11460 SW HAZELWOOD LOOP 11460 SW HA.ZELWOOD LOOP
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City of Tigard
INSPECTION REOUEST
for
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INSPECTION TIME : PERMIT NO. : .
QATiE: 1 "'6 DATE. ISSUED:--11.-
1 OWNERS NAME :
ADDRESS .
I CONTRACTOR :._ ---_-._-- _--
TFST. Air O, Water �Z , Vist�a[)6 , Laboratory []
RESULT: Approved t Disapproved ❑ , Pending 0
SKETCh.
SP CTOR - DATE
COTE Attach supplemental test datu hereto]
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City of Tigard
I
1
NSPECTION RECUEST
for
I INSPECTION TIME : r O `�
.s�.� PERMIT!�!!T N U. ,. _.._
DATE: -1 P31 7G DATE I SS J E D:---j
OWNERS NAME : —
ADDRESS :
AME : _ADDRESS : �/, •r �'«d . !"
DONTRACTOR : - -
TEST: Air C , ownier 2S , Visual 3' , Laboroto•y C
RESULT: Approvad � , 'i3!3;proved C PenJing C
I SXETCH'
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INSPEC f0R DATE
! COTE: Attach fuppiemental tee' data here#—
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BUILDING PERMIT APPLICATION' IIT TIG ARDDATE'`u•ust 30' 19'76OF
{� THE UNDERSIGNED HERELY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED PIA I,L�R PHONK 777
OR AS SHOWN AND APPROVED IN 'FOE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PI —
LOT NO.
OWNER /i- ;,IBI�•I1 _ JOE)ADDRESS 11460 SLI Hazelwood HoopDORESS
.�. ARCHiTF_CT - - —�
°iAlTf(d ENGINEER
eUILOLR ADDRESS _ DESIGNER
STRUCTURE t3NEW — []REMO!"rL ❑ADDITION ❑-1REPAIRt---tt DRENE'NAL ❑FIRE DAMAGE []DEMOLITION
L_JRESIDENCE ❑COMM []EDUCA-'IOPI..L []GCV'T 0RELIGIOUS OPAl-10 IJCAF.POFT ❑GARAGE Cl STORAGE[]SLAB ❑FENCE
❑BOND C3M(`VING I iNDITIONAL USF ODE5IGN REVIEW DCOUNCIL APPROVED ❑SIGNS
—
OCCUPANCYLAND USE,'.UNE _BLDG.TYPE_ FIRE ZOiyt—_ _ PLAN CHECK BY _-- — HEAT—,_—J--
.r,:tetruct ams single family t1welliny 2 staary ubsttsc►tev gu rago !—
--- — d badronrq/3bath ----- --- �--.—_. ------- --
- --- -
641, 000
OCC. LOAD —__--E-,OOR LOAD ----HEIGHT .— ---- NO.STORIES— -_-__--. .H.flA— NOB1QMS
----
BUILDING DEPARTMENT 201 2Ll+ 304 100
_. SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE —
Permit 9€lEi(3•L�i.7 -- ---__._
— eQ� THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS C6rvTAINED IN THE BUILDING CODE ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HFREBv AGREED TI'4T THE
WORK WILL BE DONF IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE CUJL•S AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTHACTOR ANI; SUB CONTRACT,JFIS TO HAVE CURRENT CITY BUSINESS
State Tax $410 I LICENSE. SEPARATC PERMITS REOUIRED FLIP SEb4ER, PLUMBING AND HEATING.
Total ;1��J•��
By E.TL'
AL14�ANT 00 AGENTApproved Recpipt NoADDRESS - PHONE
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AIP RO "D FOR' CONSTRUCTION
OF TICARU
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erITLE _ - - —�ATE .
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UNIT- IID SEWERAGE AGENCY NO
VVIV131A I NGTON COUNTY DATE
APPI_.ICA TION 1-011 S[_WER Co NL-CTION PLRMIT
OWi.ER: .__.Hnh_Smi�b
OWNERS ADDRESS: -__ - ZIP
CITY 1ek0—P4—_----.---------
BUILDING SITE: LUT BLOCK
','7 D I T I U N E_.n�_----AX LOT NO. --_---
_ TYPE OF OCCUPANCY ,-ing
1
C 1.14-6�_ ,S+l��?e_l.wgod _tool) _
ADDRESS
DWELLING UNITS -_-L_.--- - ----
_ FIXTURE UNITS ------
SURCHARGE IF APPLICABLE -- rJ A _
PERMIT FEE -"5..? ,QD --- INSPECTION FEE 1.;25.D0T0TAL DEPOSITED .-69S1�Ilfl.-----
INEW) (EXISTING) BUILDING SEWER SYSTEM ____.---_— -- - — -- -
The Applicant agrees to comply with all rules arid regulations of the Unified Sewerage Agency.
�iAPPLICANT__._. -- -
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINL >I.-c __-._. .._____ INSTAL'_ER
RECEIVED SY 1gGENry OR 17S AOENt)
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will he forfeited should expiration occur.
PERMIT Ct4ARGE none
OWNER CONNECTION FEE cl
PAID BY ------
TYPE OF BUILDING DATE C014NECTED
SERVICE RATE INSPECTION FEE
I,UNTRACrOR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT . PAID
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