11495 SW HAZELWOOD LOOP SW HAZELW-k)D .-.,OOP
i
I
I
City of Tigard
INSPECTION BEQUEST'
for
tPECTION TIME. /? � 1'�. PERMIT NO. -. —.—.
DATE : 11 DATE: ISSUED .___LL_. I
NN E RS NAME :
ADDRESS:
)NTRACTOR
ST . Air 0, Water El , `visual [] , Laboratory I] i
VSU!_T: Approved Disapproved C , Pending C
(ETCH: i
I
I
I
IN . E&0R DATE I
tE Attach supplemental test data beretaa I
1
UMIFIED SEWERAGE AGENCY NO. ----L15�2
WASHINGTON COUNTY DATE
CI-ry OF Tigard
APPLICATION FOR SEWER CONNECTION PERMIT
"WNE R: 910oxXxIAM) Boyd Thornton
OV,,'NER'S ADDRESS: STREET
C!C!ry ZIP
BLIILD!t'qG SITE: LOT-..93 -__ BLOCK ADDITION
TAX LOT NO. TYPi- OF OCCUPANCY ____ residence
ADDRESS . Loop
DWELLING UNITS FIXTURE UNITS
SURCHARGE IF APPLICABLE
575. 600,,
PERMIT FEE -- INSPECTION FEE TOTAL DEPOSITED --
(NEW (EXISTING) BUILDING SEWER SYSTEM --r,&nnjL-r-r-"k--
The Applicant agrees to comply with all rules and regulation, of the Unified Sewerage Agency.
APPLICANTA41�
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION 1-0 THE SEWER SYSTEM.
LINE SIZE INSTALLER
RECEIVED BY-..- (AGENCY 0 R 17,5AGENT) *<
COMM E NTS:0j_dg.f---f1 33 5
This Application and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.
_...,..rhw+w•.r�w. - P �mr+r^ �,�..r;1�p-werlK-rN'.".+w •,-.w tY�.:.
BUILDING PERMIT APPLICATION CIT TIGARD DATE 3-8 77OF
_
THE UNCEPSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUII�DL:RPHONE
OR AS SHOWN AND APPROVED IN ?HE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
Ha Toortiton LOT NO..-���..
OWMErT _ JOB ADDRESS �_— HOME ADDRESS
ARCHITECT
ENGINEER.
BUILD 'R "I i M a ADDRESS DESIGNER
STRUCTURE _ NEW _ 0REMODEL_ _ ❑ADDITION ❑REPAIRrr--11 _❑_RENEWAL ❑1"RED/'_,Ar_c- ❑DEMOLITION
('� RESIDENCE ❑COMM ❑EDUCATIONAL L_IGOV'T ❑RE.1_IGiCUSL PAT-cT LICAR PORT—❑GARAGE LI STOFAGE❑SLAB ❑FENCE
' A L_IbONU ❑MOV'NG ❑CONCITIONAL USE —❑DESIGN REVIEW ❑COUNCIL APPROVED ❑,IGNS
OCCUPANCY-I--LAND USE 2UNt_ _ ! BLDG.TYPE FIRE ZONE_ PLAN CHECK BY_ HEAT _
I tadtoMuilt
4SS�L4AR—_
__ HEIGHT ---I1I0.ST0RIES 2 ARBA-1246 N9 ILE_ EUQM$—:- lUE nou•
BUILDING DEPARTMENT SET BACKS FRONT REAR 60 LEFT SIDE E d t `"r RIGHT SIDt
Permit �•na s —�
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDYNG COC'E, ZONING
Plaal Check n.00� REGULATIONS AND ALL. APPLICABLE. CODES AND ORDINANCES, AND IT IS HEREBY AOREE.D THAT THE
-- WORK rVILL BE DONE IN ACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE.WITH
Sub-wtal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PFRMIT DOFS NOT WAIVE
— RESTRICTIVE COVENANTS, CONTRACTOR AND SUR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 'y 56 LICENSE, SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total I r.
BY _
APPI I ANT OR AC,ENT
Approved >tw Receipt No
.....�,...µcy:,,.�,us.rw..... , ...,.,..www...w..uw :...�_..r. ..:..,a,...,. ., .. ,., .. .. ..,,, ,.,.....,........... ..._,.......:,.e..d.y:a..w...,.. .., . ...-..
FWAIWAM
PLUMBING DATE
OATE INSP. TYPE 11.5PECTION REMARKS
Contracto,
Permit No.
Zj/
Rough-in
AL 1.0i
F:XtLire
Final
HIEATING
J,k
Contractor
.,) 3 liv 5-- 1-"7
Permit Nom—_! l9
Gas or Oil
R h-in
Final
SEWER
Fmal---
DRIVEWAY
Final
§IoLim Orainaue---.-
(Rain Drain) Final
Si Jewal-k
Curb &Street Final
A roach
BLDG DEPT' FINAL TEMPURA6Y CERTIFICATE OCCUPANCY Final
CE9TIFICATE 01:(,I1PA NCV
Landsupinq
Zoning F trial
�4 * �1
(0QV0M000ag
W00000coloo
W ,!i M 6' M Cv M C^ u7 O M
O
LL CV N
w
J UJ
S N F-
E N n
CL
VJ LL
LL -
U
CD CL
�n a :: .l Q
w = J o U c, `
.1' w o o > o a �a v QQ 4)
to O j N ^
LJ U F ~ 1
Q
A.j_ C CC
W x
L` O- Z C u n cn
LL (n L+ W > `r
�- O v E u
!- c c E E J7 cn p
Q O ZQ N mQQw > > TC. UO cc
u
O t�
O t
a
0o0000Cl0C) c� a
C;f tj w 0 0 0 O o Q C'? f_7 LC) 0 O Cr I
C.a a ` M v ri -a v .vlv v r--: O gill r
7
O
LL
14) w r U
a O z 4 w
cr �-
"� ❑ ° Q
cr
a 4 U w
w I
p t
v w (u
n ,r
i A 0 E 0 o c o a n :iU
O
'id O m C_� ~ ,O O v: (n 0.' C7 U7 O �
iO Q O ...1O C TJ N ` O � Z �� .• b O N W
>
C v J7
,j..1 (Z w , M c 7 h O , F-
� —4 C Z C O N U ` lL — �. N N ` N W m /� d
w O p S 2 , O v a3, 2 ro ~ c 6 .O ya 6 d CL W •
0 a S (L LLZ Z LL "C (r m m (� m I J Q c
i
�r
r
1
Address Permit No.
Permit charge 22C.)12
t2—
Owner � � �„� Connection fee _ S _
Paid by ,.
Type of building Date connected _
Service rate � '� Inspection fee
Contractor Paid by _ rlate
Size of connection Assessment Paid