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OREGON
D.W.D. Const. ,
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1165 SW Fai�•view Lane
Building Address........... .
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Certificate is hereb g
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iven this........1.... day of.........P... ................. ly..... . .
that said building may be occupied and �.
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that it coplies with all requirements of
' the Building Code for the City of Tigard,
/ as approved by the Tigard City Council.
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Building inspector
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ADDRESStti r�- PERMIT NO.
PERMIT CHARGE _ none
OWNER^� CONNECTION FEE- -5
PAID BY A
12. CtJ
TYPE Ut BUILDING �f� DATE CONNE"TED y
SERVICE RATE Ve ' _ _ _ INSPECTION FEE J
CONTRACTOR _ PAID BY DATE T_ —
SIZE OF CONNECTIOi! ASSESSMENT PAID
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I City of Tigard
4-INSPECTION REQUEST
for
ic-
INSPECTION TIME , PERMIT NO. :
DATE: DATE ISSUED:__L_L__
0WNERS NAME : -D ,LA-)
I ADDRESS : 3 � I(zU►�'�� -� .
CONTRACTOR :-
TEST'.
ONTRACTOR TEST. Air ❑, Water p , Visual�, Laboratory ❑
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RESULT: Approved , Disapproved O Pending r]
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INSPECTOR DATE
CNOTE: Attach tupplmmintal test data horst]
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :
DATE: == LIZ 7 DATE ISSUED :.�.L.L_
OWNERS NAME :
ADDRESS; Z -, l�y - t""
C:INTRACTOR : 1f6..crt. ? 3� 11fVi:I
TE:ST : Air p, Water(] , Visual li, Lab story [3RESULT: Approved 0 , Disapproved Pending p
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INSPECTOR DATE
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City of Tigard
�r�
INSPECTION ,�"
. �'EG?IJEST
for i
INSPECTION TIME: PERMIT NO. : _-
DATE: i 11-`17-7 DATE ISSUED : Z Z I
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OWNERS NAME : - ---
ADDRESS: !v'CONTRACTOR : — --
rE ST : Air 0, Water p Visual tT, Laboratory O
4ESULT: Approved 0 Disapproved E Pending CJ I
SKETCH:
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f NSPE TOR DATE
COTE : Attach supplemental test data bere4 I
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City of Tigard
INSPECTION C�'1 N REQUEST"
for
INSPECTION TIME: PERMIT NO. :
DATE: ATE ISSUED ._.1�! I
OWNERS NAME :
ADD RES S: �/G, 5� .a�-t-� t.Ly�- �✓ _�'^ I
CONTRACTOR :
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rE ST : Air C], Water f ;'Visual Cj,'Laboratory p I
,RESULT: Approvoe, 2 Disapproved C Pending p
SKETCH:
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NSR CTOR DATE
FrTE Attach supi,lemenfol test data bareto� I
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UNIF- IF- D SEWERAGE AGENCY NO. 11.009
VV,/\,S 1-11 N GTO N C 0 U N T Y DATE 11-?4-76
C11-y OF Tir.4rd
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER'S ADDRESS:
STREET
STATE ZIP
BUILDING SITE: BLOCK ADDITION
TAX LOT NO. TYPE OF OCCUPANCY residence
ADDRESS 6 3
115 SP Fairview 7 an
DWELLING UNITS__ FIXTURE UNITS
SURCHARGE IF APPLICA13LF. ....._ $50.00 Derry Dell
575.00 25 nO_ 600',)00
PERMIT FEE- - - --- INSPECTION FEE TOTAL DEPOSITED
tNEW) (EXISTING) BUILDING SEWER SYSTEM ___ Fanno Creek
The Applicant agrees to comply with all rules and regul,itions of the Unified Sewerage Agency.
APPLICANT /N -\`',
SEWER PERMIT
THIS PERMIT AUTHORIZFS CONNECTION TO THE SEWER SYSTEM.
LINE SIZE - INSTALLER
R F C E I V E D BY-
(AGENCY OR ITS AGENTI
t:OMMEN J'S: I 1.113
This Application and permit expires in one hundred and twenty (1120) (jays.
The amount paid will be forfeited should expiration occur.
BUILDING PERMIT APPLICATION of TIGARD DATE ll_2R.-]r. ! ,173
THE UNDERSIGNED HEREBYAPPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHON, Gc
OR AS SHOWN AND APPROVED IN THE .ACCOMPANYING W_ANS AND SPECIFICATIONS. OWNER PHONE
LOT NO_
1 al a.C tr l �J, w_
OWNER _ JOB ADDRESS 3 HOME ADDRESS _
ARCHITECT
ENGINEER
dL!ILDER ^� ADDRESS DESIGNER
STRUCTURE ONEW_ ❑REMODEL `❑ADDITION UREPAIR, ❑RENEWAL ❑FIRE D,AM4GE ❑DEMOLITION
Q RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSL^ ^ ❑
IPATIO `.JCARPORT ❑GARAGE ❑STORAGE❑SL-AB FENCE
OB
OND MOVING ❑CONDITIONAL LISE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
QCCUPANCY LAND USE ZONE �r BLDG TYPE FIRE ZONE 3 PLAN CHECK BV 1 1 HEAT : Bre
t. l t-fy elvel !ir.k, per Il I a wirkgA 3 b e+1roonl f3 bath ,garage
1 2+ 27 � J 35.000.
CCC, St92 �1498J.4Ai? _N€JGN_I_ N_Q._iT :--- AREA NOjfI2f34SZS_YAL.lJE --
BUILDING DEPARTMENT SET BACKS FRONT 22 REAR 74 LEFT SIDE d y RIGHT SIDE
Permit L42.00
0
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check LD.00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 17 IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCOROANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPL'�:ABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY DUSINFSS
State Tax 4.56 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING,
Total 156.5h
By
— -- -4APM ICANT OR AGENT
Approved
, Receipt No../' I.
ADDRESS ;Ni -
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor _
Permit No, O'7�?_2
" _ Rough-in
_ � Fixture
319 6 _ _ Final
4--,l HEATING
Contractor
�! ��� I ermit No.
), Gas or 0i1
A - C Rou tg"r) - - —i
- Final
e F SEWER ,B /—it-7
1-6
A— Final
6. DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
_ Sidewalk A.
Curb 6 Street Final
Approach !C t'V -*7
BLDG.FJEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
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