11865 SW SCHOLLWOOD COURT ■ R
1865 SW SCHOLLWOOD COURT
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C {ARGE _ .� .�_none�_
OWNER CONNECTION Ff E _ J—JV °-
PAID BY
TYPE OF BUILDING � � DATE CONNECTED _.._
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SERVICE RATE INSPECTION FEE
CONTRACTOR
PAID BY DATE
_______ ______� �_�...._._.
SIZE OF CONNECTION T _._ ____ _ ASSE S5MENT _ PAID _
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City of Tigard
INSPECTION REO U E ST
for
INSPECTION TIME :lL. *,# PERMIT NO.: _.
I DATE: . r.LA_L7_C DATE ISSUED:___.L�
OWNERS NAME :
ADDRESS : _. �� �� _.S �✓_•Sc�ioO�wQ•sL
I CONTRACTOR . Ano& ^
TEST' Air 4, Water ['Visual ❑ , Laboratory ❑
IRESULT: Approved [I , Disapproved ❑ pending C]
SKETCH:
�o , 1Y•
1 PEe OR DATE
EN OTE : Attach supplemental test data heret-
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9583
LNIFIED SEWERAGE AGI N C Y NO.
':JASIAINGTON COUNIN DAT-F
CI-1-y OF,___, Tigqrd
APPLICATION FOR SLEWLI-3 CONNECTION PERMIT
OWNER: ---Art--Lut7&-L-0--
OWNER'S ADDRESS: -- ___0. 2
.5_ Ovtn
Huy
STREET
Beaverton OR 97005
-zip
Ty
BUILDING SITE: LOT--- BLOCK ADDITION
Tax Map 1S1-348Dd resider,-e
-TAX LOT NO. TYPE OF OCCUPANCY
ADDRESS -.1-18-155 SUI Ct.
DWELLING UNITS - 1 - - FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FFE --550-00-- INSPECTION FEE 25-OOTOTAL [)F--POSITED 575.00
(NEW) (EXISTING) BUILDING SEWER SYSTEM . Fanno Creek
The Applicant agrees to comply with all rules and regulations of the Unified Sjvwerage Agency.
APPLICANT—_
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO 'THE SEWER SYSTEM,
LINE SIZE 4" INSTALLER -- ----
RECEIVED BY '64 C-{-1 L,
(AGENCY OR 11S AGENT)
COMMENTS: 131dg. Permit 0903
This Application arid permit expires in ninety (90) days. The alTIOU11t paid will be forfeited
should expiration occur.
w* r;.. h.,, .,..,,, - , �; ,,....w•;iri"r"'�",�'y>�p�'...vrurpy/"�y�y;1r".+. a.�,+-s:...a-r...,....,.a.: ...., ...,.,,
CITY OP
BUILDING PERMIT APPLICATION TIGARD DATE____ Illy I '' N° 0 03
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE___ __-
t Lutz 4 Co. OM"
OWNER ADDRESS T` BUILDER PHONE
ENGINEERIgp
EUI,LDER �1 ARCHITECT _ —�_ DESIGNER
STRUCTURE ONEW _ ❑REMODEL ❑ADDUI—T,�ION ❑REPAIR IJRENEWAI_ _ ❑FIRE DAMAGE --11 ❑DEMOLITION
RESIDENCE OCOMM ❑EDUCATIONAL ❑GOV'T LJRELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE Irr-JSLAR [:]FENCE
❑BOND DMOVING ❑CONDITIONAL USE ❑DESIGN REVIEW DCOUNCII. APPROVED ❑SIGNS
Q(CUPANCY_ _LAND USE ZONE_ BLDG.TYPE FIRE ZONE a PLAN CHECK BY �� HEAT I��it9
Construct 1437 $q. ft. frame dwelling uibh ottechad garage
�! a bea►ement 3 Bedrooms Re-lgsufn I.f. 11360 SU Irckntwind Laop
�x mat) ISI-3401.) Tau Leat 24170
OCC. LOAD FLOOH !_OAD 4 01 1 L.1 HEIGHT _ NO.STORIES 1 AREA .922tM.LUF 1331,00u.
11 BUILDING DEPARTMENT SETBACKS FRONT ' ' REAR ��t LEFT SIDE ' RIGHT SIDE 4
136. 01-1 - ---- -
PermitTHIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILOINO CODE, ZONING
Plan Check �• REGULATIONS AND ALL APPLI,.ABLE 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
1%State 4. LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
A' CANT OR AGENT
LA By vend Rereipt No
ADDRESS PHONE
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
e x _ Contractor _
- Permit No. Y' -- ar p �/y17G
_ Rou h i A>tSr IZA _
Fixture `
Fine
HEATING
Contractor
_-_ — Permit No. -76
Gas or Oil
Rough-in
_ Final
- -- -- SEWER f .276
_-- Final _
DRIVEWAY
Final
;torm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
Approach _
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANC',
��
CERTIFICATE OCCUPANCY 3 � Final
/ - 3 - jz - �
Landscaping
(r ( Zoning Final
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