11700 SW TIEDEMAN AVENUE 11700 SW TIEDEMAN AVENUE
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INSPECTION NOTICE
City of Tigard Building Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
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Type ., nspection 7&vay- ---- —. - - --..--- --
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�� Time_ A.M.f-41"Q P.M.
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-L/7 06 Fe I d1k 4,111--_ Permit -
Owne - --- - Lot #
Builder - --- -----� -—The following Building Co:le deficiencies are requir^d to be corrected:
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Presented to -_ -�- - -- Approved
Inspector - I Disapproved
_ --�,_,.,�.Gr'- ----
Date T— -
CALL FOR REINSPECTION
❑ Yes V3 NO
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- SEWER PERMIT
Unified Sewerage A!,ency /
of Washington County CITY OF a DATE
OWNER : - /_�Y -rf �� _ P H 0 N E
OWNER 'S ADDRESS: 17���1::� _ ✓�G`-���rl�/�
TYPE OF INSTALLATION:
❑ SIDE SEWER ❑ LINE TAP AND SIDE SEWER Q LINE TAP
TYPE OF OCCUPANCY:
❑ NEW [:] EXISTING SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS _ DWELLING UNITS-
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ADDRESS OF STRUCTURE : _- _ :,, i.E_
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency,
When calling for inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be forfeited should expiration o^cur.
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 and depth given.
If not so located, the Installer shall purchas 3 'Tap and Side Sewer' Permit at the current charge and the Fgenry
will install a la!eral at the location specifiMd by the Installer.
FEES: U_c
PERMIT FEE s ��
CONNECTION CHARGE
LINE TAP INSTALLATION
ISSUED BY
OTPER
TOTAL
- -----� APPLICA,NTu----- ------ -�- DATE
SEWER PERMIT
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ADDRESS OF STRUCTURE Z 7 04f444 L-
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�3 �.• _ TAX LOT
TAX MAP SYSTEM
LOT BLOCK - _ OF
!°PROVED BY DATE �►J ISSUED BY DATE.�.�,
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0., U. ' S _ Xf/ REroARKS �""+�' ;• f`�