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G� CITY OF TIGIARD Cy y I ,
k. OREGON
f Uwner............Bob._Smi-th Permit No......1463......... r • ,
11110 SW Cottonwood Lane
Building Address...............I_ .............. ..... .
� ,• ►' Certificate is hereby given thi: 2� September 7
......dayof....S ... .., 19.. ......
that said building may be occupied and
thrit it complies with all reLillirementg of
y • i the Building Code for the City of Tigard,
as approved by the Tigard City Council.
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Building! Inspector 1
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ADDRESS /%/i � �1�-����c� �....r,/�� PERMIT N0. /7-2
PERMIT CHARGE none
OWNER P�-� � LIL - ev----
CONNEl:TION FEE
PAID By
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TYPE OF BUILDING _ L.« DATE CONNECTED
S E R V I C`. RATE GINSPECTION FEE
CONTRACTOR _ PAID BY DATE
' SIZE OF CONNECT10N ASSESSMENT PAID
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City ,ard of Tio I
INSPECTION REQUEST I
for
1,1 4- i
'SPECTION TIME: PEF(MIT NO. : _ I
DATE: _ 1' - DATE ISSUED
WN E RS NAME :
ADDRESS:
)NrRACTOR
ST : Air [-,, Water [] ,
Visual O . Laboratory ❑
FSULT: Approved Et' , Disapproved C Pending D I
SKETCH: Cl
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INSPECTOR DATE
DATE I
[OTE. Attach supplemental tett data hereto
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City of Tigard
INSPECTION REQUEST {
for I
I' 'SPECTION TIME ' ,�p ��, HERMIT NO. :-----
OAT E:
0. ;__---OATE: l 1/ �i-i'1 DATE ISSUED .--.-/ Z I
W N E RS NAME :--.
ADDRESS:
)N rRACTOR : _._ ._r 11L.
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ST .' Air r), Water 0 , visual O , l_abnrotor-y 0
FSULT: Approve* Disapproved C
Pending []
SKETCH:
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�IFICTOR DATE
[NOTE: Attach sut+rlemental test data hereto I
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City of Tigard
INSPECTION�Tl N REG?UESTi
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SPECTION TIME: PERMIT NO. :
DATE: P, ZZ DA'T'E ISSUED
NN ERS NAME :
ADDRESS:
)N TRACTOR : __17 n .tel 103 '.----._
!1/ v (.7u�,��iu.�et7 l
ST : Air ❑, Water [1 , Visual ❑ , Laborotory p
FSULT: Approved , Disapproved Cr Pending ❑
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INSPECTOR DATE
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SEWER PERMIT
N9 12172
Uf nf'edSewerageAgency Tigard DATE 5-1E-77
of Washington County CITY OF __ --
PHONE : ac
OWNER : _ I�ob Smith _ —
OWNER ' S JIDRESS:
TYPE OF INSTALLrTION:
Lx]BUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF 'JCCUPANCY:
❑NEW L] SINGLE FAMILY ❑ COMMERCIAL
❑EXIST . (PRIOR TO 7- 1-70 ) ❑
MULT . RES. ❑ INDUSTRIAL
FIXTURE UNITS
pWELLING UNITS 1 .
PERMIT CONDITIONS: THE APPLICANT ASREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWF.RAct AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFL l'0 THE PERMIT NUMPER . THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS . THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATION OCCUR .
FEES:
PERMIT FEE
CONNECTION CHARGE ---5-�5.--------
SEWER INSTALLATION ��uBYt�t
SIDE — ISSUE
OTHER
/ OTALII2.
-----{ D A 1 E
J
APP' ICA
SEWER PERMIT NV 12172
ADDRESS OF
L_OT _ SYSTEM Fanno Creek
TAX MAP-------.- TAX - --'""-
L 0 T
`APPROVED BY DATE - ISSIt D BY DATE
REMARKS_ Bldg. #1463
. . . ...�. .. _._..._..+T_........._.-..—__..•,.�,,,,....,.. -.._.....�.._....,..�ti.ri..-. ......i...r..•..,. v+..-i.+.w..�«.. .e . .....,..,.., a..ie..—....,.:.r.++w�*YP•vow►+i«,.r.w.r+w�n.wwr.•..r-.....w+.+►-•.. ....
BUILDING PERMIT APPLICATION cOF TIGARD DATE J-17"77 '19 + rr
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF6,144—Jauli
OR AS SHOWN AND APPROVED IN 1HE ACCOMPANYIN PLAN'S AND SPECIFICATIONS. OWNER PHONE
LOT NO.
OWNER ., .i 1, 1{ j i;fl -JOB ADDREC 1-ij-1 ) SU LOtti/ri4l'vJjHOME ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRESS _ DESIGNER
tSTRUCTURE P etcNEW 1:1 REMODEL . ❑ADDITION ❑REPAIR�1 ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
ST
( RESIDEACE OCOMM ❑FDUCATIONAL 13GOV'T EIRELIGIOUS❑PATIO OCAR PORT ❑GARAGE ❑STORAGE❑SLAB []FENCE
C--)ND ❑MOV ING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
J 1 l
OCCUPANCY— –LAND USE ZONE_ BLDG.TYPE� FIRE ZONE—w�J PLAN CHECK BY__ _ HEAT___'
caxnsto amyl® fall J. dww11in%i 'w/a'%.tGChud yaregs --_—_ -
Lot ?,- 1 —3 bedroom 2 Unth ------- - --
17.p —RQ,5IQ8IE5_�_— AREAVALUE 4)s `-
BUILDING DEPARTMENTZhu 1d 0+
SET RACKS FRONT HEAR LEFT SIDE RIGHT SIDE
Petmit
---� "` THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZO'VING
Plan Check 100 00 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
--- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax fd� ��� LICENSE. SEPARATE "ERMITS REQUIRED FOR SEWER PLUMBING AND HEATING.
Total _ ayfi�wk �arre �.ia� ln�,rli i:hvtlyt:J ;
By
/ P,
--- - -- APPLICANT OR AGENT ------
Approved ` Receipt No. (�' j��
A U OttE SS F C) ^-
....._ ... .,.,.... ...._.....,.,..........:,.....,.w.,YWri.,,,...�...,:._..,..+....,.W...,W.......+.a...w........,.�...,rw��ar+wwsn►w«rwr.u. u :�.,We........a.,...,.....,....wu.t....,.....w�w.:.++..u.wu..r..<,
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
i=q Contractor v
Permit No.
U2 Rough-in
4a. 01 Fixture
Final
COI/F_rZ 13Ar2!E IfArt�as ,vor 1 �x raT HEATING
Contractor
17IGP_�. — Permit No. 77
Gas or Oil
Rou h-in
Final
— ------ --- -- -- ----- — SEWER, /�� -- —
Final _
DRIVEWAY
Final
Draina e
(Rain Drain) Final
Sidewalk
Curb&Street Final
— — -- — — - ------------ A roach ------
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY A r
CERTIFICATE OCCUPANCY
Landscaping
( 7onong Final
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