10825 SW BLACK DIAMOND WAY-1 CD
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10,325 Sir ILACK DIAD WAY
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ADDRESS ID�'�S �Gy PERMIT NO. jSq O
( � PERMIT CHARGE none
nijNFR w 4y(. c� �(�, CONNECTION FEE
PAID BY •-w.�-
TYPE OF BUILDING DATE CONNECTED
SERVICE RATE INSPECTION FEE
CONTRACTOR PAID BY GATE
SITE OF CONNECTION ASSESSMENT PAID
✓-• SEWER PERMIT �► 15909
f) U
:� •nfied Sewerage Agency 5-17-78
of Washington County CITY OF T i q3 rd_d DATE
OWNER : Don Hellick,on Bldrs. , Inc. PHONE
OWNER 'S ADCRESS:
TYPE CF INSTALLATION:
Q ABUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY: �-�c
u 'NEW U SINGLE FAMILY ❑ COMMERCIAL
❑ EXIST. ,:PRIOR TO 7- ] -70 ) ❑ MULT. RES. ❑ INDUSTRIAL.
FIXTURE UNITS DWELLING UNITS 1
ADDRESS OF STRUCTURE : 10825 SW Black Diamond Way
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION,
PLEASE RErER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE--
HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR.
FEES:
PERMIT FEE $ 25.
CONNECTION CHARGE COO.
SIDE SEWER INSTALLATION B. Greene
OTHER ISSUED BY
TOTAL $-6-2,1:1.
APPLICANT DATE
:.air•' ,'•.. ,r.�;
SEWER PERMIT N? 15909
ADDRESS 0i STRUCTURE 1082.5 SW Black Diamond Way
TAX MAP TAX LOT SYSTEM Fanno creek
LOT 24 _PLOCK OF
E. Walden 5-1.7-® '78_
APPROVrU BY DATE ISSUED
BY (�� �
DATE
D. U. ' S 1 REMARKS bldg. #2102
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BUILDING PERMIT APPLICATION 11T TIGARD DATE _OF
TIME UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONF ,_,—
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
t�tlnt LOT NO_�
OWNER l.ui-� }aiiif Ly,k8�f1 t:u1DlA�QRE s_ ti5�i:; Ulock I mMGA4
ARCHITECT
ENGINEER
BU:LDER fa aBlu1 ADDRESS DESIGNER
STRUCTURE AO*JgW ❑RI MnDEI- ❑ADDITION CREPAIR _—_❑nENEWAL ❑FIRE DAMAGE ❑DEMOLITION
DRESIDENICE ❑COMM ❑EDUCATIONAL ❑GOV'T DRELmiouS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BONG ❑MOVLI'G ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS���
OCCUPANCY—__LAND USE ZONE_ Ir,o e7 BLDG.TYPE Jtu FIRE ZONE •3 PLAN CHECK BY_
rot. r>'y -,91a family dwerilin4 wjattachad gars Ws 'r Uadroom 2 4eI`th �sragw 4
permit J5909 A f) 20 3 7, 7
0CQ.J.QA2ls'S22R L.9gP HEIGHT _ NO,5TUBIES. OREH 'i4�@f:QHS2i?MS VAL�1- .._._.
EUILDING DEPARTMENT SET BACKS FRONT 20 7EAH 20 LEFT SIDE 70 RIGHT SIDE
Permit
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THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDINr LODE, ZONING
Plan Check .1,a 1-10 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANC=S, AND IT IS HEREBY AGREED 1 HAT THE
WORK WILL 3E DONE IN ACCORGANC,: WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub total 244,bU ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCF_ OF THIS PERMIT DOFS NC f WAIVE
`— RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax _ fjk LIC-NSE. SEPARNPERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
•
Total 2:S1.0 'i $WU.
By _
-- — --- APPLICANT.OR AGENT
Approved _—� I�' Receipt No.
L
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor -^
Lvtic!_ GSE - P !No. �a r —
Rough-in
7::? —
�_s Fixture
Final _
HEATING
f 15-7 Contractor
P rmit No. �z -7/•31 9
Gen or Oil � —_--
Rough-in
Final
v TTNA G l�pr�ol.�.�_ �sv�r �b�� (��y• — SEWER
TnA CL Final _r---
DRIVEWAY
Final
Stone Drainage
(Rain Drain)Final.
Sidewalk
Curb&Street Final —_
Approach
oLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY --- — —'
Landscaping
/ Zoning Final
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