12196 SW LANSDOWNE LANE �M J
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-- 12196 SW LANXSDOWNE LANE
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iTtOFTIFARD
C'lrYOFTMRD
COMMUNITY DEVELOPMENT DEPARTMENT
131268W IWl slid. P.O.Box 23=,,Dgvd,omgcon F,,1p 75
.:;in ADDRESS. LiM96 4.,3W LAN9DOWNE LIA P A R L S 19,3 B C WG/'4)0
SUPDIVIStCON. F*YRF.:STON!: R 4. t)
BLOCK — . U31
CLASS )F WORK. IINEW
()(X U PO W.,Y ;f• P. IR 3
0 L C U P n N CY L.C)'=11) V 2 5 4
''I'--'NAN', NWIL".
J. (*. ROTH CONSTRUCTION INC
1*2306 BW 691H AVL.
TIOARIP OR 37223
Phu-ne 4ig 639-263
;f. T. ROTH GONSTRUCTICIN
12300 5W G`*TH AVE
JIGAN) ON, "41?!23
1 1
�11011e
Rog fi. . r IL700
Uccupa"cy of the abovv refvt -- ,ced bu.J.1,00-ty J,% hereby given,, ;Arj(jp
C .. I, : .die
H-10 c-0111plialice wi.J.11 the GEal;e Of O-regall Speci 'Ity Gcldtv-.c fu'', t.he grat'll),
oc1ct-q)a%ncyj and time cinder which the rpfe-renced permit, was
.............
FIRE DEPARTMENT b U 1 J)IN S IN S i*r
POST L14 GON13ptc(A)US PLACE
JI SPSCrION NOTicE
City of Tigard Building Departrant
13125 RK Hall 51wd. Tigard, Oregon 97273
Inspection Line )Re -O-Phor-4): 639-4175 Business Phonj: 639-4171
Inspection: _
Fcx.`ing Plbg. Underslab Mach. Rough-in Apr/£.dwlk
Found. Plhg. Top Out Gas Line 7INA—,z
Post/Beam Strvct. San. Sewer. Framing ldg.
Post/Seam Mach. Rain Drain Insulatr.on A4,1-Pluab.
Plbg. Underfloor Water Line Gyp. Bd. ech
Dare Request/eds-----,�_Q�_ �----y.�7 Times _AM _—PH
hddrees: _ ( x_14-_— rG? /nA -Permit
THE FOLLOWING CORRECTIONS AR' REQUIRRD:
n
-� Date'
APPPr)VRi7 DISAPPR:3VED hPPP.OVED 'IUHj sCT TO ABOVE
Call For Reinsp.
k
1 e1 FOR 4[
i
j�l$1��CTIQ�s NOTICF. � /,
City of Tigard Building Dep--t—nt
1.3125 BW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-P ne): 639-4175 Buiiness Phone: 634-4171
Inapect!ons
Footing t.'. Underslab Mech. Rough-in �Appr/Sdwlk
Found. PI Tog Out Gas Lino FINAL:
Poet/Beam Struct. Ban. Brier Framing -Bldg.
Post/neem Mach. Rain Draiu Tneuletion -Plumb.
plbe i! leriloor Water Line Gyp. Dd• �Nh
n.._.. ::equested:M� - U -.._Timet
Addreeesr #s
Builder:__
TNN FOL,'.OWING CORRECTIONS ARE REQUIRED:
Inspwa l n � L.17�zer_ — Dates
-
CPROVED DISAPP D "TROY D AtlBJICT TO ADM
Call For Reinep.
INSP$CTIO!( NOTICE
City of Tigard Duildl.ng Department
13125 SW Full Blvd. Tigard, Oregon 97223
Tnapection is (Rec-O-Phone): 639-41"5 Business Phare: 639-41`.1
Ict ion:
rig Plbg. Underslab Mech. Rough-in Appr/Sdalk
Found. Plbg. Top Out Gas Line U'NAL:
Pont/Beam Atruct. San. Sever Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation ( Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date Requeateds. — � (
___ TiUdI AM'
h6dreas: -2142
THE FOLLOWING CARRECTIONS ARE RFQUTaan.
n <r�
[nspuct')c:_.-- --- --- - ----- - -- --- - Date: p
--_,APPROVED DISAPPROVED APPROV9!1 81113JF.C'T TO ABOVE
Yor Re:nsp.
w MR sir
p p�' T ION,—NO_ CE
city of. Tiga.td Building Depart'set:t
13125 811 Ball Blvd. Tigard, Oregon 97223
Inapectfon Line (Rec-O-Phona)t 629-4175 Buelnene Phone: 639-4171
lnspectiont_-- ------ ----- --_._.
root ln,q Plbg. underelab Mect . Rough-in /#��M%/Bdwlk
Found. y• P
Plb To Out Gas Line FINALS
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain
Insulation -plumb.
Plbg. Underfloor Water Line O,p. Bd.
-Mach.
Date Requesteds
- � __TLast AM PM
Address:
�—
THS FOLLOWING CORRECTIONS ARE REQUIREDt
*.nspsctort�� Date:
APPROVED DISAfF D AIPROVED SUBJECT TO ABOVE
Call For Reinsp.
I
;j!$?FCTION NOTICE
City of Tigmrd Ruildinq Dopartment
13125 BW Ball Blvd. Tigm d, Oregon 97223
Inspection Tine (Roc-0-•Phone): 639--4175 Business Phone: 639-4171
Inspoctions__
Footing Plbgi/Underslab Mech. Ro -.tn Appr/Sd ,lk
Find Plbg. Top Out Cas Line FINALt
Poet/Bea,n Struct. San. Sower Framing -Bldg.
Post/Beam Mech. Rain Dr:air, insulation -Plumb.
Pibg. Underfloor Mater Line / ayp_�ed.� -Mer;h•
Date Requestedt � ` __Titre! AM
Address:
Buiider:^�
THE FOLLONIro 00RR1R4.TIONS ARE REQUIRED:
--- 111 i1 —� —.._-_----------- —
fMpeotol'tj 'Y]' �—� Date:
Al NNEO DISAPPROVED __— APPROVED SUBJECT To ABOVi;
Call For RMinsp.
vwx we wr war sera IW
IN9�ECTIOl� 'iATICE '
City of Tigard Building Department
13125 on Ball Blvd. Tigard, Oreqon 97223
Inspection Line (Rec-O-Phone): 639-4175 Bus inane Phone: 639-4171
Inspection:y
i
Footing Plbg. Underslab Mach. Rough-in Appr./Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet:/Beam Struct. San. Scegr Fra:uing -Bldg.
Pnst/Beam Mach. Rain Drain Innulation -Plumb.
Plbq. Underfloor Water Line ( Gyp. Bd. -Koch.
Date Requested'___--� ��� �- -TLme: _ , _AK ---PH
Address: 1 t C?(o eIrl(Ad—n/ C Permit #:CC71 Q-
Builder:_--
i
THE FOLLOWING CORRECTIONS ARF. REQUIRED: l
11
7�TT"i✓C. / 1t/��fJ /'���A.yGc=S"�. l' -✓vim-!'T� .
Inspector: -_ _ Datt:__�
APPFOVED nISAPPROVRD APPROVED S'18.TECT To ABOVE
Call For Reinap.
1NSPE.CTI N NOT._CE
City of Tigard Building Department
13125 SX Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone: 639-4175 Business Phone: 639-4171
Inspectl.on:___ -- -- i
Footing Plbg. Under-alab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/a"artl Strucr. San. Sewer __Framing, -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Rd. -Moch.
Date R• -gated. / Time: AM PM
n
Address:---/ �_'ls_ ���Gy�.i —_ _ Permit /s d / cam+
Builder:_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: Date:
4: 7OPROIZD DIShPPROVED APPROVED SUBJECT TO ,%BOVE
Call For RLIvisn,
JPSPYCIION 11(MCE
City of Tigard Building l:epartment
13125 BN Ball. Blvd. Tigani, Oregon 97223
Ineraction Line (Rea-O-Phune)- 639-4175 Busineas Phoney 639-4171
Inspections -- —..� _ __-
Footing Plbg. Unde:slab Mach. Rough-in Appr/Sdwlk
� r
Found. P1bq. Top OutGae Line FINAL:
Pant/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain naulation -Plumb.
_i
Plbq. Underfloor Water Line Gyp. Bd. -Mach.
y
Date nequentedr_ -��-��- � Tiroar -- -AMPM
Address:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
1 /
t.7_A,_A
w
Inspector:_ Date:
APPROVED DISAPPROVED—� ----- VED -- APPRGYED SUB.TECT TO ABOVE
--Call For Reinap.
I�¢�ZC1't OO�LIOT I CE
city of Tigard Building Deparl„:nt
13125 BW Ball Blvd. Tigard, Oregon 97223
rnapoction Line (Rec-O-phone): 639-4175 Businesr Phoned 639-4171
i
Inrpectfor.-_�_ --+
Footing q. nderslab Meeh. Rough-in Appr/Sdulk
Found. Plbq. Tap Out Gas Linc FINAL:
Poet/Be.rro St ruct. San. Se"r Framing -Bldg.
Poet/Ream Mech. Raln strain Insulation -Plumb.
Plbg. Unde*floor stater Line Gyp. Bd. -Koch.
Date Requested:-- — Time.:/ _AM�fj—� 7`/PK
Address:_ c� ��%� i it �s—r-1---=}'�
Builder.:_y�// __THE FOLLOW Lyfi CORRECTIONS APE REQUIRED:
s /
Inspector!
APPROVED DISAPPROVED APPROVED SUBJECT TO AB(jJE
Cell For Rainsp.
Ld9PEC�i_O�f NOTICE
Cit' o: Tigard Building Department
13125 M Hall Blvd. Tigard, orn!son 97223
Inspection Line (Rec-o-Phone,)) 639-4175 Susin•ss Phones 639-417
•nspections___-_
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Seam Struct. San. Sewer Framing -Bldg. Ei
Post/seam Mech. Rain Drain Insulation -Plumb. I
Plbg. Underfloor Mater Line Gyp. ed. -Hoch.
Data Requestedt - I Timer AM �__PM
Address s 1�+ L CAv,-Q- Permit #,91
ry
THE FOLLOWING CORRECTIONS ARE REQUIREDs
Inepertcr:—�.�� --- -_� --- Dates_ -�� Com'
`_APPROVED DISAPPROVED C TPPRoVED SUBJECT TO ABOVE
Call For Reinor.
t4 R&CI 2N NOTICE
City of Tigard Building Depart:aent
13125 SU Ball Blvd. Tigard, Oregon 97223
Inspection Line (Ree-O-Phr s): 639-4175 Business Phone: 639--4171
Inspection:.
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Found. �Plb� Top out ) Cas Ling FIN' :
Poet/Ream Struet. San. Sewer Framing -Bldg.
Poet/Ream Moch. Rain Drain Insulation -Plumb..
Plbg Uiderfloor Water Line Gyp. Bd. -Mach.
Data Req jested!_ �—� — _ Timet _– _AM _- i M
Address= /.!f C1? . 7CG )ermit t.-
Builder:
:Builder:_ `'fes _ _-
THE roll LOW INt4A RRECTIOhS ARE REQUIRED:
f
Inspectort-
^11�_ APPROVED CFSAPPROVED APPROVED SUBJECT TO ABOVE
—_CAil ftr Aaieap.
ar• nw aar tirtr a.. � .,. .ar s. .w
�NSPBCTION�IOTICE
City of Tigard Building Deparl-arent
13125 BW Ball Bled. Tigard, Oregoa 97223
Insper:tion Line iRuc-O-Phone): 639-4115 Buaireas Phone: 639-4171 �
Inspectionr—
Footing Plbg. Underelab Kech. Rough-in Appr/6dwlk
Found. Plbg. Top Out Gas L'.ne FINALt
Poet/Beam Struct. Sari. Sewer FlM�Lp�--� -Bldg.
Pont/Beam Mech. Rain Drain l\V,N-< Insulation -Plumb.
Plbg. Underfloor NaterLine Gyp. Bd. --Mach.
Date Reyueatedt �u Timet AN r '7 M
Address: I�G� x �L/JZ�' l�ydrmit ft l/-�\L/ /!a
BuLldert��
T THE FOLLOWING CORRECTIOUS ARE REQUIREDt
Liepectors~ _ ---.—„-�- Dater s '
"PROVED DISAPPROVED _-- APPROVED SURJECT To ABOVE
-_---Call For Reinap.
WON
INSPx9now NOTICE
City or Tigard Building Department
25 BW Ball Bled. Tigard
���' . Ow 97223
Inspection Ll: . (Rec-0-Phone: 639-4175 Business Phone: 639-4171
Inspections_ i 7;L�/
Footing Plbg. Unt.eralab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Oar Line FINALS
Poet/Beam Struct. San. Bawer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insu aation'l -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
Date Requested: L_ T1me: AN _ PH
Address:
Builders
THE FOLLOWING OORRE(TlONS ARE REQOIRI*.Ds
f
r --
Inspector:_--,Z�
Date:
—`APPROVED _ ✓ DTSAP41tOVED APPROVED SUBJECT TO ABOVE
_Cell For Reinsp.
INSPiCTION NOTICE
City of Tigard Nsilding Dipart=mt
13125 ON Hall Bird. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone)t 639-4175 Business Phones 639-4171
InaPectlont
Footing Plbg. Underslab Hoch. Rough-in Appr./Sdwlk
Found. Plbg. Top out Gas Line FINAL:
Fust/Beam Struct. San. Sewer Framing -Bldg.
Post/Beata Meeh. Rain Drain Insulation -plumb,
�j= __Underfloor I Water Line Gyp. Bd. -Mach,
Date Requested:_ `l 7�-
)�' �' _�Tlmes _ AM —_PM
AddresetZT ,� /�C y.=7� � It Permit
7`
Builder: �_-
THE FOLLOWIN / RRECTIONS ARE REQUIRED:
Inspector: _ — _-_ Date: a J/
APPROVSU `-- DISAPPROVED !— APPROVED SUBJRCT TO ABOVE
__Ca.1 rot. T-innp.
INAFZCTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 BUSIVAos Phone: 639-4171
Inspection:
Footing Plbg. Underelab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
P at r"am Btruat.�� San. Sewer Framing -Bldg.
PP079eam !tech. Rf.in Drain Insulation --Plumb.
P11.sg. Underfloor. Water Line Gyp. Bd. -Mech.
.G
Date Requested: .f+ -_ -_ _ _Timm: __`AM /"-_PN
Address:_-� �� kbermiC
Builder:_ _ L _
TFM FOLLOWING CORFECTIONS ARE REQUIRED:
Li' D�/i p� /LTi /OGT ��a-%AGK �OC/fc=TZ_
Inspectors _ betas J -
APPROVED DISAPPROVED APPROVED SUBJECT TO ABCIIE
Call For Reinsp.
i
+.. M
f
jNSP12TION BOTICR
City of Tigard Bul."Ad g Departw nt
13145 SW Bell Blvd. Tigard, Oregon 9771(3
Inspection Line (Ref-O-Phone)t 639-4175 Business Phonet 1,39-4171
Inspectiont
Footing Plbg. Underslab !loch. Rough-in Appr/t:e.wlk
Found. Plbg. Top Out Gas Line FINAM
Post/Been Struat. ilsan.�Sewer Framing -Bldg.
Post/Beam Nech. Rain Drain J Insulation -Plumb.
Plbg. Underflooratar LL_ne j Gyp. Bd. -Meeh.
Date Requestedt �� - _Time:
Addresst Z-2
Builder:_
TNR FOLLOWING CORRECTIONS ARE MITIIRRDt
Inspector: patat - a�
--
APFROVED __ DISAPPROVFD APPROVED STIRJECT TO AWVV
----.Call For Reinnp.
j!(EM-21ON NOTICE ,
City of Tigard building Department
13115 sw Ball 911rd. Tigard, Oregon 97223
Inmpection Line (Roc--O-Phone)+ 639-4175 Business Phones 639-4171
Inspections
Footin� Plbg. Underslab Mac) . Rough-in Appr/Sdwlk
Plbq. Top Out Gas line FINAL:
Poet/Beam Struc*. San. Bower Framing -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Pibg. Unslar'loor pater Line Gyp. Bd. -Hoch.
Date Requested Tlmar
Addrese s (,F G�. 7/i'7 /i� L Permit
Builder:_
THE TOLIA-MING CORRECTIONS ARE REQUIREDs---
72,
(��7yv�lJ� S/,/cA1L :i Ey�DCi�•v•� ('� �'Ar',R-�
14 QuS �iTi� ��✓ iii?"=t_Z/nom ���d�
inapectors&''_ Dates —
.���
_____APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
`Call For Rainsp.
W ON W W W INS
CITYOF TIGARD► ® MASTER PERMIT
CIIYCJP COMMUNITY DEVELOPMENT DEPARTMENT 011100";ORD *. . . . . . . . M S Tj 1--0 07&
13125 SW Hell Blvd. P.O.Sm 23397,TOW,Oregon 97223(SM)630-.4175
1 1 " i DATE ISE)LJED: 04/29/91
L HUD IiE I, 19G SW -.t iN'.3I)(3WNE LN PARCEL: 2S10313 11167Q.10
,Z-;LJBU I V I S I OP.:. . . . FRYSIONE
ZON][NLi:
L 0 C!-C. . . . .. . . . . .
BUILDING
RE I SSUE i DWELLING UNTTS: 1 BASUMENT. . . . . . . . :0 s F
CLASS OF' WC 'd<. -NEW BEDRMS:3 BATHS s 3 GARAGE. . . . . . . . . . ..528 S f
TYPE OF USE. . . :SF FLOOR AREAS REQUIRED SETBACKS-—
T'Y F'V OF' CLAST. .5N FIRST. . . . , 1323 sf LEFT. . : 15 ft RIGHT. : 15 ft
UU-UPHNLY URP. R,3 SECOND. . . : 1120 Sf FRONT. -20 ft REAR. . : 15 Ft
I URI L'S. . . . . . i? THIRD. . . . :0 S f REPUIRED--------------- -----
IE 1.GHT. . . . . . . E5 -Ft TOTAL—-_..- ----:2443 S f 5MOKE DE.TECTORS. :Y
,=:LOOR LOAD. . . . :40 psf VALUE. . . . . 1LIB82 PARKING SPACES. , :0
Remarks :
PLUMBING
I N KS. . . . . . . . . . : 1 FLOOR DPAINS. . . . :0 SACKFLO14 PRFVNTRS. . :0
04V"TORIES. . . . . ..4 WATER HEATERS. . - 1 TRAPS. . . . . . . . . . . . . :0
I UB,'SHOWERS. . . . :3 LAUNDRY TRAY S. . ,'-1 CATCH BASINS. . . . . . . .!.0
WITER CLOSETS. . :3 SEWER LINE (ft ) GREASE TRI'rPS. . . . . . . :0
D I'TAWASHERS. . . . : 1 WATER LINE (ft ) . : 1.00 OTHER FIXTURES. . . . . �0
GARS,"40E DISP. . . : 1 RAIN DRAIN (ft ) . :@
WASHING MACH— - 1 SF PAI N1 C.tAINS. . : i
MECHANICAL FEES
I-IJEL TYPES---- ----------- UNIT H1 RS. . -0 t y r)e A M 0 1A n t by date r,p(:Pt
L VENTS . . . . . .0
-r I F $ 1350. 00 JLH 04/29./91
MAX INPUT:0 STIU VENT FANS. . .5 PPRT $ 488. 160 11_14 04/,"''a/9l
F'URN ( 1,60K . . .-0 HOODS. . . . . . : 1 BPLC $ 317. 20 JLH 04/29/91
FURN ) =100K . . : I wnoDSTOVES_-0 B3PC t, 24. 40 JLH 04/29/91
FLOOR FURN. . . . s@ CLO DRYERS. : I SSDC $ 375. 00 JLH 04/29/91
)1OI1_./C"MP i 3HP-.0 OTHER UNITS:@ P()P.H ;, 51710. 00 JLH 04/29/91
(iAb OUTLETS: I MPH-( $ 43. bO JLH 04/,?9/91
1V11.,1_1,,, * 10. 88 JLH 04/e9/91
J. 7'. ROTH C0NF.3TRUCTTnN INC MFIPC $ 2. 18 JLH 04/.29/91
J.2300 SW 69TH AVE F4-,P''T S 147. 750 JIAA X14/29/91
P5PC t 7. 38 JLH 04/29/91
—
1 TGARD OR 97P23
I hone +).- 639-2637
1- 7. ROTH CONSTRUCTION INC,
IC-11300 SW 691,11 AVE
IIL-ARD OR 97223
Req 31700
04 7'OTAL
This oarmit is issued subject to the regulations contained in the REQUIRED INSPRCTIONF-i
ligard Municipal Code, State of Ore. Specialty Codes and r.11 other Fo o t t a u n d Insp f- I r-e P I ace .1 11 S P
avolicablo laws, All work will be done it :cordance with approved Vlost/Beam Str-uct Gas Line Insp
clans. This pe)-vit will expire if work is not started within 180 Post/Seam Mecham Insulation Insp
Java of issuance, or if worL, i.: suspended for more Pan IN days. Plm/undslab Insp Gyf) Board Insp
PLM/Undet,floor Pain drain Insp
"t'r1littee si.qylatl merliAll i�:_-A I Insp Water- Line Insp
Plumb "Fop out Appr/Sdw14 Insp
By : Pt-Aminq Insp Mechanical F'iyial
U--a 1 1 for- inspection 639-4175
CITY OF TI ARD SEWER CONNECT:ON
C" Tnwm WERM 1 T
COMMUNITY DEVELOPMENT DEPARTMENT m #. . . . . . . : SWR91-0080
13125 SW HWJ Blvd. P.O.Ba 233g7,TOW,OrSW 07223(SM)4304176
SITE ADDRESS. . . : 12196 SW Li^)NSL)nWNE LN PARCEL: e610313C 06711-1 -
SIJBDIVTGIQN. . . . t FRYSTONE ZONING:
HLUUK. . . . . . . . . . : LOT. . . . . . . . . . . . . :6
TqNANT NAME. . . . .
USA NO. . . . . . . . . . :43623 FIXTURE UNITS. . . :
CI-ASS OF WORK. . . :NE:W DWELL ING UN I T'S. . : I
'rYPE OF USE. . . . . :SF NO. OF SUILDINCS- 1
iNSTALL TYPE. . . . :BUSWR IMPERV SURFACE— : f
Rem,--Arks:
Ownf?r- --------------------------- ----------- FEES
J. T. R(JTF-j CONST-RUCTION INC type amfilint by date rec4)t
12300 SW 69TH AVE PRMT $ 1500. 00 JLH 04/29/91 -
I NSP $ 00 JLH 0111/2-19/91 --
T I( ARD
TIGARD OR 972e3
Phone #: 639-2037
Contractor:
J. 1 . ROTH CONS-TRUCTIDN 1N
12,3o0 SW 69TH AVE
' IC-ARD OR 97223
PVlane U : 633-2637 $ 13"L!5. 00 TOTAS..
Req #. .. : 31700
REQUIRED INSPECTIONS
This AppliQant agrees to covply with all the rules and regulations Spwer Inspect inn
of the Unified Sewage Agelcy. The pereit expires 122 days frve
the date issued. The total mount paid will be fo-feitpd if the
rernit expires. The Agency does not g.iarantee the accuracy of the
side sewer laterals. If the sewer is not located at the aeasuresent
given, the installer sh%ia prospect 3 feet in all directions froe
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer' Pervit and the Age Will install a lat t-al.
t 01 1 t t L-e Si gnat itt-i
I - �1 P IJ By
Ca{ 1 for inspect ion 639-4175
CITY OF' TIGARD RECEIPT OF PAYMENT RECEIPT NO. a 91--P- 121571
Cl lr,.r,K AMOUNT s 4701. 04
;lf 01E.. t XT ROTH CONSTRUCTION CA314 AMOUNT 0. 0f1
PAYMENT DATE a 04/29/91
SUBD I V I S ION
PURPOSE OF PAYMENT AMOL)Nr PAID PURPOSE OF PAYMENT AMOUNT PAID
i;CJILDING PERM 488. 00 PLUMBING PERM 147. 50
MECHANICAL PE 43. wO ST. BUILD PER 33. 96
PLAN CHECV, FE 228. 08 SiWER LISA 1500. 00
SEWER INSPECT 305. 00 RESIDENTIAL TRAFF'IC FEES 1250. 00
PARKS SDC 500. 00 STORM DRAIN SDC 375.00
MASS TRANSIT TIF' FEES 100. 1110
1 _196 SW I—AN9- DOWNE I..N
10TAL AMOUNT PAID 4-701. 04