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CITY 01111
76 W 0 774
BUILDING PERMIT APPLICATION TIGARD DATE Aprf l 2619
INE UNf`1':ri311GNED HEREBY APPLIES FOR APEFMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMI ANYING PLANS AND SPECIFICATIONS OWNER PHONE 639-`�'� �
QWNER !.3rucs Anderson AUDFiESS BUILDER P!-'(SNE
r1P1er ENGINEER
Rill[ DERI-� DESIGNE_R
STRUCTURE ❑NEW 0 REMODEL � rJALDITIOIJ —OFIEPAIR _ ❑RENEWAL. - OFIRE DAMAGE ❑DEMOLITION
0 RESIDENCE DCOMM ❑EDUCATIONAL 0GOV'T ❑REL IGIOUS OPATIO [3CAR PORT ❑GARAGE: ❑STORAGE_OSI-Ab CFENCE
GOND 0MOVING QCONDiTIONAI_USE ❑DESIGN REVIEW EICOUNCII_ APPROVED OSIGNS _
OCCUPANCY—._ LAND USE ZONE 13LDG,TYPE-- FIFfE ZONE, PLAN CHECK BY_ __ HEAT.- -__
.7st.ruc r. u sq. i�am F.TrT rirL w s� 7:lrlc na tri ia�Lraa��n _� —._
— ---
--ordint; —0s ppvd—v" Arra.
OCC_LO1�13_�_ FLOOR LOAD 40 lb HEIGHI�_——� NO.STORIES 1, AREA 864 VALUEW 000
--BUILDING DEPARTMENT - SET BACKS FRONT-- _ REAR LEFT SIDE RIGHT SIDE
Permit �,�7.OL1 ----- - -------- -_-_ _------------..---------- ---_-- ---_
`---'"'- 4r�•�� THISPERMIT I'S ISSUED S:IRJECT TO THE REGULATIONS CONTAINED IN THE BUILDINI'r CODE, ZONING
Plan Check REGL.ILATIONS AND ALL APPLICABLE CODES AND ORCIO)PNCER, AND IT IS HEREBY AGREESL, THAT THE
-- WORK WILL BE DONE dN ACCORDANCE WITH THE PLANT$AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recordlnr; AI..L APPLICAPLE CODES AND ORDINANCES. THE IS'UANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CCI TRACTORS TO HAVE CURRENT CITY BUSINESS
1 State 4. L� LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, ft.UMBING AND HEATING.
Total 1142.
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_—. - __
APPI_—I('t,NT O___n ACr. ---
Approveo Receipt No.
11.,.. ADDRESS ----- tyHON€---- —'
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Entractcr
;7")-';7t,1- P t t4c
"r eLz cv--k� Permit No.
.Z/ Rough-in
z zz
Fixture
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWEF�1,,-1,70e,
Final
DRIVEWAY
Final
----
Storm Drainage
(Rain Drain) Final
Sidewalk
Co,fb&Street Final
A,proach__,______,
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CURTIFICATE OCCUPANCY Final
Inal
Landscaping
Zo
tc niny Fwz-1
April. 28, 1976
Mr. Bruce Anderson
11205 S. wl. Gaards
Tigard, Oregon 972.23
io:3awor As:aesamants – Tax Lota 813 & 1102
291 3DC
l)r3er Mr. Anderson:
Thin .lotter is to advise you of the folliw+fig facts relating
to the rotentiality of any future sower I_. I .D„ nsseesmonts
agiinst: your pruperty.
Upon the issuance of r, )Llilding permit ('or thri subject site,
you will have paid a doublo cunnactlon frac for drawer servion
in accor.danco with current rules and regulations. This fea
ie charged to those propert:ias which have never participated
in the coat of extending the sewer main to which Conner-.tion
is heing mads. In thin wav , you will have paid, by definition,
an nquit.able share of that facility,
Any futi.ra :sewer .`.n your s re 3 will not i-c l.tr ie the
abcvs described site dua to the fni-t that:
y )u will h Av(? ps .d a fee thot lay doVinitton
Cr,;,n"ti tut fin yrs-.,".' sharrj C"' ew.iijtln:g 3'fjwk, : flf llr
fvscilitiujp c-nd
I Y(.a"u ,ii11. Ei".t n0/ bH 1,f3r1:1vI n : Liu r=r :jai vic.r: so t h:3t
'yny ''?utu,"If $nwo:r L.. I . U, ' e .`.n t.hr nrrje .iSil ►inf; t.r;ner 'it
y uur propa rt ;. Every I. .1 , J. ,_,asvia t3mor 't. mu,a t, t.jy leer,
confer a spo—lal or geu,vr�-i1. I.ionen.t upon t'riv assessed
property.
This tv.)uld not however, oxclude y(.' Jr propwi t,y from '-.axas do�:iving
From my general brjnrfit bond i.,ssue that wean approved by the
votfira, however, no iuch bond iarjwFF, aro cu )t6mplrat;ad.
truly yours,
3rt. C9 p. Clark
Citi- Administrator
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GWNER CONNECTION FEE
PAID By
DATE CONracl-F-D
TYPE OF -
INSPECTION FEE
SERVICE RATE
CONTRACTOR PAID By DATE
SIZE OF CONNECTION ASSESSMENT PAID
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