12502 SW 123RD AVENUE low
12502 SW 123RD AVENUE _
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CITY OF TIGAR D '
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Owner.... .................................
D.W.D. Contractors..........................Permit 1`io........1391
Contractors
Building Address.. .2502 SW 123rd
Certificate is hereby given this......?....... day of....[lecember 19.17'..
that said building may be occupied and
that it complies wit>> all requirements of
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�� {► 'ie Building Code for the City of Tigard,
t approved by the Tigaru City Council. p
s Building Inspector
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Address /al�' � /�� ���'<�— Permit No.
Permit charge
Owner Connection fee
Paid by
Type of building ,moo Date connected
Service rate
/sf{" Inspection fee .2 r
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Contractor Paid uy Date
Size of connection _ Assessment Paid
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City of Tigard
INSPECTION REQUEST
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INSPECTION TIME: PERMIT NO. : --
DATE: k /2/2) DATE ISSUED :--L-1—
OWNERS
SSUED :--L-1—OWNERS NAME : Sw -
ADDRESS-. -----
C O N T R A C TO R : ----------- -
TEST : Air ❑, Water0 ,, Visual 0 , LabLratory ❑ I
4ESUI-71" Approved EJ , Disapproved C Fending ❑
SKETCH",
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IN ECTOR DATE
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[NOTE Attach •upplamental test data Ae;eta I
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SEWER PERMIT N 121 zU3
c Tigard DAZE 4�-12-77
Unified ewerage Agency
of Washington County CITY OF ___.----- —
OWNER : D.W.D. _ ___ -
PHONE : 639'6081
O W N E R ' S A U G R E S S: � _-------- ---- -_-----------__.��
TYPE OF INSTALLATION:
[_�BUILDING SEWER `IBUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
)EXI.EW
SINGLE FAMILY ❑ COMMERCIAL
❑EXIST . (PRIOR TO 7-1-70 ) ❑
MULT . RES. ❑ INDUSTRIAL
1
FIXTURE UNITS_ DWELLING UNITS —_ --
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGF_NCY . 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 FURFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FE=E $ 25. -
575.
CONNECTION CHARGE ----
SIDE SEWER INSTALLATION
—_------- VI SSUED BY
OTHER -----
TOTAL s 600.
A.
APPLICANT DATE
SEWER PERMIT N(, 1 123
-----
ADDRESS OF STRUCTURE-- 12502 SW 123rd---- --A'�Q.- _.--
- S' -STEM Fenno Creek
TAX MAP TAX LUT
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BLOCK F=_�__---- ---
l_UT — —
APPROVED BY
DATE ISSUED BY DATE
REMARKS Bldg. #1391 _ _ -
I log 191 111119 0 IN
BUILDING PERMIT APPLICATION 11 Y TIGARD DATE d—i —'dry 19_ I[391
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONF ',,39-6861
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
LOT Nv._
OWNER U*U*D* JOB ADDRESS 12501 ii3yd "' HOME ADDRESS _
ARCHITECT
a�� ENGINEER
BUILDER _ ADDRESS ^^ DESIGNER
UC _
STRTURE '` W ❑
_ _REMODEL_ ❑ADDITION CIREPAIR ❑RENEWAL. (:]FIRE DAMAGE ❑DEMOLITION
DOESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS OPATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB [-]FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY-1—LAND USE ZONE L'"'7 BLDG.TYPE - FIRE ZONE-2- PLAN CHECK BY_ Ql4L __ HEAT____�;
const. s.inVle family di.611ing _ attalbhocl iiarao tsedroom :3 bath
I,ara4e `')72 sqs, fte baostndnt 1320 sq. Pts
LCtIiI.._._.�. NO.STORIES_.__AREA1`iO7O.BEDROOM$. V—L>LAJ.E 43t 200.
BUILDING DEPARTMENT SET BACKS FRONT 21, REAR 50♦ LEFT SIDE 91L)" RIGHT SIDE 9
Permit 1t�9 00_ _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BF. DONE IN ACCORDANCE WITH 1 HE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTC tO HAVE CURRENT CITY BUSINESS
State Tax 7*I']' LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING h.10 HEATING.
Total 2b1 11
By --
_� APPLICANT OR AGENT
Approved ^� RI,i o- ISI No ����� (~�
ADDrrESS - _ -
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- ww+.ter. �na�a,u.a.+wr..rw......rw..�.•
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DATE INSP. TYI'E INSPECTiON REMARKS PLUMBING DATE
Contractor
Permit No. O Sr
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Rough-in
h_in
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Fixture _
' Final
2-it �t HEATING
_ Contractor
Permit No. 5
Gas or Oil
p - (C 5�6��i �C L<, Rough-in _...
.,2iv0-4rFinal _
G AS SEWER
D Zte Final _
_ -�43 DRIVEWAY
v�,e it � b' _ Final
Storm Drainage
Vj v (Rain Drain) Final
Sidewalk
Curb&Street Final
A proach
BLDG DEPT. FINAL TEMPORARY` CERTIFICATE OCCUPANCY Finel
CERTIFICATE OCCUPANCY
( _ Landscaping
`. Zoning Final
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