11665 SW HAZELWOOD LOOP 11665 S'A HAZE,LWOOD LOOP
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City of Tigard,,
INSPECTION REQUEST
f o. r
INSPECTION TIME' PERMIT NO. :--.—
DATE
4IZ7DATE. ISSUED
-)WNERS NAME ' ., TIP—W21"MAt< 400'Gf
ADDRESS:
CON TRACTOR
*EST Air 0, Woter 0 , Nil eiial [3 , Laborotory L]
RESOU': Ap,-rovevf Disapproved C Penditig [I
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SP R DATE
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[NOTE.' Attach supplemental test data bereto I
244- 1 y 9 L
-77
UNHHED SEVVEIRAGE AGEN(--#Y NO.
VVA- !3H1N(31-0N COUNTY DATE 1-12-77
CITY OF-_ Tigard ------
APPLICATION FOR FEWER CONNECTION PERMIT
OWNER:
OWNER'S ADDRESS:------
STREET
ZIP
RUILDING SITE: LOT___ BLOCK __—
'TAX LOT NO. TYPE OF OCCUPANCY
ADDRESS _1_1.665 . S-W —he zolwood
DWELLING U!%I ITS FIX URE JNITS ---.--
SURCHARGE IF APPLICABLE
PERMIT FEE _-_575-.- - INSPECTION FEE TOTAI. DEPOSITED __Lac4_____
,FW) (EXISTING) R(JII DING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
SEWER PERMIT
TRIS PERMIT AUTHORIZES CONNECTION 10 THE SEVER SYSTEM.
LINE SIZE INSTALLER
RECEIVED BY t,_—) , - - -
(AGENCY OR ITS AGENT)
CO%%� ENTS: ___ . ._BLdg. #1246
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeiledshculd expiration oc,!ur.
..: .+.:s.:.. -r.r.w4FMI'r. .�..✓yMr+Yya;p�gyY�^r"i.W'l47lw.M Mr...w
BUILDING PERMIT APPLICATION COF T'GARD DATi-� x" -77 ,�_ 1746
THE UNDERSIGNED 'FF,--9Y APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED EILJILDERPWONt ' `
OF AS SHOWN AND Ai'PROVED IN THE ACCOMPANYING PLANS AND SPECIF!C;ATIONS. OWNERPHONF
-_ LOT NO..
OWNER� L)111 Q L_, JOB ADDRESS JJ.I,IGIO0_ L F:Af1DRESS
ARCHITECT
EUk_UER _ ADDRESS ENCINELR
__SIGNER _
STRUCTURE Y' FNEW nREMODEL ❑_ADDITION_ ❑REPAIR ORENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑IFR--I..}SIDENCE ❑COMM ❑EUUCAT'CONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAN PORT [-]GARAGE O STORAGE❑SLAB []FENCEL� ` ❑MOVING y [)CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL.APPFI_OVED ❑SIGNS
OCCt Ph.CY._ I LAND USE.:'LNE._-..__ _BLDG.TYPE 5N FIRE ZONE PLAN CHECK BV.-A F TW
_ - HEAr__LQ_-
onst. eingis fawii y dusiliag 6/attechad garaLa all per pa.r.;lrie shoot 1-2-3-4
3 bedroom 2 bath Type 104F � --
garage 460
OCC. LOAD FLQQR LOAD HEIGHT 4_-NJQ--T0RIE5-�. pEq l5tiq NO.BEDRooMs J VALUE 34, .,4u.
BUILDING DEPARTMENT , 2[I �4
SET SACKS FRONT REAR LEFT SIDE �'` RIGHT SIDE
Permit 142*00 ---
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Pli.n Check 11.0closQe REGUI.,TIONS AND ALL APPLICABLE CODES AND ORDIN`NCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DOPE IN ACCORriANCE WITH li*PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub total ALL APPLICABLE CODES ANr, ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS 1"0 HAVE CU9RENT CITY BUSINESS
State TeX bo 39 LICENSE. SEPARATE PERMITS S1faUIRED FOR SEWER, PLUMBING AND HEATING.
Total 219.39
By -
- — APPi ICAIII T GR AGENT
Approved Peceipt No.
ADDRESS pilOiVE - --
_ _ i PLUMBING DATE
--
UATE INSP. TYPE INSPECTION REMARKS- --'----
_ &; &tractor _
L,�`7)4- . �')-Q /�� -- � �;;,�„�,,, P. •mit No. C� � .�._-
rF('u
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F gyral
HEAPING
_� L� Contractor )
�r tae m T
Permit No.i(�
as
Final --
,Z1= SEWER
Final _
_DRIVEWAY
- Final
— — ___ Storm Drainage
-- !Rain Drain) f=inal _ _ --
Sidewalk -
- — - -- — Curb&Street Final___ ----
,__ --- Approach --
_ _
BLDG DEPT.FIVJAI- — TEMPORARY CERTIFICATE OCCUPANCY Final _—
CERi'IFICATE OCCUPANCY
Landscaping l
�, Toning Final
Address --� �(c�5l _ . 1. 1 V-A'11
Permit
Permit chargo
[7Wner L,.�.LC Connection fee
---- Paid by
type of building Date connected _
Service rate ,i. Inspection fee
Contractor Paid by date
Size of connection _ Assessment Paid
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