12345 SW KATHERINE STREET 112345 SW KATHPRINE STREET
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIM`' 'moo PERMIT N��. : _��
DATE: ?9 DATE ISSUED 2—
OWNERS
—
OWNERS NAME
ADDRESS.' - A-29.�ss�.ct_�LU�-
CON'rRAr'TOR
i ES
3T : , J , vVoterQ , Vstni ' I_abJYQMr}/ [J
RESULT : Aporrivedlo-1, >i..upprwed Q !�endinct C:l
SKETCH:
P
INSPECTOR DATE
NOTE' Attach supplemental tett data heretal
Ci 'y of Tigard
INSPECTION REQUEST
f o r
INSPECTION TIME '. ,,) PERMIT NO. :----,
DATE ' DATE ISSUED :--t-Z.—
OWNERS NAME ' __LL__6
ADDRESS*
CONTRACTOR '
TE ST : Air 0, Writer 0 , V,sual t-J , Laboratory 0
RESULT '. Approved ni3approvad 0 , Pending E]
SKETCH.' 4-lC7j_*7?- f4,-51_0"--14A4 %e._Z-0e C4,0'r-ee
j/n/ -Ve.,jp e,e .0ewo— ixftooeov ep ro It"W."V(s (w 776w-C
7"o y se- I
TO
N P E(�,TO R DATE
NOTE. Attach supplemental test databeret
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : �, e'C PERMIT NO. : --
DATE:
O. : _DATE: DATE ISSUED:__!_L—
OWNERS NAME . L' - �3 ,
ADDRESS : 5 , c,' r:r� rid .►
CONTRACTOR : ��'' "`�•N'''+--� — __. _
Ii TEST. Air ❑, Water Visual, Laboratory []
RESULT: Approved Disapproved ❑ Pending ❑
SKETCH:
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INSPECTOR DATE
ICpTE• : Attacn supplemental test data hsrsto,
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City of Tigard
INSPECTION REQUEST
or
IINSPECTION TIME ' �, w PERMIT NO. : ._
DATE: '3 ,fZaZ3 DATE ISSUED ' _L_L_
OWNERS NAME ' ''-
ADDRESS ' �iL' /c 4+.LE +_
C 0 N T R A C T 0 R :_� t —._ >� f=�✓ ___.
1'FS1 � , Water D , Visv La'- ,rafory (l
RESULT: Approved Disapproved 1 Pending
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INSPECTOR DATi
IrNOTE : At ach supplemental test aato iereto
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Address 12345 jW. Katherine Street _ Yermit No. �1u 1
?emit charge
Ovmer E iij.l I.tjrzner Connection fee s
paid by
n esiderice Date connecter)
a —
Type of building R
service rate _3,_00 ,nth Inspection
Paid by sam�_�. Date
Contractor C. B. Shirley -
Assessment
paid
Size of connection 41 l _ �- - _---�-�
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : _ /L"-w2— PERMIT NC. :
DATE ' —LZ.-:3—.,/7-1 DATE ISSUED :�
OWNERS NAME : ����
ADDRESS: -- --
C 0 N,r R A r,T Q R : — — ------ — -- — -- ------
EST . i o Watery , V suai '] , I_aboratorY t7
RESULT : Approved 19< Oiaappraved G !-endhig p
SKETCH.
INSPECTOR DATE
NOTE: Attach supplemental test data hereto]
City of Tigard
INSPECTION REQUEST
f o r
INSPECTION TIME* PERMIT
DATE .' DATE ISSUED :—.—I---Z—
OWNERS NAME .
ADDRESS'
CONTRACTOR :
TEST : Air El, WoterO Visual EJ , Laboratory ❑
,
RESULT. Approved 0 Disapproved 0 Pending
SKETCH
of
FNS-OP?
, N SC IT 0 R DATE
[NOTE Attach t-motementol test drto beret
i
city �of Tigard
. a rd
.
INSPECTION REQUEST
for
-LL�=�Vv��-kr
IINSPECTION TIME : _. PERMIT NO. .
DATE: co D TE ISSUED.-LA2L 3
I OWNERS NAME :
ADDRESS ' -��3 S %d�-< a
CONTRACTOR :----
(;-,-- b Y Cl
TEST: Air Q, Water .�-�--;'Visual orator
IDisapproved L d
, Pening []
RESULT: Approved f3'"� _
SKETCH: -
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INSPECTOR MATE
i [oTEAttach suppiementol teat data hereto]
1
PLIUMBTNG PERMIT APPLICATION
Jurisdiction of
No. Type ,f' Fixture Fee Permit No.
Permit fee
Watei: Closets Permit Issue
Bath Tub,; Approved by
Building Permit
S ho W T Receipt No.
Sink D'.3hwa-?
-S TnT K 1 to ri
Sinks Location of Building-
ink
Sinks.
A u t r.)m�at 7T7s T,7 1,!,—( r
D;�c,5,-,1
7-a 77 Nam(- & Address
y T,-aya_.
F o r
D .sera Mme—
Ro .ri Dr�i,-nL�
AuUmatar, WasFr Narrif:� Address T m b,�,r
Muntal Dr-7 ,xi.nK
Fountain,;
--
Hc, t. 3 7 E:r T aj n-k
BU Idin eOld r,W
(Alte-, , Repair
TT's
Lawn ..,Lrink:er
Thea perm .-.,m nu 1 1 atiki void if w,,.)rk (,r constru--. *. . r, th:lrized I.; yi(-.t
:i- if constructicn w:,, k -iband.-,-�ned
f,)-, -, ,gid 1- 1. at ;.iny time after work is - :mmerx':-
All. plumbi,tig f ) rm.-, ria. t, be licensed by the City of Tig3, d and pest a $1,000 bond.
I hereby ^r-.-rtify ",tol I risvp --ad and exatn.!n(-!d this appli,.af..,, �n and know the same
to be ard All. provi.3juns of laws and governing this typ
of w,:,r-k wj . 1 be . . ,.Tlpi ied wi. th whether spec. i f ied herein r- nc.t, the V
,ranting of a
Permit 1--c- t-. t r—sump ti, g..ve authority to an: El fhe
of . ny tt-, : — lo.-al iaw regulatinty, the P�rfnrinanc.e Df
-K"gna tui- f A�I
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: _ PERMIT NO. :-.1-125 s
DATE: 3 961� DATE ISSUED : ,3
OWNERS NAME : _ Hi0 c- r� y
ADDRESS:
CONTRACTOR :TEST : Air ❑, `Nater 1:1 , Visual 0-- Laboratory ❑ f
RESULT' Approved.El Disapproved ❑ , Pending ❑
SKETCH:
INSPECTOR DATE
FNOTE: Attach supplemental test data hereto,
CITY OF TIGARD
17410 SW WWW $"*0
r IOAa0. OaaOON frtri
APPLICATION FOR NUILDINr, PE:PM!"
New Construction a 0~1&sh Q Addition � 160046 � Moi,e
ZONING--"-' DATE ISSUED_ .j . � BUILDING PERMIT
BUILDING PEE
DATE: RECEIVED
PLAN CHECK S
LY�fy _...___._.._ .._..._
OTHER !j VALUATION $ 2fli� ..
W E I PT No. k 7
TOTAL R; 1.'`.•,�� 2
TWO SETS OF PLANS AND PWT PLANS MUST BE FURNISHED WITH APPLICATION
LOT 1 j'k. MAP I 11i CENSUS TRACT k5a JOB I
Architect or Engineer C. A. surle
Address--} 3,.�..b. 4 icat :it. Phone-
Owner—
hone_^_Owneri..�_ _..SN_rwa_. �. _ _____.___
Address Phone
Builder � *
Address
BUILDING ')SE Single Res. ox Multi Rtes. Comm � �Industrialo
OCCUPANCY GROUP i No, of gtoraee m Total Height «'.' Area of Lot 95M
Type of Construction V Floor Area 9 '144 2 lkjzt
Set Becket Front,—mow_ Backer_ L.Side. j__ R.SideA
Private Sewer Pipe Site V trwerusa Turd Septic Tank
eater Service Pipe Site_ ye Storm Sewer Cj� Bitch � Urywwll
Street and Curb Requirelsents� l ;yrs _� �µ��„ �'
Driveway Width 11i.___...._..__.._._._.._.___...___ __No. of Parking
SEPARATE PERMITS RCQUIR u POR SEWER AND PIXMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED
FIELD CHECK HY aw
DATf.�3y�_
PEP11IT APPROVED BY
it is understood that ,all work will conform with applicable codes and ordinances
of the State of Oregon ar.d the City of Tigard, Oregon, an(l that the building will
not be occupied -antil a Certificate of Occu ancy ha L n issued by the City of
Tigard Building Inspector,
gnatura ApFi`� ant ��� �
Fk
e
UNIFIED SEWERAGE AGENCY NO. 4812
WASHINGTON BOUNTY DATE __3-116-73
C I T Y O F-,----
APPLICATION
. _ _APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: . - - ----4. Be
OWNER'S ADDRESS: G' �« G�t�cc•?
--
STP.EET
9T223
CITY STATE ZIP
BUILDING SITE: LOT_4$._- BLOCK ._ _ -- _ ADDITION Brook'ftY� __..-.
TAX LOT NO. -_ ___- TYPE OF OCCUPANCY
L23 9.w. U "tkWrivA St/
ADDRESS
DWELLING UNITS 1- __ FIXTURE UNITS _
SURCHARGE IF APPLICABLE - ___ __ - - ---- -- ------ —
PERMIT FEE 425450- - INSPECTION FEE 25-_ TOTAL DEPOSITED - __4-
EW) (IFXISTING) BUILDING SEWER SYSTEM T.Jard
The Applicant agrees to comply with all rules and regulations of the Uni d Sewerage Agency.
f
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE V __ _ __- INSTALLER Xd. Ttoewas
RECE;VED BY V(-1-t �t- ____ __..._. _
ENCVuOp ITS AUENTI
COMMENTS: 4- yJ it .r 7j
This Application and permit expires in ninety (90) days. The amount Haid will he forfeited
should expiration occur.