12118 SW 125TH AVENUE WA
12118 SW 125TH AVENUE
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of Tigard I
INSPECTION REQUEST
for
SPECTION TIME:I` (!t-- PERMIT NG. :-
DATE
G. :DATE ISSUED : f
INEERS NAME : —
ADDRESS: .
)N rRA�TnR ; SAZino _. Jnh� �5�•�
Nater❑ , V;suai , I_a borr,tory ❑ i
=SUI. ikvroved = )isuppro�ed 0 Pending ❑ I
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i CT0R DATE
Tt- Nttccn supplemental iegt data hereto,
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of Tigard
and
City g
IN3PEC TI® N REOUEST
-for
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I 1!!,-)PECTION TIME : NERMII" NO. :
DATE : -2LI --3 DATE ISSUED-_ ,'--1
OWNERS NAME '
IALIDRESS :
C0NTRACI0R _ -- —.
TEST , Lj , Water r] , Vist-al [3 , La" .ratorl n
RESULT. Approved , Disop- oved 1 F'�ndt7g E]
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SKETCH:
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.z,;PE TC 0R DATE
ICOTE Attach uppIprntnt(II test J '^ hero t]
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City of Tigard
EST
IIVSPECTICJ�' F�EQIJ
I for
IINSPECTION TIME: PERMLT NO.: S
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DATE , ¢ If-1,73 DATE ISSUED:
OWNERS NAME,
I ADDRESS : -- S•
CONTRACTOR :---------
TEST:Air ❑, Water [j , Visual,0 , Laborntory ❑
RESULT: Approved,0 , Disapproved ❑ , Pending ❑
SKETCH;
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I INSPECTOR DATE
�NOYF Attach supplemental fest data heretol
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PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit Nc.
Permit fee
Water Cl.cse*: (Toi.lets '� Permit Issued
Bath Tubs V Approved by
Lavatory (W. ah asin _ _ Building Perm.V37j
Shower_ Receipt No.
=s , Dishwac::"..ng -
S.tgks Ci tchon
Sir:k Ordin-,tri- _ Location of Bu i.' d i.r,g
_ ink far----- -- - ----•._______.______---------.
.inksS7
_Aut.,matic D 7iwas er
Laundry Trays.___. Name & Addre.5- Owr,, , _. •i. �c -- -= _ _
Dra iris , Floor__ — _, ,. -•�=-- __.__----_.___ ___-------------
-Drains Area _-- --- -------_____------------
Dr ai . a r':i, rai,or ----- -------_ ------ - ------- -
L Ra,-n ^rai.ns
Autor«rattic. Washe, Name & AddrE:-
Fountains,
lint ate,r 7°Q -----------G-L--t —_.►.._..r.. �,�.
Wa,_;
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Address 12118 _S.W, 12,i .h IyP Permit No. 4';
Permit ebarge
Owner George Heusser (contractor) Connection Pee
Paid by Geort5e I':Ausser
Type of building Residence Date connected -73
$eZ'ViCe rate 3.00 per month Inspection fee ">
Contractor George Heuser Paid by same Date
Size of oonLAction _ 4! Assessment � Paid _
�rs O O G / d
City of Tigard
INSPECTION REOUEST
for
INSPECTION TIME :; 7c' _ PERMIT NO.: l—LL`—
DATE: ,� 1-51VI DATE ISSUED:_ Z -,L-
0 W N E R S NAME :
ADDRESS : .
CONTRACTOR :
TEST. Air Cl, Water ❑ , Visual 2 Laborctory U
RESUL:r: Approved ® Disapproved D , Pending p
SKETCH:
INSPECTOR DATE
rNOIF Attar,h supplemental tett dato hereto]
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UNIFIED SEWERAGE AGENCY NO. 4786
WASHINGTON COUNTYHATE
_1-9-T3 _
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: ------
- - --
255yj S.W. 198th
OWNER'S ADDRESS: STREET
Aloha _ _ OMS°A —---_. _ - —97005
— -~—JCITY STATE �21P
BUILDING SITE: LOT, BLOCK — ----- ADDITION By.-
--.
TAX LOT NO. TYPE OF OCCUPANCY
ADDRESS � S.W. 125th
DWELLING UNITS _--- 3..-- - - FIXTURE UNITS _.__- ----- ----
SURCHARGE IF APPLICABLE --
PERMIT FEE S.---- - INSPECTION FEE25-----.. TOTAL DEPOSITED _-. 40
(N" (EXISTING) BUILDING SEWER SYSTEM .-------------
The Applicant ,igrees to comPly with all rules and regulations of the Unified Sewerage /Agency.
APPLICANT--. . . �-
I SEWER PERMIT
TH:S PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
4" Alobe Plumbing
LINE SIZE __ INST4LLER
RECEIVED BY___._
IAQ CY i i:i AGENT)
COMMENTS: .
This Application and permit expires in ninety (90) days. The amount hard will be forfeited
should expiration occur,
CITY OF TIGARD
12420 S. W. MainStreet
TIGARD, OREGOM 9=
APPLICATION FOR BUILDING PERMIT
New Constructior. ® Demolish ❑ Addition ❑ Remodel 1:1 move 13
zrNING_�7 -_ DATE ISSUED BUILDING PERMIT
DATE RECEIVED /2-22 -72 BUILDING FEE $ No. O 3
BY PLAN CHECK $ 43 E._'
�� OTHER $ VALUATION $
TOTAL $ /-2 y or-0. RECEIPT No. 7,,276,
TWO SETS OF PLANS AND PLOT PLANS MUST BE F17RNISHEO WITH APPLICATION
LOT 9 Z S' MAP N�-/ -�X34 CENSUS TRACT Lf'% 1 �- JOB N
Architect or Engineer-,��-2'21' 0,
Address �1 Phone
Owner-1 - { - u1r�i►� __ - - ---- -- —
Address
/J�yL' - L.N / 4 5=�1Co ,n, ____Phone -4 :
Builder
Address _ Phone
BUILDING USE Single Res. ® Multi Res. ❑ Comm. 0 Industrial
OCCUPANCY GROUP No. of Stories �/� Total Iieight1y, '_ Area of Lotft c
Type of Construction 1 II IIT IV C) Floor Area B 1 (v� pLl) 2
Set Backs: Front Z� , Back4�y" L.Side b' R.Side__C- '
Private Sewer Pipe Size Sewer 7 - Septic Tank LJ
Water Service Pipe Size Stov.7% sewer ® Ditch ❑ Drywell❑
Street and Curb Requirements
Driveway Width / ) ' No. of Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED��L� 1._�1�55i-�-1_
FIELD CHECK
PERMIT APPROVED BY
It is understood teat all work will conform with applicable cotes and ordinances
of the State of Oreuon and the City of Tigard, Oregon, and that the building ril
not be occupied until a Certificate of Occupancy has been issued P,y the City of
Tigard Building Inspector.
S gna ure oE App aI t