Permit CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
I'` PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # • SW R97 -0126
DATE ISSUED: 04/23/97
PARCEL: 2S103BA- 00137
SITE ADDRESS... :11920 SW LYNN ST
SUBDIVISION •LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK LOT :27 JURISDICTION: TIG
TENANT NAME •PERCY
USA NO FIXTURE UNITS...: 0
CLASS OF WORK...:ALT DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS: 1
INSTALL TYPE •LTPSWR IMPERV SURFACE: 0 sf
Remarks: Must pump, fill, and cap septic tank.
Owner: FEES
JACK PERCY AND KATHERINE PERCY type amount by date recpt
11920 SW LYNN PRMT $ 2200.00 JSD 04/23/97 97- 293619
TIGARD OR 97223 INSP $ 35.00 JSD 04/23/97 97- 293619
Phone #: 590 -4185
Contractor:
OWNER
Phone #: $ 2235.00 TOTAL
Reg #..
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
of the Unified Sewage Agency. The permit expires 18? days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement —
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a °Tap and Side Sewer° Permit and the Agency will - install a lateral.
Permittee Signat��
Issued By: -t �
Call for inspection — 639 -4175
- • Plan Check #
TY OF TIGARD Residential Building Permit Application Reed By
..',125 SW HALL BLVD. New Construction Additions or Alterations Date Reed
- .GARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E.
503- 639 -4171 Date to DST
° 503- 684 -7297 Permit # 51•i2 9 - o ! 2 G
Print or Type Called
Incomplete or illegible applications will not be accepted . _
Name of Project Name -
Job - 5- e•wleir .{t -- - _ _ ..
ddress Site
I 11 Address Architect Mading Address
{ l SW ffJ _.� 2-y n n 3* •
City/State Zip 'Phone
N ack f kc l effn l l-C-1 Name
cme Owner Marlin Address
I q S vJ/ -y b n Crtate Phone Eng inset . Mailing Address
our ' P 423 ,996 -4 City /State Zip Phone
ar li General Describe work New 0 Addition 0 Alteration 0 Repair 0
Contractor Mailing Address to be done:
Additional Description of Work: '
City/State Zip Phone C CJ `, { a6 7 - U C
•
Oregon Const Cont. Board Lie# Exp. Date .
Attach Copy of -. . 1 . -
Current COT Business Tax or Metro # Exp. Date PROJECT
Licenses ! VALUATION $ . ::.:.,-T.,. .
- - Name - --- -. - -- • - •- - •
Mechanical NEW CONSTRUCTION ONLY:
Sub- - Maifing Address Sq. Ft House: Sq. Ft Garage
Contractor Corner Lot YES NO Flag Lot YES . NO
City /State Zp Phone (check one) (check one)
- - -• Oregon Const Cont. Board tic.* Exp. Date Restricted Audlo/Stereo Burglar -- 1 --
‘ttach Copy of Energy System Alarm
Current COT Business Tax or Metro * Exp. Date Installation Garage Door -' J HVAC
Licenses
Name Opener Systems
(check all that Other. - . -,- • . •-
Plumbing _. - - - - . . - .` apply)
Sub Mailing Address ; Will the electrical subcontractor wire for all . • YES NO
Contractor restricted energy installations?
City/State Zip Phone Has the Subdivision Plat recorded? . N/A .YES NO
Oregon Const. Cont. Board Lie# I Exp. Date Reissue of MST;#: Solar Compliance
Attach Copy of (Calculation Attached)
Current Plumbing Lie # Exp. Date I hearby acknowledge that I have read this application, that the
Licenses
COT Business Tax or Metro # Exp. Date information given is correct, that I am the owner or authorized
agent of the owner, and that plans submitted are in compliance
- - with Oregon State laws.
Electrical ; $ign�t u��re� Oned gen-t p�t��319 7
Sub- Mailing Address • Contact i P e cf rson Nam Iirem
P hone #
Contractor .. - _ , , " � , .r - 90- 1?_5
City/State Zip Phone - FOR OFFICE USE ON .
Plat #: MaplTL#:
Oregon Const Cant Board Lie# Exp. Date --
+rach Copy of Setbacks: Zone: Solar.
Current Electncal Lie # Exp. Date .
Licenses • Engineering Approval: Planning Approval: TIF:
COT Business Tax or Metro # Exp. Date -
i:sfapp.doc (dst) 1197
Permit # Account Description Amount Amt. Pd. Bal. tiue .
MST. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit • _ (MECH) •
ELC/ELR Permit (ELPRMT)
State Tax (TAX)
- - - Bldg: _ . _. _ .
Plumb: - .
ELC /ELR:
Plan Check - - . -
- MST: -- - - • — - -• - - -• (BUPPLN)
Plumb: • (PLMPLN) _. .
Mech: - - :. - ( MECPLN) _ - - • �.. . •
CDC Review - -- - (LANDUS)
c l^ ,(-. Sewer Connection _- - _ (SWUSA) -- �i 6 - • %. U�
= Reimbursement District - - -- - : ( " -) -- --
_ .. Sewer Inspection - -- - (SWINSP)-
Parks Dev Charge (PKSDC)
Residential TIF V V - (T1F -R) - - _ ..-
Mass Transit TIF (TIF-MT) -
Water Quality (WQUAL) -
Water Quantity - _ (WQUANT)
Erosion Control Permit (ERPRMT) -
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
Fire Life Safety _ (FLS) �J
TOTALS: v
i:sfapp.doc (dst) 1/97
•
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
Gas Line Appr /Sdwlk Reins.
Other:
Date: y A.M. P.M. ! Entry:
Address: / 1 q Z d 5-1-
Tenant: Ste: MST:
b�``p MEC:
1` /U MEP:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
SW 497—el i.z,
Ins ector: Date: iil!✓sil I
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO