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INSPECTION NoTCE
City of Tigard Building Department
P.O. Box.23397
Tigard, Oregon 97223
/�
�/� Phone: 639-4175
Type of Inspection _If1�T�� , — -------
Date Requester) c;;?- 7 V9 —.— Time X A.M.—_.--P.M. ?
Address _.���� y Permit
Owner— r* us le6r Lot #
Builder - ---The following Building Code deficiencies are required to be cirreoted:
lc//lei
—as row
Presented to __ —_ r Approved
Inspector / _ _ [� Disapproved
^'1
Date _ —e __—
CALL FOR REINSPECTION
f� YES O NO
ME,CAAONILAL Pr--PMI:T'
I"T
CITY OF T167A RD NO. : ME8900,L3
CITV OF WARD
COMMUNITY DEVELOPMENT DEPARTMLNT aloe" DATE RJE
TSED: 1./1 01?
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223,(503)53!`-41751:)PTM - PHIT .NO. 89001(13
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This permit is issued subject to the regulations contained In Title 14 ...............
TOWi
of the TMC, State of Ciregoi -Colty Codes zoning regulations hFM
. .)I VIE D -.I:NSPF:.(A-.
and all other applicable codes w . irdinances. and it Is hereby F*T NAL-
agreed that the work will be done in accordance with the plans and
specifications and in compliance with all applicable codes and
ordinances. The Issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax paimils This permit will expire and become null and
void if work is not:carted within 180 days.or if wor'A Is suspended or
abandoned for a period of 180 days any firra after work has
commenced 11 Shall be the responsibility of the permittee to assure
all requl,,od Inspections are requested and approved.
Permittee SlgflkUre
Issued By
W'1W 0"AQ-11 4*4
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRI93ED ABOVE
- SEWER PERMIT N �
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Unified Sewerage agency
of Washington County nn CITY OF 1 ,, _ DATE
OWNERe r / J '� PHONE .
OWNER' S ADDRESS: �L�/ ��lEiP�
TYPE OF INSTALLATIONS
9 BUILDING SEWER ❑ LINE TAP AND BUILDING SEWER ❑ LIN[ ] A['
TYPE OF OCCUPANCYr
NEW EXISTING SINGLE FAMILY ❑ COMMERCIAL
❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING NITS
ADDRESS OF STRUCTURE r �Y/�o I
Permit Conditions: The applicant agrees to comply with all rules ind reyul s of the Unified
Sewerage Agency. When calling for an inspection, please refer to the Permi tuber. The Peri-+t
expires one hundred twenty (120) days from the date of issuance. The total amount paid (permit
fee, connection charge, line tap fee and/or other charge) will he forfeited if the permit expires.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer
is not located at the measurement given, the installer shall prospect three feet in all directions
from the distance given. If not ao located, the installer shall purchase a "Tap and Side Sewer"
Permit at the current charge and tt,e Agency will install a lateral.
FE=ES
PERMIT FEE $ dS CfcJ
CONNECTION CHARGE �,(� 0
LINE TAP INSTALLATION
ISSUED BY
OTHER
TOTAL
APPLICANT DATE
SEWER PERMIT N? 28467
ADDRE-7S OF STRUCTURE _� g<)
TAX MAP _ TAX LOT _ _ QORTSSFCT 10 N — --
LOT BLOCK _ OF
APPROVED Y DATE ISSUED BY DATE OF ISS1jANCE
D. U. ' S REMARKS
tai' f
INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639.4171
Type of Inspection
Date Reque d._ / l
/op / Thne A.M. P.M.
AddressX 114 Permit
Owner- Lot
Builder
The
The following Building Code deficiencies are required to be corrected,
Presented to _
Approved
Inspector __- Disapproved
Date
CALL, FOR REINSPECTICIA'
LJ YES 0 NO