13900 SW 114TH AVENUE 13900 SW 114TH AVENUE
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CITY OF TIGARD
130M a W WA* sk"M
TrsAaD. (WOO ee .fts7
APPLICATION FOR BUIU)INO PEPM;T
New ConstructionoxDemolish C� Addition ❑ Remodel ❑ Move
ZONING R-7 _ DATE ISSUED BUILDING PERMIT
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8ATE R1;CF,IV6U BUILDING TET. $ No. '73 186
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-" PLAN CHECK $� -
BY----r - OTHER $ VALUATLOW
TOTAL $- 10.00 RECEIPT No.
TWO SETS OF PLANS AND PIAT PLANS MUST BE FURNISHED WITO .;F!.7CATroH
IAT 1 MAP CENSUS TRACT JOB 1
Architect or Engineer,
Add re
owner^—_ _ Barbs" Spencer
Address_13iP0 S.M. .�.4EA .TjNNrd . --------Phore_ ---_--___
Builder_- �i. •!s V /�- _ __.____-_-__ -. � _.__.___._..
Address - Phone_
BUILDING USE Single Res. a Multi Res. Comm. ❑ Industrial r
OCCUPANCY CROUP No. of Stories T_ Total tieight - Area of Lot_
Type of Constftgtion I I1 III IV Vloon Area D- J. `\4 2` -
Ser tracks: Front_ Back- L.Sid
_ R.Side
Private Sewer Pipe Site -, SewrarSeptic Tank l-1
Nater Se[Vice Pipe Sias Storm Sower ❑ Di\%6qh U Urywell
Street and�C Wb Requirements
Drivevay Width. ' --
� No. of Perking aces
rar�.,...� mac--
StV.AAATF. PFWiITS REQUIRi6,,�OR SEWER AND PLUMBS
SPECIAL INFOR"TION
ADDRESS ASSIGNF.U_-----_-_ 1��00 S M 114th AA.
FIELD CHECK BY —_-._JS,_._ ---DATE_0-15-7_1
PEPNIT APPPOVED i
It is understood that all work will conform with applicable codes and ordinances
of the state of Oregon and the City of Tigard, pregon, +�pdr- hat the building wil
not be occupied until a Certificate of Occupapf�y has tp Idisued b the City of
Tigard Building Inspector.
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Cily of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : / r00_ PERMIT NO. : 1�._r
DAFE:!G, krd� 7� DATE ISSUED: `" %' '
OWNERS NAME : 1 2.c L-',
ADDRESS : __ /3500 5w
CONTRACTOR :. X6r--- 'P-.�;�—
TEST: Air L7, Water ❑ , Visual O . Laboratory rl
RESULT: Approved 1_.1 Disapproved ❑ Pending L7
SKETCH:
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INSPECTOR DATE
C07E : Attach supplemental test data heret]
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Address ' 39W S-W. 114th Permit No. X= 4724
Permit charge _�
Owner Columbia Custom Connection fee 125
Paid by Columbia Cuatamr..HQ=s
Type of building Residence _ Date r.onnected
Service rate 3.W per month Inspection. fee 25
Contractor 3JXMKKNZK Columbia Custom Paid by son __. Date
Size of connection 411 — Assessment Paid