15640 SW ALDERBROOK DRIVE 1
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15640 SW ALDERBROOK DRIVE
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City of "I"igafu
INSPECTION REQUEST '
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INSPECTION TIM!_: 42 , 221 PERMIT NO. -____ I
DATE: .42_122Z DATE ISSUED .--1 __ 0
OWNERS NAME :- ,
ADDRESS:
CONTRACTOR :
BEST : Air p, Woterm , Visual C) Laboratory
RESUI T : Approved t] Disapproved C Pending El
SKETCH.
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1N ECf� TOR DATE I
[NOTE Attach supplemental test data beret] I
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UNIFIED SEWERAGE AGENCY NO. _ IvIt8 -74
WASHINGTON COUNTY DATE _-12713776
CITY OF_ ri4,B_r_C._
APPL !CNATION FOR SEWER CONNECTION Pl- ILMI T
OWNER T.D.C.
OWNER'S ADDRE)S:
STREET
CITU STATE i IP
BUILDING SITE: LOT383___ BLOCK . _ — ADDITION
TAX LOT N0. _.__-- ___-__ TYPE OF OC';UPANCY __ reeidlence
ADDRESS ___11M__5W___Ajderbrook t)r.-_
DWELLING UNITS___ ___1_____ FIXTURE UNITS
SURCHARGE IF APPLIC/-.BLE
PERMIT FEE_ ,!!Il___.___ INSPECTION FEE _2.5,0Q- TOTAL DEPOSITED 600. 00
(Nb ) (EXISTING) BUILDING SEWER SYSTEM _____Fenno geek____. _
The Appiicant agrees to comply with all rules and regulations of the Unified Sewerage Age",y.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE - _____ _ INSTALLER ._.._. ......
RECEIVED BY --� __- ._.__
(AGENCY OR ITS, ENT)
v'
COMMENTS:-.----. . Bldg. # 1195
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.
CITY TIGARD DATE-12-13 19_
BUILDING PERMIT APPLIC 4TION OF t ��
THE UMb RSIGNED HEREBY APPLIES FOR APERMI I FOR THE WORK HEREIN INDICATED BUILDERPHUNE—
OR AS SHG,'VN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
1"'f rJo"- -
OWNER TOSC„ JOB ADDRESS SW Alderbrook HOFAEADDRES5
— NI ARCHITECT —
80m ENGINEER
BUILDER fj ADDRESS DESIGNER
� F
SFTRUCTURF- MfjNEW ❑REMODEL _ El ADDITION C1 REPAIR _❑RENEWAL _❑FIRE DAMAGE _❑DEMOLITIL`N
uREFIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB LIFENCE
❑BOND ❑MOVING ❑CON",ITIONAL USE ❑DESIGN REVIE.J ❑COUNCIL APPROVED ❑SIGNS
- I - - -- - - — _ —_ - _LTi-
OCCUPANCY LAND USE ZONE____ - _BLDG TYPE--FIRE ZONE__. PLAN CHECK Br HEAT,
Lot #38:5 Ink XXII Re-JeOU6 + maw. as 16634 SW SummNrfisl�J Lane
Frame dwsllig6 b/att.achud garaVe 2 bedrooil,2 bath T
-- 1
UC t.LOAD__— FLOORI.OAD HEIGHL— NO•STORIES 1222 2 24.887.
AREA NO.=FIOOMS VALE --
BUILDING DEPARTMENT SET BACKS FRONT �'� REAR 1 LEFT SIDE is RIGHT SIDE
Permit 00
1� l� THIS PERMIT IS ISSUED SUBJECT' TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, 2.ONIhs
•
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT ThE
WORK WILL BE DONE !N ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WIT-i
Sub-total ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOTS NOT WAI) E
— RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINcSS
State Tax 39 LICENSE. SEPARATE PERMITS RFCIUIRED FOR SF'WER, PLUMBING AND HEATING.
Total 1215 b6 _
By _ ------ -- --- ---------
--
171P1 '(.ANT OR AGENT
Approved Receipt No
�---- -
ADDiiE45 pI IONF
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
]Contractor
Permit No.10 �•� or �� ''1 7
- -�Lr �L. --- ---- - — R)u h-in
Fixture
Final _.---
_ HEATING
_ Contractor_
Permit No_
Q'rp
.7.1 �' ?� � a r^' c••yr -c.. Gas or Oil --
- .11 . L.L's�� .�� � Rough-in
Final
SEWER
i -- - ----- — renal -- .—
— DRIVEWAY
_ ----�— Final
— Storm Drainage
— (Rain Drain) Finel
Sidewalk
Curb& Street Final
Approach
8LD(3 DEPT. FINAL `T TLMPORARY — CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
landscaping
7onivg Final
I
Addrez,s c < < etct. �1,.r.. rJermit No.
"ermit charge
Owner �. .� , C Connection fee -.j-�� 5 =U
_ Paid by
Type of building }sem Data connected
Service rate
G' Inspection fee
Contractor Paid by _ _ date
Size of connection Assessment Paid