13820 SW 115TH AVENUE-1 13820 SW 115TH AVENUE
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City of Tigard
INSPECTION REOUEST
for
+NSPECTION TIME :pkv iiv7f- PERMIT NO. . ..
DATE. 226 `BATF ISSUED'__
OWNERS NAME * . ,A4 �T---
WDRESS : ���-------
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CITY OF TIGARD
12420 S. W. Main WrW
TIGARD, OR130N V=
APP-KATION FOR BUILDING PERMIT
New Construction F-1 Demolish C1 Addition ❑ Remodel ❑ Move C�
ZONING _ DATE ISSUED _ BUILDING PERMIT
BUILDING FEE $._1G��'
No, '136
DATE RECEIVED
PLAN CHECK $
By VALUAPIOtd $-
O:^HER $
---T5 TT_ RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT w MAP A - CENSUS TRACT __- Jolt M
Architect or Engineer /V?il? _5/Jy ___- -
is/ _Phone1
Address.`. � 2U -!5w i/5 ------ —
Owner [h� ------- --- -
Address -._ ----.-__-- ___Phone
Builder
Phone
------'
BUILD USE Single Res. ❑ Multi Res. ❑ :Omm. ❑ Industr
OCCUPANCY GR0 No. of Stories Total Height__.___ Are Lot
Type of Construction II III IV V Floor Area H-- 1 -_-._ 2��__
Set Backs: Front Back L.Side R. e_
Private Sewer Pipe Size-- Sew —��Septic Tank LJ
water Service Pipe Size Stor we Ditch ❑ DryweI ❑
Street and Curb Requirements
nriveway Width - �No. of Par':ing Sp
Pj\RATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED
FIELD CHECK BY —_ �--__-•--DATE
PERMIT APPROVED BY
� -I
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tiqard, Oregon, and that the building will ,
not be occupied until a Certificate of Occupan�y s been issued by the City of
Tigard Building Inspector.
S gna re o i ant
i,
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT" N�l 1629 DAT1T
PURMIT 1S GIVEN TO � G.c.. :g -'�
OF
,
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT s I
THIS PERMIT MUST RE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEF. PAID $.............` L)L I.............TIGARD SANITARY DISTRICT
Byi
f
CONNECTIO� INSPECTED AND APPROVED
Date — Superintendent ---- --V
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Address 1384 S.W. 115th Ave. Permit No. 4w /lam 9
Permit charge
Owner 2c,y c«LerConnecti.on fee 400
Paid by _ Columbia Custom
Type of building Res. Date connected
Service rate 3.00 per month Inspection fee �5
Contractor Columbia Custom Paid by same Date
Size of connection 411 Assessment Paid
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