11391 SW IRONWOOD LOOP mm
11391 SW TRDI*MD LOOP
.r
O
O
v
U '
G
3
y
Q
" I
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT PERMIT NO. :__�
DATE: ? 1.2Z 7 DATE ISSUED :-- I
OWN EWS NAME :-
ADDRESS:
AME :_ADDRESS: // / � 4..►••d j
CONTRACTOR : Md4en,
I
TEST : Air p, Water® , Visual ® ; Laboratory ❑
RESULT: Approved �1 , Disapproved 0 Pending ❑
SKETCH:
`A w �` !
' el /
' i
INSPECTOR �F DATE
FWOTE ' Attach sugplemertal test data hereto]
I
s �. w ■. at .r .a � .r w
/7r
U f\f I F I FE D SEWERAGE A G [ ISI G Y NO. -------9589
--
WASHINGTON COUNTY DATE —Jul 13P 1976 _
C I -I-Y O F - - - `.('i.L R-j" - - - I ------ - ------ ---
APPLICATION FOR SEVVER CONNECTION PERMIT
OI'VNER: -
OWNER'S ADDRESS:
STREET
- I I Y STATE ZIP
BUILDING SITE: I OT BLOCK .BLOCK . __ _ ADDITIOI ,'
TAX LOT NO. 2000 __ TYPE OF OCCUPANCY __ residence T
Tax Map 1S1 34AC
ADDRESS _ __ __ ___1_1391 SW ironwood Loop
DWELLING UNITS -_— - -- --- -. _ __ FIXTURE UNITS ----
SURCHARGE IF APPLICABLE -
.9
PPLICABLE _C -.j— ti cv to L: Ir
PERMIT FFE_ 5-75_•00 ---- INSPECTION FEE 25.0031TAL DEPOSITED _._600++.00
LN E WJ_ (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER P1=RMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEN"=R SYSTEM.
LINE SIZE _ _----._._.._ _ INSTALLER
RECEIVED BY---- .-i%
(AGENCY OR ITS AGENT)
COMMENTS: - Bldg. # 0916 _ .___------._- ._._.._._ __--- -----____ _ -----._
This Application and permit expires in ninety (90) days. The amount paiH �Alill he f:,II lmj
should expiration occur.
�:,.,�.,..._....__s,y.� .:.z.;-:x�, r:.ru.. ,.:-;ur,;., � .epwf ......+re•w,..�y,�;,ry„•a..-,;wxlis3�.::-...v..rw::,.wcrC.fiA1':+E W" .I.x...rndya�'�"�' UR r'.,,YJq"�w+.s�.yu�iM'u► IYMY�1t�1
CITY 0F
BUILDING PERMIT APPLICATION TIGARD DATE--. 19. P)N2 0916_
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE —_
,fib 11391 A�'� 1 rortwood LOOP
QWNERADDRESS BUILDER PHONE -•_
ENGINEER
BUILDER sa" r1 ARCHITECT t-1 DESIGNER
STRUCTUREIJNE ❑ O
_W REMODEL A_DDITION El REPAIR ❑RENE-NAL []FIRE DAMAGE [:]DEMOLITION
D RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOWT DRELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE [1 STORAGE❑SLAB ❑FENCE
1 1NOND 7VING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE - _BLDG,TYPE_ --IRE ZONE.— PLAN CHECK BY
Tax I',iq) ISI 14A' Tax ]:AQt ?5W
.] A rP- .5E11.Ie4 (,7 lotT--- --- --
OCC. LOAD _ FLOUR LOAD_ —HEIGHT RIGHT SIDE
---.-NO.-STORIES AREA 14013 VALUE
- BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE_-- '�1 Wv 10� a. 1
Permit 136.00 _-
--"- �� �� TMLS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS ()NTAINED IN THE Sim nING CODE, ZONING
,
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANL -S, AND IT IS HERBY AGREED THAT THE
'YORK WILL BE DONE IN ACCORDANCE WITH THE PLANS ANC SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISVU.NNCE OF THIS PERMIT DOES NOT WAIVE
�c� RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRA.TORS TO HAVE CURRENT' CITY BUSINESS
1%S*ate 4• LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUM31NG AND HEATINU.
Total 150.30'
BY _ ---- - - ..--__ ----------
— —� l�P1 ANT OR AGENT
Approved Receipt No,
ADDR 95 ---------
� rrs re awi
DATE INSP, CTION REMARKS PLUMBING DATE
Contractor
Permit No.
Fixture
Final
_HEATING
166 UA- �c�c�2�� �L�s� _ Contractor l
Permit No.
!k — _� —_ Gas or Oil - -
- — — --- ---- - Roughh in ---
- _ Final _
-- — ----- -- --- - — -- SEWER
Final
DRIVEWAY
Final
Storm Drainage _
(Rain Drain) Final
Sidewalk
Curb&Street Final
Ap roach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CLt;TIFICATE OCCUPANCY Final _ -
-���,� Landscrping
( r Zoning Final t
i
9
t
1
t
I
i
A U F�F:S 5_-lr - -���-1%�' y`�� .'o E f- NO.
0 `. .. -�
PER,-i3T CNARCE none
OWNER _ L ._.sK = ��._�_ -.- CONNECTION FEE 'f'� _-,r
PAID BY eL
4 CONNECTED
Ty PE OF BU I LD I NG _1_L ca — ___ DATE ECTED
_'.GINSPFCTION FEE 5 ��
SERVICE RATE _ .G .._
CONTRACTOR
PAID BY _ DATE
ASSESSMENT PAID
SIZE OF CON N E C T I O N ___ _ --- -------'"'
Iy � l - � �
M i s