11045 SW COTTONWOOD LANE-1 0
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110.15 SN COTTONWOOD LANF
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Address �j/e) permit No.
Permit charge J) c� r�
Owner ;� L� ., _ � Connection fee !Iry -,—
Paid by
TyEIc of building A"- Date connected —
Ser,. ice rate ��� Inspection fee
Contractor Paid by Date
Size of connection Assessment paid
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :_ PERMIT NO. : -
DATE: —
O. : _DATE: _ DATE ISSUED:—/
OWNERS NAME: _
ADDRESS : 11,2 '4�
CONTRACTOR :__ '2L," _
TEST' Air 0, Wuter p , Visual p , Laboratory p
RESULT. Approved 0 Disapproved D , Pend ng []
I SKETCH:
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INSPECTOR DATE
I [COTE . Atfach Supplemental teat data hereto
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UNIF= IED SEWERAGE AGENCY No. -- 11651
WASHINGTON COUNTY DATE — 2-9
Tigard
CITY OF-- ---- -
APPLICATION FOR SEWER CONNECTION PERMIT
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OWNER: ._
OWNER'S ADDRESS:
S -- -
_— --- TREET J
--CIiV - -3TAtE ZIP
BUII DING SITE: [,OT 194 - BLOCK ADDITION -
TAX l_OT �,0
I . _ TYPE OF OCCUPANCY -..---- residence
ADDRESS - 11QA5 SW -Cottonwood --
DWELLING UNITS .-- --- - - - -- — FIXTURE UNITS .
SURCHARGE IF APPLICABLE
PERMIT FEE _52.5._------..- INSPECTION FEE TOTAL DEPOSITED
(NEW) (EXISTING) BUILDING SEWER SYSTEM _____Eal1no
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT --
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE
INSTALLER ---- —
---..—_--_.'_____- -- % J
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RECEIVED BY.- __._=
IAOENCY ORBITS AGENT)
Bldg. #1295
COMMENTS: _�_....__ __�___ __ - -- ------
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.
BUILDING PERMIT ,APPLICATION " y TIGARD DATE 2-9-.77
lV'
THE UNDERSIGNED HEREBY APPLIES FOR APERMI T, FOR THE WORK HEREIN INDICATED BUILDER PHONE. �__
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER PHONE—
LOT
HONELOT NO..---__.
OWNER S;RJ► f' 1� 1}1U(illd$ JOBAODRE.SS 11U4%.; JW Cattunwouc Fjd7ItADDRESS
ARCHITECT
BUILDER f3nmCf ENGINEER
_ I �� WEADDRESS DESIGNER
STRUCTURE ❑ ADDITION ❑REPAIR ,,RENEWAL
❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARP,E ❑STORAGE❑SLAM ❑FENCE
❑BOND ❑MOV ING LICONDITIONAL USE -- ❑DESIGN REVIEW ❑COUNCIL APPRC%/ED ❑SIGNS
OCCUPANCY-j—LAIN D USE ZONE --H-7 BLDG.TYPE S&FIRr ZONE3 PLAN CHECK 13Y 6tW HEAT Ll
9111u1C, family dWe%.in+: w/attached ye+rous. 3 bedroom 1 broth Lai. .i.!4,-'I
garage U10 sq. I t. re—i taus, 801116 as MK 12941
1 174 S 37i00,r
UCC LQ kLL.QFiD___
2 .. _F1,QQ _�� _. HEIGHT__I ' _. L`1B SIORIES AREA NQ,_nQ01QQM.___VALUE ,_r
BUI:_UIN- DEPARTMENT SET BACKS FRONT 20 REAR 3�� LEFT SIDE 7 RIGHT 12
Permit --- SIDE
Play Check LD.00 REGULATIONS
PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL HE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANrX WITH
Sub total ALL APPI_ICABLF CODES AND ORUINAKICES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
–" RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS .J HAVE. CURNENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total r
By --
'P.Pei.IC'AN7 OR AGENT —` ----- -
Approved �\'1 Rerrilit Nu ( I �
AD NO E
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
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retractor
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Permit No. OY ��iy`7�7
6 rbi Rough-in
T F ixture
S 123 Final _
HEATING
` Contractor
Permit
Permit No. 6I- 7/ 7 %L 7J
—_r Gas or Oil
Rough-in
Final
SEWER
Final _
DRIVEWAY
Final
Storm Drainage
—. (Rain Drain) Final
Sidewe lk
__. Curb&Street Final
A roach
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
`. toning Final
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