - 77
s
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :A�Z- PERMIT NO.: -
Dt,TE: Y ZA-12 DATE ISSUED:___L_-j
OWNERS NAME :
ADDRESS : _11 (;Q
CONTRACT 0 RE ---.�- .---- -
TEST: Ai► O, Water (1 , Visual (,,') , Laboratory ❑
RESULT. Approved , Disapproved O , Pending
SKETCH. 5' �
� w
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- - _...
I NSPECTOR GATE
COTE : Attach supplemental fast data he►et"I
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e.
C11I- Y OF
BUILDING PLi?!,.1,I APPLICATION TIC�AR� DATE____2-!�-_, 19z�N°
""HE UNDERSIGNED HE3EBr APPLIES FCIi APERMAT FuR THE WORK HEREIN INDICATED �1`�"
C R AS SH WN AN .APPROVED IN THE AUCOMPANYI�IQ l �1'5- NDSPECIFICATIONS. 'o�NL'R PHONE—�1--.
QyNttl — -- —= ADDRESS PLALDER PHONE
ENGINEER _ _
.B=VGR �ij4� _AR&HITECT DESIGNER
STRUCTURE NEW ❑REMODELIOADDITION ❑REPAIR RENEWAL ❑FIRE DAMAGE DDEMOLITION
EkRESIDENCE UCOMM OE1111CATIONAL DGOV'T ORELIGIOUSn—PA'f10 []CARPORT ❑GARAGE [:]STORAGE❑SLAB CFE
BOND []MOVINGi ❑CONDITIONAL USE DDESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
CUP/1 :_LAND%IB.ZONE— A / BLDG.TYPE--S:-
_FIRE ZONF� PLAN CHECK BY Cwf / �_ HEAT �-
ft-
01,C-IOAJ FLOOR LOAD ^_ HEIGHT _.- NO.STORIES AREA VALU. ,.0dd
BUILDING DEPARTMENT SET BACKS FRONT _- _ HEAR LEFT SIDE RIGHT SIDEPeimit
--__
—— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED 'V THt; BUILDING CODE, ZONING
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
State / LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMPING AND HEATING.
Total -___I_J7.titLU
RV -- ----- - ---- ---
-_—._. —_ APPLICANT OP.AGENT
Approved Receipt fJo.
—--- ADDRESS PHONE--� —-----
t
1,7�
UdNIFILD SE! V'-_ RAGE AGENCY NO,
WASH i N�;TON COUNTY DATE __ J!j1y 19_,^ 1975 -
CITY O F __. _. Tiga rd __
APPI_..ICATION FOR S[ WLR CONNECTION Ply- 13MIT
01NNI-R: Bob 51nith —OWNER'S ADDRESS:
ADDRESS: - - - - - -
STREET
CITY STATE ZIP
BUILDING SITE: I.OT 131-OCK _ ADDITION
TAX 1.0-T NO. _ TYPE OF OCCUPANCY residence____
ADDRESS 11605 SW Hazelwood Dr.
IDWEI.1-ING UNITS FIXTURE ur4ITS _
SURC'1ARGE IF APPLICABLE _.__
PE=RMIT FEE -,75,00____ INSPECTION FEE _25. 00 TOTAL DEPOSITED
(N.J.J,' ) (EXISI ING) BUILDING SEWER SYSTEM __.FannQ Cuak.
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPI.ICANT _ __� 4 _. �.---✓
SI=WEF3 PE= RMIT
HIS PERMII AUTIIO131ZES CONNEC'-ION TO THE SEWER SYSTEM.
I.INF SIZE __ INSTALLER
RECEIVED BY. -9GENCY OR ITS AGENt)
Bldg, -,',-'0937
C.OMMI_N I S: _
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
,.r ClTY OF I-t1.Y 19 ,19_ � 0937
BUILDING PERMIT APPLICATION TIGARD DATE
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR 'THE WORK HEREIN INDICATED OWNER PHONEr
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIE ICAT�O .^' ER PHS E r -
t.lt>f --- nDOREss_--
QW N E R -------
ENGINEER DESIGNER
1 iAOIa0 AF1 [3
a r1 ❑FIRE U'MAGE `JDEMOLITION
STRUCTURE _❑NF:W -_ ❑REMODEL `__ ❑AUDITION r US❑a CA❑ORT E LJGARAGE C7 STt._tAGE OSLAB OFE"CE
❑gES�DENCE_ r0MM QED OGOV'T C iRtLl,Inr-t— SIGNS
— ► ar30MD ❑MOVING � ❑CONDITIONAL USc- ►JUESIGN REV--_�EW - COUNCIL APPROVED _ _------
---- _
= - HEAT
_BLDG.TYfE
FIRE ZONE-- PLAN r,HECK By—
O,
Y0a CUPANCY_—__L.AND USE ZONE-- _ Chel
Jon LOt :; .L.34 6-t :,
HHT
----- NO.STORIES AREA____.---.--_ ------------
QCC LEIG
OAD FLOOR LOAD --- -- — _+GHT SIDE
_ LEFT SID'
_ -
B111LDI DEPARTMENT SET BACKS FRONT REAR f__
Permit_ THIS PERMIT IS ISSUED SUBJECT TO THE RE 3ULATIONS CONTAINED IA THE BUILDING CODE, ZONING
Plan Check ��',1,��C REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT AND SO S ANVY AGREED THAT THE
_ - WORKAWPLI E DENS IN ACCO
CANDAORD NANCES. THEN SUANCECOF`THIS NPE COMPLIANCE WITH
Recording _
ALL
RCE VSETSEPARATE PERMITS REQUIRF.DRFOR SEWER Stle rPMUMBINCi ANO TRACTORE HEATING.
HAVE IRRENT CITY BUSINESS
I%State L
Tota!
B�-- At-P' --,NTOR AGEN1
A.eceipt No
approved ADDRESS
a
DA'E INSP. TYPE INSPECTION REMARKS PLUMBING
GATE
Contractor —
—_ Permit No. C'�?o� ,/�i,, j�2 `J�?1
Rough
Fixture -- —_--
• L�
Final
HEATING —
1'7 (/ --
Cotdroctor
/C A-76 Permit No. 4/55
— ti •— Gas or Oil
Rou h•in ---
n v
Final ----
SEWER — —
� -� Final -
-- DRrVEWAY-
-- Final
Storm Drainage— — -
-- - -- _ (Rain Drain) Final
---- — - ---_.._— Sidewalk —
—_—_
Curb&Street Final —
SLOG DEPT, 1 INALTEMPORARY—_ -' ---- A roach CFR FIFICATF OCCUPANCY _CERTIFICATE OCCUPANCY Final
LandSLaping
�. 7oning Final
I