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10900 SW 115TH AVENUE ••0. SW 115TH AVENUE Ln ci :. Ii Address Permit No. 1 � Permit charge /22 072 Owner ' y Connection fee C�15 Paid by Type of building . PRS Date connected _ a Service rate �'g __ Inspection fee CutiLractcr _ Paid by date Size of connect. on Assessment Paid r�% I I 9 City of Tigard � INSPECTION REQUEST for f .'SPECTION TIME. . PERMIT DATE: 6�9 DATE IGSUED .__._LZ _ MINERS NAME : ADDRESS. 01- 20�, I .)N rRACTOR : _0 o�� r- + S. ST ' Air p, Water[] , Visual [71 , l-aborotory r� ,ECt.:!T: Approve , Disapproved L , Penainq p S KiTCH. I ! I i r ; INSPRTOP DATE NOTEAttach supplementol test data beret] I t I I ^ City of Tigard INSPECTION REQUEST for INSPECTION TIME : , PERMIT NO. : DATE : 6, //(I -; DATE ISSUED'. _LZ OWNERS NAME ADDRESS : CONTRACTOR :-ZZY,�42Z-�- �L -- - I ,TEST. Air O, Water 0 , Visual t , LaboratoryC] RESULT. ApproveDisapproved O , Pending j SKETCH: _ I I iSPECTOR DATE CN OTE Attach supplemental test pato heron i' _ d N N ii (7 p ei w � I y tl O N b yam- [1) J r I �l •1. 0 3 c ti 1 to _ r to l7 IQ M hl N uJ 01 n t }� no G! C W n t n CT•� p ui - Ii b to ,r u C n o (� aI) rte. !] r) (s / ULPffilm SEWER PERMIT �� Uf 1238 Unfied Sewerage Agency 4-21-77 of Washington County C I TY OF T?g2rd DA I E _ OWNER : Bob Smith — PHONE : 644-8955 OWNER ' S ADDRESS: TYPE OF INSTALLATION: ®BIJILDING SEWER ❑BUILDING SEWER AND SIDE SEWER TYPE OF OCCUPANCY: ®NEW ® SINGLE FAMILY ❑ COMMERCIAL i. ❑EXIST . (PRIOR TO 7-1-70 ) ❑ MULT . RES. ❑ INDUSTRIAL i FIXTURE UNITS DWELLING UNITS 1 : 6 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. THIS APPLICATION EXPIRES IN ONE-•HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD EXPIRATION OCCUR. Y FEES.,, PERMIT FEE $ 25. _ CONNECTION CHARGE 575. _ (^ SIDE SEWER INSTALLATION A.2k ISSUED BY OTHER _— OD1 TAL $ 600. PPLICANT DATE SEWER PERMIT N': 12138 AUDRLSS OF STRUCTURE._ 10900 SW 115th St. TAX MAP TAX LOT _ SYSTEM Fenno Creek i FIT 706 BLOCK OF — APPROVED BY DATE ISSUED BY DATE REMARKS Bldg. #1415 i i city OF TIGARD ORDINANCE '07-26 STREET SYSTEi^ DEVFLOPMENT CHARGE DATE : 4-21-77 ESTIMATED SALES PRICE $ _ 49 96 APPLICANT NAMEBob Smith _ TELEPHONE #_±44-!6!955 JOB ADDRESS ingnn sj.j jjFtta__g.t,­_.­__.-_______ BLDG. PERMIT AMOUNT GF FEE FOR S. 0. C. 300. 00 D E.S C R I P T I O N OF IMPROVEMENT___-_____ EXEMPTIONS -PER ORDINANCE m-'7-26 r FEE PATES: A. Single family :!welling u-ft under $60,000.--------- $300. 00 B. Single family dwelling unit over $60, 000. --------- $400. 00 C. mobile Home Court Space (New Deve'lopment)- --------- $150. 00 0. Multi-Family Dewllings--per unit------------------- $240.00 E. Commercial, Industrial & Institutional(Park. Space) $ 50. 00 each F. Single family unit under $40, 000. ----------------- $250. 00 �I �r1 BUILDING PERMIT APPLICATION Of CITY TI���AR.D OATE--4--.21-77 , �40;. 5 THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOP THE WORK HEREIN INDICATED WIJILD•TRPHONE- OR AS SHOWN ANC APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHONE C t 7 ll LOT NO..— OWNER t"3OU '71111th! JOB ADDRESS 109LIO SW 1bt• HOME ADDRESS _ ARCHITECT ENGINEER BUILDER ADDRESS _ DESIGNER _ STRUCTURE LJNCW� El R' MOD.:L_ ❑ACDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE [:]DEMOLITION 'OAhESIDENCE El comm ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE_❑STORAGE❑SLAB [-]FENCE ❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED _ ❑SIGNS OCCUPANCY L'LAND USE ZONE--L,.-i--BLDG.T!PE "IN FIRE ZONE_ PLAN CHECK BY L l is �HEAT—S�___ rsa-insult run&t_j;jrjt family d rL(�jA�*>tLLC.hiid —�.a t;--::t3b A be raala 2 hath _-- 4G�;..LQAD _F-QQfj-wAIZ—__�� Li�l.Oilit.__ 20 1.-_.2-Ai. A2RUA-N0-ED8O4M,s 4 YAl UE 37..1.96, BUILDING DEPARTMENT SET BACKS FRONT -- REAR �� LEFT SIDE Z nIGHT SIDE Permit 1` ,*CO s THIS PERMIT IS ISSIIED :UBJECT TO THE REGULATIONS CONTAINED IN THE RUILDING CODE, ZONING Plan Check tog,00 REGULATION; AND AL: APPS-ICABLE CODES AND ORDINANCES. AND 17 IS HEREBY AGREED THAT THE -- — WORK WILL BE CONE IN A,'CORDANCE WITH THE PIANS AND SPECIFIrATIONS AND IN COMPLIANCE WITH Sub total ALL APPL.I:ABLE CODES .1NU ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS Stlte Tax Q.P'1 LICENSE, 1EPARATF PERMITS RCOU1RED FOR SEW[R• PLUMBIN, AND HEATING. TotalBy PPPLICANT OR AGI id I Approved �� Receipt No. - DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE Contractor L19 77 J-blC ozc, ---- Permit No. 91 Nough•in ��3 9 Fixture _ r1a o - C, -lS! ls� Final _ ------ - HEATING Contractor _ Permit No. % ✓ 7 C.as or Oil -17 (3 r �_ �e t �Rouyh-in �7? 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