12860 SW 107TH COURT 12860 SW 107TH COURT --
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ADDRESS (.0 4.00-�� �t� PERMIT NO. ;�jp[a! -
PERMIT CHARGE none �
Z ' �� CONNECTION FEE ::
OWNER i
PAID BY
TYPE OF BUILDING DATE CONN UTED
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SERVICE RATE ._.L��1S. INSPECTION FEE �S
CONTRACTOR ' PAID 3Y GATE
SIZE OF CONNECTION 1 � �� A55F55MENT _ �__ PATO
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City �of Tigard `
INSPECTION REQUEST
for
iNjPECTION TIME: PERMIT NO. :____�.
DATE: DATE ISSUED :--
OWNERS
SSUED :_OWNERS NAME : G.
ADDRESS:
CONTRACTOR :
TEST : Air ❑, Woteri, Visual, Laboratory p
RESULT: Approved IV), Disapproved D , Pending I
SKETCH. I
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INSPECTOR DATE
50TEAttach supp10menlal tilt data bare;y, I
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City of Tialard
INSPECTION REOUE' ST
for
INSPECTION TIME : „�/�• _ PERMIT NO. '.....-
DATE :
O. : _..._---
DATE : 7 /3 / ?Z. DATE ISSUED:_
OWNERS NAME : h�:,eC
IADDRESS : IW_, 07f-" -.I.
ICONTRACTOR .'— nt-I
TEST: Ai► ❑, water ❑ , Visual [] , Laboratory ❑
RESULT: Approved , Disapproved ❑ , Pending o
SKETCH:
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INSPECTOR DATE
ILNOTE Attach sunriemnrtnl test dnto hereto]
City of. Tigard
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INSPECTION REQUEST
for
INSPECTION TIME: , L�r'1 PERMIT NO. :
DATE: S/3D/ 7J DATE ISSUED : LZ
OWNERS NAb!E t" p,
ADDRES'3: 1 D � 4'" C •___ �' _ I
CONTRACTOR :
TrST ' t,ir ❑, Water , Visual, Laboratory p I
RESut:"* Ahrr A,'ld Pending ❑
S KETC 14,
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CityofTigard
for
INSPECTION TIME.- .. `1PERMIT NO. :
01-1.1 E' / /7$' DATA
OWN F 7S N AME
TO R
Tr* r' a r r WatorQ , Visuai
RESULT: jlr-. C , 1.fsapproved
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i!l1r Er rOR DATE
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CITY Of
BUILDING PERMIT APPLICATION TIGARD DATE—� 19 N2 0223
THE UNDERSIGNED HEREBY APPLIES FOR APERM IT FOR THE WOR K '-1REIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATJQNS. OWNER PHONE.___._
OWNER f'e'rry KBIT_�y ADDRESS 12860 —' 14' 107th BUILDER PHONE~
taWlZd4r ENGINEER
$j,IILDER _ ARCHITECT ' DESIGNER
STRUCTURE ❑NEW ❑REMODEL ❑ADDITION ❑REPAIR ❑RENEWAI- ❑FIRFDAMAGE [:]DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE C]STORAGE ❑SLAB ❑FENCE
❑BOND ❑MOVING [:]CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE_ BLDG.TYPE _FIRE ZONE_ PLAN CHECK E)Y__ HEAT_______
-- con truct 1)74 Sq. !t. frame dwelling split leve]. ---_ - ----with ,firige in basement acco, dint,: to app; oved plant
3 bedroomp
--
- 40 1b _ 4
QgC, LOAO FLOOR LOAD _ HEIGHT NO.STORIES AREA VALUE _
7;
BUILDING OF.PARTMENT SET BACKS FRONT REAR LEFT SIDE lf` RIGHT SIDE
Permit � -- .-- ---- — ___--------___-�_—_-_— _
`---- THIS PERMIT IS ISSUED SLaJEC1 TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
'---- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State 1.4. LICENSE, SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total _ 153.42
By --- r .a
APPLICA14T OR AGENT
Approved Receipt No
ADDArSS _ i iiilrif — ----- — —
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor„�. -
f”. Permit No. Ota h
l -�J� l�' � i�� Rough-in
Fixture
Final —
�� HEATING
'i- 7� i /L.,,l% !�Z"G.�u,,• Contractor`
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Gas or Oil
Rough" n —
>� ._/ter _-/• .� i�.,yw•c'^ Gx!. Final —
ScU c. SEWER 5iTJ�
FlnaI
DRIVEWAY
Final
Storm Drainage
(Rain D(ain) Final
---� Sidewalk � � }• 4'" "r=
�, .
Curb &Street Final
_ Approach
BLDG.DEPT, FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
�l Landscaping
1 Zoning Final
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UNIFIED SEWERAGE AGENCY NO. 5066
WASHINGTON COUNTY DAt F _---3-27-75_
C11-Y OI=_--- Tigard - --
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: -_-1arr7-Re1eY _
OWNER'S ADDRESS:
ST HrC_T
-
CITY STATE 1:P
BU!'..DING SITE: LOT 39 BLOCK . ADDITION Pathfinder Subd.
TAX LOT NO. _ _ TYPE OF OCCUPANCY _ residence
ADDRESS --
DWELLING UNITS- -- Z__.__.._ FIXTURE UNITS ---
SURCHARGE IF APPLICABLE 50 to derry dell
PERMIT FEE 525 INSPECTION FEE 25 TOTAL DEPOSITED
(NEW) (EXISTING) BUILDING SEWER SYSTEM
Fanno Creek
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANTk lei
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE 4" . INSTALLER
RECEIVED BY-
1AGF.NCY OR ITS AGENT)
COMMENTS: _ _. building permit 0223
This Application and permit expires In ninety (90) days. The amount paid will be forfeited
shnuld expiration nccur.