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11105 SW COTTONWOOD LANE CY
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CITY OF TIGARD �c
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Owner: Eob n� Permit No. ..
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Building Add ress... .11.105...SLIT .Co.ttarlwpad .Lunt....... . Lot. i""
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,:,` ►� `• { Certificate is hereby given this...... .. day of ................................ 19..?.�.
that said building may be occupied and
that it ci nplies with all requirements of
P
I the Building Code for the City of Tigard,
as approved by the Tigard City Council. r
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11� yr►
Duilding Inspector
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Address Permit No.
Permit charge iJ 0 i-2 �-
Owner _ .�,.� Connection fee 5-
PaidPaid
b y �„_. ,`•t,E
Type of building Date connected _
Service rate Inspection fee .12 °y
Contractor Paid by Date
Size of connection Assessment paid _
x/7/77
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City of Tigard
INSPECTION REQUEST
for
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atop
INSPECTION TIME : PERM:T NO.: 1
DATE: DATE ISSUED:_.1_.L_
OWNERS NAME:
ADDRESS:
CONTRACTOR :
TEST.Air 0, Water p , Visual At , Laboratory p
RESULT: Apprmed g , (Disapproved U , Pending p
SKETCH:
Zit/ 22
INSPECTOR DATE
COTE : Attnch supplemental toot date herat�
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City of Tigard
IN I ION REQUEST
for
DMINIS amt: DATE IK!lillto:--_[_t_ I
"AMC: _
COIUTIIACTOE :
TEST:ft O %tw
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=KETCH:
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114WECTAR DATE
NO?L' Aft.Gh suppl.ffi."fol toot dot* hereto I
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i City of Tigard
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INSPECTION REQUEST
for
INSPECTION TIME :— PERMIT NO. :
I DATE: DATE ISSUED:—
OWNERS NAME :
IADDRESS : sem%r r l-,. . _
ICONTRACTOR :--.----.—
TE ST*
ONTRACTOR :_ .__TEST: Air 0, Water O , Visual r� , La bora torr p
I RESULT. Approved O Disapproved O Pending U
Sc ':TCH:
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INSPECTOR DATE
1 CNUTE Attach Supplemental rest datri hereto
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SEWER PERMIT
NY 12107
Unified Sewerage Agency
of Washington County CITY OF___ Tigard _ � DATE � 3-311--77
OWNER: Boh Smith PHONE
OWNER 'S ADDRESS:
'TYPE OF INSTALLAi?ON:
BUILDING SEWER EBUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
®NEW SINGLE FAMI'-Y COMMERCIAL
❑EXIST. (PRIUR TO 7- 1-70 ) ❑ MULT . RES. INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
PERMIT CONDITIONS: THE . APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGO °rENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBEk. THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FEE S 75.
CONNECTION CHARGE 575•
SIDE SEWER INSTALLATION
ISSUE BY
OTHER _
TOTAL 600. _ [
APPLICANT DATE
SEWER PERMIT N° 12107
ADDRESS OF STRUCTURE_ .11105 SW Cottonwood Cane
TAX MAP_^ __ TAX LOT _ ^ SYSTEM_ FannQ_Crek
L O T ---- 1 ftA ---- d I.0 C K --— OF-
APPROVED
F-APPROVED BY DATE ISSUE BY DATE
REMARKS__ Bldg. #1368
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BUILDING PERMIT APPLICATION �FY TIGARD DATE. 3-30-77 __, t9_ f 368
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE��yy�rryy�
OR Ac QHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICAT;ONS. OWNERPHONF �t�l#I�•�iarf
LOT NO
OWNER UU0 1.3'imio; _ JOB ADDRESS +1105 SW Lottr011{ ag( HOMEADDRL•SS
ARCHITECT
ENGINEER
BUILDER $CIIV _11----11 ADDRESS _ DUSIGNER _
STRUCT.IRE W _l_REMODEL ❑ADDITION OREPAIR _^❑RENEWAL _ ❑FIRF DAMAGE ❑VEMOLITION
Cjtk%I0ENCE ❑comm ❑EDUCATIONAL ❑GOV'T URELIGIOUS❑PATIO ❑CAPoORT ❑GARAGE ❑STORAGE❑SLA13 ❑FENCE
❑BCNU OMOVING ❑CONDITIONAL USE ❑DESIGN REVIFW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY—, LAND USE ZONE BLDG.TYPE_ bra _.FIRE ZONE` PLAN CHECK BY_ ur.6! HEAT 633`;
Lot J. 3 I::( pai.. uinfjilk family dwolling w/ett:.ar.hed garegto. Ea-issue
3 a��droom 3 t)oth ------ "amment. 93.1 -gavage 4SU
OCC.LQ-AD._ —FLQQR_LQA.Q—_____ -HEIGljY------- NO.STo iEs 1___AFtE 1368_xQ.,_DEo_ao_QM$___3_VALUE 3TA�UU•
BUILDING DEPARTMENT SET BACKS FRONT () REAR 40♦ LEFT SIDE r RIGHT SIDE 1c
Permit 1_i1.Of) ----- -- -_ — -- --- —
'� THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN 'rHE BUILDING Com-, ZONING
Plan Check 10000 0 REGULATIONS AND ALL Al AL:CABI-E CODES AND ORDINANCES, AND IT .3 HEREBY AGREED T14AT THE
WORK WILL BE DONE IN AC('ORDANC! WITH THE PLANS AND SPECIFICATIONS AND IN COMPI.IAN(F WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCE1. THE ISSUANCE OF THIS PERMIT DOES NOT WhIVE
RESTRICTIVE COVENANTS, CONTRACTOR AND SUB -019TRACIORS TO HAVE CURRENT CITY BUSINESS
State Tax 49133 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING. AND HEATING.
Total _ 165983
BY -
- APf�lICANI []R AGFN1 ,
Approved ; eto Receipt No. /
AUURE55
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
J ntrar:tor _
Q Permit No. v
1i .lRough-in
S7 61
Fixture
Final
' , HEATING
,Ld:, 44f. ucn Contractor
/..-# QjQi?4,-v4 -2.6-9Permit No.
t-
Gas_or Oil
Rough in --
Final _
SEWER
Final _
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
jApproach
dewalk
urb&Street Final
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY nal
andscapingoning Final
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