14420 SW 114TH AVENUE-1 14420 SW 114TH AVENUE
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection —
Date Requested_ –97-- Time �-'O A.M._ P.M.
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Address . ' � Permit #__..—
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Ownee / Lot .4
BuilderThe following Building Code deficier.:ies are required to be corrected:
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In
Prmented t0 % l l_1 �+PProved
Inspector Disapproved
Date
CALL FOR REINSPECTION
0 YES LF NO
SEWER PERA1I'i 34010
U
Unified Sewerage Agency CITY TY OF DATE Junc.30, 1987
of Washingt%xiCounty _� ;S and —
OWNER : Alhrarf Mi ,tarok PHONE : 620-1701
OWNER' S ADDRESS :—_ 14420 SW 114th Ave .
TYPE OF INSTALLATION:
0 BUILDING SEWER ❑ LINE TAP AND BUILDING SEWER ❑ LINE TAP
-CYPE OF OCCUPANCY :
❑ NFW L^J EXISTING ❑ SINGLE FAMILY ❑ COMMERCIAL.
❑ MULT . RES . ❑ INDUSTRIAL
1
FIXTURE UNITS DWELLING UNITS _
ADDRESS OF STRUCTURE : 14420 SW 114th Ave.
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 di.ections
from the distance given. If not so located, Lhe installer shall purchase a "Tap and Side Sewer"
Permit at the current charge and the Agency will install a lateral.
FEES :
PERMIT FEF $ 35 .00 _
CONNECTION CHARGE 975 . 00
LINE TAP INSTALLATION —
SSUED BY
OTHER
TOTAL s 1,010.00 �`� 3 h
DATE OF ISS NC:
1411,
_7
APPLI DATE OF EXPIRATION
SEWER PERMIT
ADDRESS OF STRUCTURE 14420 SW 114th Ave. �-
TAX MAP 2S1-10TAX LOT 2300 QUARTER
- SECTION — —
LOT gc.R BLOCK 6-30-87 r
4" pipe regd.Septic tank to be pumped & filled
APPROVED BY DATEW7sand or gragv qS�p>.j pecon
O . U . ' SL IN'EMARKS
> �v 3 0/�'
i
SEWER PERMIT �
Unifiod e Agoney CITY OF DATE
of Washington County
OWNER : /;'� 3%.e r _ /�"� s TriPC _ — PHONE ,
OWNER' S ADDRESS r
TYPE OF INSTALLATION:
❑ BUILDING SEWER ❑ LINE TAP AND BUILDING S 'WER ❑ LINE TAP
FYPE OF OCCUPANCY ,
❑ NEW EXISTING SINGLE FAMILY ❑ COMMERCIAL
❑ MULT . RES . ❑ INDUSTRIAL
FIXTURE UNITS ^ DWELLING UNITS _
ADDRESS OF STRUCT RE : — `� ��'l —' --
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, rine 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 virections
from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer"
Permit at the current charge and Vie Agency will install a lateral.
FEES:
PERMIT FEE $ __ ` --
CONNECTION CHARGE
LINE TAP INSTALLATION
ISSUED BY
OTHER _
TOTAL f �'�'%'' DATE OF I SU +—
_ ICANT DATE OF EXPIRATION
SEWER PERMIT
ADDRESS OF STRUCTURE
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T A X MAP 2 5 — _ 1"A X L O T 2 3 QUARTERS E C T !0 N
LOT _ BLOCK --- - OF - -.__—- — -----
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