7925 SW DURHAM ROAD I
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7925 SW DURHikM ROAD
INSPECTION NOTICE
City of Tigard Building Del,artment '74L
12420 S.W. Main St.
Tigard,Oregon 97223 1�
Phone: 639-4171
Type of Inspection
Date Requested, Time _ A.M. P.M.
Address — *??�*— Permit #--5A-Zi 6 —
Owner _—Dk-ec— — Lot
Builder ------ _
The followii.g Building Code deficiencies are required to be corrected:
-
Presented to —.,._ �✓ Approved
Inspector _ — �.. Disapproved
Data
CALL FOR REINSPECTION
❑ YES tJ NO
Uf SLI VER PERMIT N : 27! 18
Unified Sewerage Agency CITY OF DATE
of Washington Co fy
OWNER t - 1 (,�- ��J GL(�� _ PHONE
OWNER' S ADDRESS:
TYPE OF INSTALLATION:
® BUILDING SEWER ❑ LINE TAP AND BUILDING SEWER ❑ L_INE TAP
TYPE OF OCCUPANCY:
NEW ,� EXISTING SINGLE FAMILY ❑ COMMERCIAL
❑ MULT. RES. ❑ INDUSTRIAL
R
FIXTURE UNITS DWELLING UNITS
ADDRESS OF STRUCTURE t ). -
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified
Sewerage Agency. When calling for an inspection, please refer to the Permit Number. The Permit
expires one hundred twenty (120) days from the date of issuance. The total amount paid (permit
fee, connection charge, line tap fee and/or other charge) will be forfeited if the permit expires.
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 given. If not so located, the installer shall purchase a "Tap ant' gide Sewer"
Permit at the current charge and the Agency will install a lateral.
FEESt
PERMIT FEF
CONNECTION CHARGE _ �� , `)�1
LINE TAP INSTALLATION
ISSUED BY
OTHER
TOTAL
APPLICANT DATE
Jhs rnnM THE SEWER PERMIT
;.�. . :. .- ;_rt•�;er N" 2791.2
�.•.,c_ ' . :!P FOR TINS PERMIT.
ADDRESS OF STRUCTURE
TAX MAP _ TAX LOT QUARTER
--- SECTION
LOT BLOCK OF
APPROVED BY DATE ISSUED BY DATE OF ISSUA
D. U. ' S - REMARKS _-�