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11055 SW COTTONWOOD LANE
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City of Tigard 9,
INSPECTION REOUEST
for
INSPECTION TIME :—�...t�_ PERMIT NO.: ___-_____
DATE: �.=lJ,. DAT1- ISSUED -- -
OWNERS NAME .
I ADDRES S : __Aff _
I CONTRACTOR
TEST:Air ❑, Water p , Visualw., Laboratory []
RESULT: Approved 0 , Disapproved , Pending r
SKETCH: 010-0-V7- 41ZIiQ-d /-4~ -V 10 i
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INSPECTOR DATE
9 EaL`
GOTC Atteeh supplemento1 teal data hereto,
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City of ' ; gard'�
INSPECTION
� REQUEST
for
INSPECTION TIME . �_trz PERMI N0, : —.._�—
DATE: _y� Z DATE ISSUED:...-L.._L
nWNERS NAME ' ____ zarrr_7--0-
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D D R F S S : . !�'s s . ��c,�..�, ,,,�� ? s. I
CONTRACTOR :-------..------
TF$T; Air 0, Woter �] , V al ❑ , Laboratory
RESULT' Approved , Disapproved ❑ Pending 1-1
SKETCH:
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1
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NSPECTOR DATE
IOTE: Attach supplementnll rstt date heret�
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME '.—/5;? '-=2 PERWTNO. ' M . -__ ....
DATE : DATE ISSUM—L-J—
I
0WNERS NAME
A D D R E S S
I C O N) RA C T 0 R
! 'TEST: Air 0, Water p , Visu O , Laboratory [i
RESULT. Approved Q., sapproved ❑ Pending
I SKETCM:
I
!
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INSPECTOR DATE
I [NOrF 3tlur.h eupPlementoI test doto here 1'0
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IJ1\111. 11,__ D SEWERAGE AG [__N CY NO. 11615
WA I-O N K-31-ON COUNTY DA IF 1-24-77
C I..r Y
/APPLICATION FOR SEWER CONNI:C_' HON PERMIT
OWNER: ._
O'A/NER'S ADDRESS:.
STREET - - -
-- -_-_ __
ri7Y STATE - ---- ziP
BUILDING S'TE: LOTLut #193 BLOCK _____ ADDITION
TAX LOT NO. ___�-� TYPE OF OCCUPANCY
ADDRESS _._ ].1L15.5 _SW__Cot tanuoadlct�__.__._
DWELLING UNITS---..--------- _ ____--
_._ FIXTURE UNITS
SURCHARGE IF APPLICABLE
25,575. 600.
PERMIT FEE ..-._ ___._ .... __ INSPECTION FFETOTAL DEPOSITED
(NEW) (EXISTING) BUILDING SEWER SYSTEM G-re-ek
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPI-ICANT
J--
SEWER PERMIT
THIS PERMIT AU-IHORIl.F-S CONNECTION TO THE SEWER SYSTEM.
C-
LINE SIZE _ INSTALLER
RECEIVED BY_.T'_, t�--- - t /8 �1
(AGENCY OR ITNT)
VVV
COMMENFS: Bldg #1262
This Application and permit expires in one hundred and twenty (120) days. '
The arnount paid will be forfeited should expiration occur.
71177
oO BUILDING PERMIT APPLICATION SOF TICA►RD DATE_
1 THE UNDERSIGNED HEREBY APPLIF:; FOR APERMI T FOR THE WORK HEREIN INDICATED BUILDERPHON
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING FLAPS AND SPECIFICATIONS. OWNERPHON97
LOT NO.---
OWNER
O. --OWNER JOB ADDRESS "�`� .3 ��1C, 111ii„{Ul}C] ' HOME ADDRESS
�'—� ---- fRCHITE.CT
ENGINEER
BUILDER ADDRESS —_ DESIGNER
STRUCTURE ONEW ❑REMODEL. ❑ADDIITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOOrION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T L_+REI_IGIOUS❑PATIO [:]CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL_ USE ODESIGN REVIEW OCOUNCIL APPROVED CJSfGNS
OC:JPANCY—_LAND USE ZONE BLDG.TYPE--.— _FIRE ZONE. PLAN CIIECK BY _ __ HEAT—_
fAmil;p dumllif)6 w/attac:had gamjeo wut .193 badvmm 2 bate,
*t._ �4 kls �LALU
HEIGFIL..— ..,.a�.�IQf3l�S N_Q 1�F�
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE HIGHT SIDE
Permit 1J..�'�llL+ ------'---- -
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check •50 REGULATIONS AND ALL APPLICABLE 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
Sub total ALL APPLICABLE CODES AND ORDINANCES. tHE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- — � �� EAESTRICTIVE COVENANTS. CONTRACTOR AND SUB COMTRA.CTORS TO HAVE CURRENT CITY BUSINESS
•
State Tax ICENSF. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total -- : IJb.48
By
— APS -ANT OR AGENT
Approved � Receipt No.
ADDRESS PHONE—--
_
MRA
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
g K -�`e —o• Contractor
Permit No. c22 �2 7Z
j
Rou h-in
Fixture
Final
HEATING
��lCvt<-,cam_ Contractor
Permit No.
_ Gas or Oil
Rough-in
Final _
SEWER
_ Final
DRIVEWAY
_ Final
Storm Drainage
_ (Rain Drain) Final
_ Sidewalk
Cvrb&Street Final
_F
oachBLDG DEPT• FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY scaping
g Final
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Address ���� C�� -G7 Permit No.
Permit charge 2j07
Owners �. Connection fee
Pa.i.d byL_L , f,, c.
Type of building . 4.,,.y Date connected
Service rate Inspection fee .J S— �L-
Contractor Paid by date
Size of connection _ Assessment Paid
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