11715 SW HAZELWOOD LOOP 11715 SW HAZELWOOD LOOP
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BUILDING PERMIT APPLICATION �o Y TIGARD DATE August 25 19 76
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONF _
LOT NO..
OWNER -'I_Jid A* ilsstty JOBADDRESS 1171� SW HaXQLWU0CJ I+RWEADDRESS _
—' ARCHITECT
ENGINEER
BUILDER _i-1 ADDRESS DESIGNER
STRUCTURE ANEW _ ❑REMODEL. JUADDITtON ❑REPAIR [:]RENEWAL _ [-IF IRE DAMAGE ❑DEMO,ITION
RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T L,JREL.IGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
,QCrCUPANCY—_—LAND USE ZONE BLDG 1 YPE FIRE ZONE PLAN CHECK BV__ HEAT___
const• a 12,x Iw concrete pad to support a grefeb metal bldg, _--
includes errsction sof bldg•
UCC.LOAD FLOQ$1•UAD _ HEIGHT f NO,STORIES i AREA 216 NO.BEDROOMS
BUILDING DEPARTMENT SET BACKS FRONT 701 REAR be LEFT SIDE :i III RIGHT SIDE 100
Permit nn - —
1HIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS 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 AND IN COMPLIANCE WITH
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 •lJ LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total w't• •�J
By -
APPi ICANT OR AGENT
Approved kl Rereipt No
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1.
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City of Tigard
INSPECTION REQUEST
f 0 -1
INSPECTION TIME PERMIT N
DATE -4�112Z� DATE ISSUED ..—.-I—/—
�.;WNERS NAME :
ADDRESS:
CONTRACI'OR .' -----
TE3T ' Air 0, Water t-j , vIsucql, Laboratoryo
RESULT: Approved Disapproved 1-j Ppndinq F
SKETCH.
INSPECTOR DATE
'Aft lrh v!4 b a r A
" I
' City of Tigard
i
INSPECTION REQUEST
for
I INSPECTION TIME : S%ct) PERMIT NO. : �
{ DATE: �-'_121 DATE ISSUED:
I OWNERS NAME :
ADDRESS :
CONTRACTOR : _- Lc &Pgt.A) 1=}.,y, .,_ •
TEST: AirC, Water, Visual Lab ora"ary0
RESULT: Approved Disapproved 0 Pending p
�
SKETCH.* T'k.,�l �-1 � 10�LH �•-C�� .
U
I
INSPECTOR DATE
ICNOTE : Attach supplemental tett data hereto
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ciTr OF
BUILDING PERMIT APPLICATION TIGA�,RD DATE— ":h I 'i ., t9 '�I11r°' 0702
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR (ISE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PL4NS AND SPECIFICATION OWNERPHONE
o
QVN �I ... , , is MAY104
_ ^ADDRESS L (
CO PHONE
fawner ENGINEER
9UILUER _ARCHITECT
— DESIGNER Thomas
Allen
STRUCTURE INEW REMODEL UtADDIITION OREP4IR ❑RENEWAL Ery�FIRE DAMAGE []DEMOLITION
RESIDENCE L3Cl1MM CEDUCATIONAL ❑GOV'T []RELIGIOUSLJPArio ❑CARPORT ❑GARAGE ❑STORAGE LSLABOFENCE
-nBCND EIMOVING IJCONDITIONAL USE ❑DESIGN REVIEW i ❑COUNCIL.APPROVED ❑SIGNS
LAND USE ZONE BLDG.TYPE FIREZONE--1 PLAN CHECK BY_ x HLAI�_
Construct le” u sq. ft. 1 *to
rY PraMv dwelY,ing with attached ---- —�
garage. No basement, According tO approved plans. --
S.ra • s. — 4 bedroom T
OCC•LOAD F1.00R LOAD _HEIGHTNO.STORIESAREA_ VALUE
BUILDING DEPARTMENT l�
SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
16
Permit ;'.� ,, ,F i•�f'a - —_
THIS PERMIT IS ISSUED SUBJFCT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plea Check _--- - REGULAI IONS AND ALL APPLICABLE CODES AND ORDINANCES, ANO IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND Ih COMPLIANCE WITH
Recording —_ ALL APPLICABLE. CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- 4rl�t RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTOR$, TO HAVE CUR4FNT CITY BU31NESS
96 Stete LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER. PLUMBING AND HEATING.
Total -- "
By
APPLICANT OF AGENT ----- _— -- ----
Approved Receipt No. 1 �
PIIONI- -__.-----..—_�---
a ■+► wr a w �r ■r a
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE +
a= .r . _ - Contractor .1j' - -
j/
Permit No. o 37
_2e-76 7 Rough-in--_--
Fixture -
Finel
HEATING
s— ,„.—tom° — Contractor
Permit No.
— — — Gas or Oil-11(4
Rough-in ------
Final _
- -__—.— ---- ------ SEWER -z, .� ',N
— Final
--_—.—__ -- - -- URIVEWA� _"_� � -
Final
— - —. _- - --- ---------�__-- Storm Drainage — --
(Rain Drain) Final -- —
Sidewalk
Curb&Street Final
— - - ---- Approach
— BLDG.DFPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE 0 CUPANCY —lol ,
� Landscaping/ 1l '6 Zoning Final
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ADDRESS // %/S r��J� S[ --,mac t�nrr 4��j�E R rl I T NO.
._____ - -
PERMIT CHARGE none
CONNECTION FEE
PAID 0Y
TYPE OF BUILDING DATE CONNECTED
SF_HVICE RATE _ INSPECTION FEE
CONTRACTOR . � ._. _ ____ PAID 8Y _ -- DATE
SIZE OF CONNVCTION ASSESSMENT PAID
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