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City of Tigard
C y� gar
INSPECTION REQUEST
for
INSPECTION TIME :__ PERMIT NO. :
DATE : 511'7757 DATE ISSUED /
OWNERS NAME : ----
A D D R ES S 19-x.`/-J iCONTRACTOR :—.------------.
TEST. Ai► O, Wa!er J , Visual ❑ , Lab-ratorw p
RESULT: Approved, Disapproved ❑ Pending 1
SKETCH:
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I-NSPJtCTOR DATE
ENOTE Attach supplemento, toot data herefol
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Fl;-,'E PREVENTION BUREAU t
OFFICE OF FIRE MARSHAL 55 qi 4
INSPECTION NOTICE
OWNER ° f �G7DATE'
OCCUPANT �( (` rte( OCCUPANCY H r kar ge
LOCATION
YOUR ATTENTION 15 CALLED TO THE FOLLOWING FIRE SAFETY DEFICIENCIES
i
FAILURE TO CORRECT THE At30VE CONDITION! WITHIN_OAVS WILL MAKE YOU Q'AbLE ;.l VJ OlECU SHOT LD FIRE
RESULT FROM SUCH CONDITIONS YOU MAY BE LIABLE FOR OAMA`/.! 7U PER59M�5 �Ir
TV yNO 1�ROY BION!
OR5 475 IPO
WASHINGTON COUNTY FIRE DISTRICT M1 j /�.R •� _ --
17880 S. W. Rk.ANTON STREET
ALOHA, OREGON 97005 649-8577 PRESWT 'r
FORM POO 40
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UNIFIED SEWERAGE AGENCY NO. _ 11049
WASHINGTON COUNTY1-10-"
DATE ----.._._—
CITY -
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER Robert Randall Co. --. - - _ -- -- _-_- --
OWNER'S ADDRESS: — ------- - - - - --
STREET
- - -- ZIP
- CI'rV STATE
BUILDING SITE: LOT-.. BLOCK ADDITION ---
TAX LOT NO. --- --- TYPE OF OCCUPANCY currmarcial
ADDRESS 10560 -S6!_1219t. Ave. ---- ___-----_--_ ---- .------.-----
DWELLING UNITS _ 6 - - FIXTURE UNITS --------- ---
SURCHARGE IF APPLICABLE —
PERMIT
PPLICABLE -_PERMIT FEE3450. INSPECTION FEE 35• - TOTAL DEPOSITED 3485.
(NEW) (EXISTING) BUILDING SEWER SYSTEM Fanno._Creek-__.__
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
'i cyx
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE .- INSTALLER
R E C E I V
EDB �•5
IA[iENCV OR It BENT) ✓ (�/
COMMENTS: _ Bldg.. #1235 -
This Applicatiun and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.
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BUILDING PERMIT APPLICATION COF
IT TIGARD DATE Is i
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR A SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
Lor NO.--
OWNER
o. _OWNER �,'k JPB ADDRESS 10560 SW 121 AWL HOME ADr1RESS
ARCHITECT
ENGINEER
BUILDER _ADDRESS DESIGNER —
STRLICTURE NEW CIREMODEL []ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE []DEMOLITION
C3 RESIDENCE 'U'tO_MM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ]CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED []SIGNS
CCUPANCY LAND USE ZONE RQ BLDG.TYPE_ ! FIRE ZONE J PLAN CHECK BY_ T HEAT`.._ _
,—Ldge H Cunote multifamily apt u/out caarskjaTall per plans as prpporPC cry U814i
Haller P.E. Sheets 1 thru 37. 6 unite Includes fall aaj.tc, driw.L1aya, pauin•.�� and k
landenpping 13 bedroom 6 bK _.._ — v
411 24 1&3 4989 13 (19 ki.
OCC,LQAD __ __-F140P_I.QAP�.---._-- HEIGHT y N0•aTVRIES AREA -- VAI
BUILDING DEPARTMENT SET BACKS FRONT HEAR LEFT SIDE RIGHT SIDE
Permit kms`
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE Bt'!LDING CODE, ZONING
Plan Check Pre-peid REGULANONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCOPDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax �Q1 LICENSE SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING,
Total 275,01
By APPLICANT OR AGENT
Approved ) I Receipt No.
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
//474f) t Contractor
l Pet it No. �, .� -,� r 7-)
-
1 -
Rough-in
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� Fixture
s e
Final
HEATING
Contractor
Permit No.
Gas or Oil
--
Rough-in
Final
• ---- - --- _.--------SEWER
Final
_-- DRIVEWAY
Final —_
—Y� Storm Drainage
(Rain Drain) Final
Sidewalk
Gurb&St•eet Final
Ap
proach _
BLDG DEPT. FINAL —^ TEMPORARY CERTIFICATE CCCUPANCYr,ERTIFICATE OCCUPANCY
ng Final
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Address _ /OS 4�-�' 1 ► �Lr`�-- — Permit No.
Permit charge _ U
Owner Connection fee
Paid by �L _ a �'��C Cb • -
Type of (
of buildingZ Date cLnnected -
,- - -
Service rate _ �_,_._ Inspection fee >;
Contractor Paid by Date
Size of connection Assessment �. paid _____