12400 SW 121ST AVENUE uuU _U L i uuu -luu .
-•• SW 121ST AVENUE
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INSPECTION NOTICE
City of Tigard Euilding Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 �
Type of Inspection �+L �%
ll I TI _A.M. P.M.
Date Requested-I --�—
Permit
Address
Lot # –
Owner `
Builder
The following --
vain Build'n9. Code deficiencies are required to be corrected:
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Presented to __ $-Approved
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Inspector ❑ Disapproved
Date ------�� r � ---
CALL FOR REINSPECTION
YES I--] NO
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CITYOFTIIFARD
SEWER SE8
�„�� PERMIT NO. : E99269263fa
(Y-11foom
OFnGARD �J�1
COMMUNITY DEVELOPMENT DEPARTMENT I' '7. ISSUED: 12/ilI
13125 S W Hall Blvd,P Box 23397,Tigard.1regon 97223.(503)639-41 + '�----.( I, 1 M.PMT.N0. 89263E
JOB ADDRESS: 12400 SW 121ST LIVE )ISA NUMBER: 39139
TAX MAP/LOT SUB: LT: BKs
LAND USE:
LOT SIZE:
SECTION: IWP: RNG:
WORK CLASS: ALIFRATION
USE TYPE: SINGLE FAMILY
The applicant agrees to cumply with all rules and regulations of the Unified
Sewerage Aqency. The permit expires 120 days from the date issued. The total
amount paid will be forfeited if the permit expires. The Agency does not guar-
antee the accuracy of the location of the side sewer laterals. Ii the sewer is
n.:` located at the measurement given, the installer shall prospect 3 feet in
all directions from the distance qiven. If not so located, the installer shall
purchase a "Tap and Side Sewer" Orrmit and the Aqency will install a lateral.
I''STALL. lYPEs BUILDING SEWED IMPERVIOUS ARTA:
FIXTURE UNITS: 15 TEN(INT IMPROVEMENT: YES
DWELLING UNITSs 1
NO. OF BLDGS. s 1
FEES:
varlcil charles PERMIT f3''t.f111
N 12400 yw 121st ave CO►MECT ION CHARGE
ti gard or, 97 '23 Li4E 1AP INSTALL.
OTHER
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R TOTALS X1.285.99
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This,permit Is issued subject to the regulatlonsrontainec'In Title 14 __________._RECEIPT_NO. /� 1_ t
of the IMC, State of Oregon Specialty Codes,zoning regulations REQUIRED INSPECTIONS
and all other applicable codes and ordinances, and It is hereby
agreed that the work will be done in accordance with the plans and SEb!ER
specifications anc, In comollance with all applicable codes and FINAL
ordinances The Issuance of this permit does not waive restrictive
ovenants Contrvctor and subcontractors shall have current city
business tax per.nits This permit will expire and become null and
void if work IR:tot started within 180 days,or If work Is suspended or
abandoncu for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required Inspections are requested and approved
Permitter Sinal re
Issued Ry ICAII I -FOR IN5fIE-ETI 6*49-417`;
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
W 1W WLale LqUWffWL rw=
PLUMBING PERMIT
PERM IT NO. : PI-870287
C1�'rOF TIGARD7C I TCY,�bF TIGAV
COMMUNITY DEVELOPMENT DEPARTMENT PRIM,PMT.NO.
09100H DATE ISSUED: 1*2111187
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard.Oregon 97223,(503)639A175 ---
i0B ADDRESS: 12400 SOI 121ST AVE LT:
TAX MAP/LOT SUB:
LAND USE:
LOT SIZE: ITEM: NO: r Ila
WORk:: CLASS: ALTERATION WATER CLOSET TRAP
USE TYPE: SINGLE FAMILY URINAL BR FLOW PRVNTR t
CONST. TYPE1 VN LAVORATORY TRAP PRIMER
OCCUP. GRP. j R7 TUB SHOWER GREASE TRAPC
DISHWASHER
GARBAGE DISPOSAL
NO. STORIES: WASHING MACHINE
DWELL. UN ITS 4 LAUNDRY TRAY BLDG.DRA'04 (DIA
FLOOR rlRAIN
SINI'*, SEWER (FT)
WATER HEATER SJORM/'RAIN (F'F
OTHER
REMARKS:
backflow pre,,,entLnt, device r1r,1Y
vane il FEP@pMIT $1 5. 00
0 12400 sw
W tiBard car 97227 FIXTURES
N STATE TAX $. 75
E
R OTHER
C MODERN PLUMB114r--,
0
N P0 B 0 X 2'?3()7
1
R t i Bard or 97221
A PHONE (57.17) 639-3701
CTOTALe $15. 75
T REGISTRATION NO. ISJ
0
R RECEIPT NO. 27804.)
This permit is issued subject io the regulations, ntalned In Title 14
of the TMC, State of Oregon Specialty Codes.zoning regulations
and all other applicable codes and ordinances, and it is hereby
agreed that the work will be done in accordance with the plans and
specificaticr-is and it, .ompliance with all applicable codes and
ordinances the issuance t;!this permit does not waive restricts
covenants Contractor and subcontractors shall have current cily
business tax permits This permit wii:expire and become null and
void It work is not started withir 180 days.or if work is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
at( required Inspections are requested and approved
Y''ittee Signature A L I.. r-nF, TNSPFrTinN S*`t9-41'7!,
Issued By
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
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SEWER PERMIT N0-
V
Unified Sewerage Agency CITY OF DAT E
of Washington County ------ — ------ ----
OWNER: ___ PHONE :
OWNER'S ADDRESS: -- -
TYPE OF INSTALL.ATIO"J:
BUILDING SEI}ER ❑ LINE TAP AND BUILDING SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
NEW ❑ EXISTING ❑ SINGLE FAMILY ❑ COMMERCIAL
❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS — DWELLING UNITS
ADDRESS OF STRUCTURE : -
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 issaance. The total amount paid (permit
fee, connection charge, line tap fee and/or other charge) will be forfeited if the permit expire
ns.
The Agency does not guarantee the accuracy of the location of side sewer leterals_ If the sewer
is not located at the measurement given, the installer shall prospect three feet in all directions
from the distance given. if not so located, the installer shall purchase a "Tap and Side Sewer"
Permit at the current charge and the Agency will install a lateral.
F=FES:
PERMIT FEE
CONNECTION CHARGE
LINE TAP INSTALLATION
^-- ISSUED BY
OTHER
TOTAL s DATF OF I SSUAN— cff—
APPLICANT DAII OF EXPIRATION
SEWER PERMIT
A111)Il1 'j') OF STRUCTURE —
QUARTER
1 A� MAI _�5 ! ,�-1 TAX LOT /UDU SECTION —
t nT BI nCK _ . -- OF
APPROVED BY DATE ISSUED BY DATE OF ISSUANCE
D. U. 'S REMARKS
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