11645 SW HAZELWOOD LOOP IA
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1' O,Arner:.........Art..Lutz............................................. .... Permit No........12-7
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Building Address.....1164.5...5W...HazelWavd.. Qo.p....... ..... .
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t'ertificate is hereby given this....15... ..-. ;ay of..A.u.gu.at................. 19.....7.3
that said building may be occupied and
that it complies with all requirements of
�., the Building Code for the City of Tigard, 4,
,. � as approved by he Tigard City Council.
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Building . .Inspector �
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City of Tigard ete-,><
INSPECTION.
REQUEST
for
IINSPECTION TIME . eT m' PERMIT NO.: -----
DATE : _1__1__—. DATE ISSUED'.. J-J -
I OWNERS NAME ' -
i
ADDRESS : _ `rte
I
CONTRACTOR :--------
TEST'
ONTRACTOR :--------TEST: Air O, doter O , Visual O , Laboratory [�
RESULT. Approved ❑ , disapproved ❑ , Perdlnq 0
SKETC4. lj ct yi.c;'u t c cr-ek.tty
i t
I d
I--iiPIECTOR DA E
ICOTE Attoch supplemental test dcta heret j
I
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City of Tigard
Illi;PECT"ION REGUEST
for
INSPEGTIOI�i V .'IE PERF =T NQ .
0'ATE 1:Al ' I SS k,; L-
OWNERS !�,A
CONTRA:.:'
TEST* A. .:: L';.,,,�� L'1. Labsrntot Y
RESULT., A� DI!.arr �'r �d C? , Pt-"'Illy ❑
?3ir<ETC��.
NSrE�T'"t _ - DATE
J-�r
LNwE'. Attach fuppl*m*nt(" tuft data heret01
City of Tigard
WSPECTION REQUEST
for
INSPECTION TIME '- . _ PERNfT NO. :
GATE : _ DATE iSSUED:__.L_L_
OWNERS 'NAME --- 2�?-
ADDRESS : ._11_ ' v
C 0 N TR A C T 0 R
TEST: Air p, 'Nater L7 , VisuaoeLabaratory L7
REJU!_T: App ovet9 [] , Disapproved Pending 0
SKETCH.
yr A(,-,
INSPECTOR , DAT
COTE. Attach supplemental toet dote heret]
City of Tigar
INSPECTION RE3rUEST
f,o r
INSPECTION TIME' PERMIT
DATE" 9SOED .,.--L—Z
DATE 1,
OWNERS NAME
A D D R E S S:
C.0 N TRACTOR
"'E ST : Air [ , Water[-J , Visual 0 , 1 abnrwory [j
9ESULT: Approved 0 Disapproved I: Pending E]
SKETCH.
tp
INSPECTOR DATE
5NOTE : Attach suF pler"ontal test data bov e t
e"Y 9
UNIFIED SEWERAGE AGENCY NO. - ---- 11.627
1 WASHINGTON COUNTY DATE 2-177
-------._._.__..___.-
CITY
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Art Lutz - - - --
OWNER'S ADDRESS: -_ - - _ --
STREET
- - - -- - - -
CITY STATE ZIP
BUILDING SITE: LCT_.-_ _ BLOCK __ ADDITION -- -- --
TAX LOI NO. TYPE OF OCCUPANCY - r.esiadence
ADDRESS 11645-SW Hazelwood Looe
DWELLING UNITS 1 --.�- — FIXTURE UNITS
SURCHARGE IF APPLICABLE - - -- -
PERMIT FEE _575• INSPECTION FEE 25• -_ TOTAL DEPOSITED _._t'�`�-• _---
_Lf�1Lld1) (EXISTING) BUILDING SEWER SYST'r_M __Fanno 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 — - - _ INSTALLER
RECEIVED B Y
(AGENCY OR ITS
COMMENI-S:-91�This Application and permit expires in one hundred and twenty (120) da',S.
The amount paid will be forfeited should expiration occur.
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BUILDING PERMIT APPLICATION 11YY ��E.���i./ DATE_''x'. t.`j�7 "^ 3..7,7
OF 19---
�HE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED 9UILDERPHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE_
LOT NO.
OWNER JOB ADDRESS xl�(!a :i4� 1LBX+SI HUME pDURE _ _
-- ARCHITECT
ENGINF_ER
BUILDER _tt--��_ _ __,_ ADDRESS rr-tt DESIGNER
STRUCTURE _ONEW ❑REMODEL. _❑ADDITION (:—]P_PAIR L_1RENEWAL []FIRE DAMAGE L,LIEMOLII ION
LJ RESIDENCE` CJCOMM 0EDUCA1IONAL« 0GOV'T ❑,%LIGIOUS(JPATIO CARPORT OGARAGE ❑STORAGEErISLA3 ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE CIDESIGN REVIEW ❑COUNCIL APPROVED OSIGNS
OCCIiPANCY�—..__.LAND USE ZON. _ BLDG.TYPE 50 FIRE ZONE PL.%N LHECK BY HE Al
twellingjgJAI toshad 0XIII1 � Ur /+
galx� a 553 sq/ ft. --
Or HrJGHT 20 No. noRIES �_ �REA MLL NO.BEQ$QQM —3—"4 VALUE.3121_It'.
BUILDING DEPARTMENT SET BACKS FRONT 24 REAR 53 LEFT SIDE VLJ � RIGHT SIDE 14
Permittk
133•ZK' _—PHIS PERMIt IS ISSUED SUBJECT TO 1HE REGULATIONS CONTAINED IN THE BLIILDINC CODs, ZONING
Plan Che11.).gt7 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED 1HA? THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
SUb totaALL APPLICABLE CODES AND ORDIWANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVERESTRICTIVE COVENANTS. CONTRACTOR AND SI 6 CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Ta4.2`) LICENSE. SEPARATE PERMIT'S REQUIRED FOR S( VER, PLUMBING AND HEATING.
Total147.29
i� ANI OR AGENT
Approvei1 Receipt No
ADDPU. % �
as
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
r - Contractor
Permit No. C:� a �7
H r ,-
Rou h•in
7� - -
t 1 Fixture
Final
gi� - oz� `� HEATING
r - ) M— CIA.,
�. Contractor
Permit No.1-1 Jbi Gas or Oil
Rou h•inFinaln SEWER
4A lasz-
Final
' DRIVEWAY
V,-,41-,k
Final
Storm Drainage. _ (Rain Drain) Final
i5 Sidewalk
'�- Curb&Street Final
J - A proach
BLDG DEPT. INA TEMPORARY CERTIFICATE OCCUPANCY
Q �#RTIFIC .E OCCU�P�NC�I Final
7;7
77 Ew c�.� % ((��tol, � a u•us�
I vl LOA Landscbping
9-2f-71
Zoning Final
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Address //(� � _1��{ rz Permit No.
Permit charge
O tr n e r L�- � _
Connection fee
Paid by �Lt.��–•� ---�-
Type of building /LEc�, � Date connected
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Service rate / �� Inspection fee
Contractor _ Paid by _ Date
Assessment Paid
Size of r_.onnectio;t —
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