11515 SW HAZELWOOD LOOP �✓ Li -
- ► 11515 SW HAZELWOOD LOOP
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Address Permit Flo.
Permit charge C?Z7 tf-
Owner �_� � '`�° Connection fee
Paid by -,f�c.�"
Type of bu.ildiiio _�r_{ � Dete connocted
Service rate �% ��' Inspectinn fee
Contractor oaid by _ date
Sire of connection Assessment ___ �� �Paid ^
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City �of Tigard
INSPECTION REOU ST
for
INSPECTION TIME : ��. PERMIT NO. :
DATE: (, LIZZ1 D14TE ISSUED:_...LL_
OWNERS NAME ' V C I - 'ZC��.�.�
ADDRESS : -�
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CONTRACTOR :_
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'FEST. Air [1, Water E) , Visual O , Laboratory []
RESULT: Ap7 )voved Disapproved l-J Pending r)
SKETCH:
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I IN PECTOR DATE
INOTE : Attach supplspinntol test do3te hsrst�
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SEWER PERMIT 196-7
if N? 1.2134
Unified Sewerage Agency
of Washington County CITY OF_ TigA:d _ DATE _-�19 77
OWNER, E h C Builders PHONE :
OWNER 'S ADDRESS: 11515 S.W. Hazelwood Loop
TYPE OF INSTALLATION?
❑BUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
O NEW [X] SINGLE FAMILY ❑ COMMERCIAL
❑EXIST . (PRIOR TO 7-- 1-70 ) bil xrxu-KxxFxfx!x• ❑ INDUSTRIAL
FIXTURE UNITS _ DWELLING UNIfS __L
PERMIT CONDITIONS: THE APPLICANT AGREES TO :OMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FCR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS. THE AMOUNT P1ID WILL_
BE FORFEITED SHOULD EXPIPATION OCCUR.
FEES:
PERMTT FEE g 575. 00
CONNECTION CHARGE
SIDF SEWER INSTALLATION
ISSUE=D BY
OTHER Insp. 25. 00
TOTACL. 6000 /
^— `
�µc ��`�1 — i r�1- �C7
APPLICANT —DATE
SEWER PERMIT N? 12134
ADDRESS OF STRUCTURE 11515 5.W,1i�LzelMopd Logo
TAX MAP TAX LOT_ SYSTEM _,If yard
LOT BLOCK OF
APPROVED BY DATE ISSUED BY, DATE
REMARKS— _ _ _
-. r�+�w+++�.ar:.M,.�„Y..,,,.,.,.,�.+n..vow.-..,e.+,.,,,.�....,,...�,.�T�r+�w,�-MA••nn
C
BUILDING PERMIT APPLICATION OF OF DATE a-le—T7
1407
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR Tllt WORD. HEREIN INDICATED BUILDER PHONF_ _
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNERPHONF
L tit C d1ri 1d61T1> 11:315 Se Lle ftzcolwood Loop LOT NO. - _--
OWNLR Herber 1 ,10B ADDRESS 140ME ADDRESS
ARCHITECT --
BUILDER 1-ar!)of ADDRESS ENGINEEP
-.--DESIGNER
STRUCTURE ANEW ❑RCMODEL ❑ADDITION ❑REPAIR _C_1FENE_WAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE- ❑COMM [:]EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPOR-T ❑GARAGE -❑STORAGE❑SLAB ❑FENCE
—❑BCNU ❑MOVING_ ❑CONDITIONAL_ USE ❑DESIGN REVIEW 1-1COUNCIL APPROVED ❑SIGNS -�
OCCUPANCY-!-.- USE ZONE BLDG.TYPE :A FIRE ZONE 2- PLAN CHECK B','_._L
'Artylu Family OwellAnj; W/Attechwd Garages — 4 Hedrnam 3 1lath ----
_—
Garage 506 Basement 1610 — -----
FL.90F3-1.QAD HEIGHT 20 N0,-U-QR-'ES 2 gREA--1_"'{�IbA"aQ MS VALUE 6-il0
BUILDING DEPARTME14T SET BACKS FRONT 250 REAR321-5" LEFT SIDE 171 RIGHT SIDE C �—
Permit 1178.00 —`— —THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE- BUILDING CODr ZONING
Plan Check 89000 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS EFFIFBY AGREEU THAT THE
WORK WILL BE DCINE IN ACCORDANCE WITH THE PLANS AND SPECIFICATI1-;NS AND IN COMPLIANCE W1 H
Sub-total ALI. APPLICABLE CODES AND ORDINANCES. THE ISSUANCE. OF T0+ PERMIT DOGS NOf WAIVE
Vic, RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
Sw Tax 8.01 LICENSE. SFPAnATF PERMITS REQUIRED FOR SEWER, PLUMBING AND HE \TING
Total
By
`. AMM�ICHNT OR AGENT -
Approved �1 Receipt No � 1 '
DATE If4SP.1 TYPE INSPECTION REMARKS PLUMBING
DATE
,v- — Contractor —
'cmc t' Permit No.
Rou h-in
LA 4 b•Q
Fixture
-77 -
Final
HEATING
Contractor
-- _ Permit No.
—_ Gas or Oil
-- M�
Rough-in
— - Final
---- — — SEWER
--- Final
DRIVEWAY
Final
---- Sturm Drainage
(Rain Drain) Final
------- Sidewalk
— Curb&Street Final
BLDG DEPT.FINAL —ERTIFICATE OCCUPANCY Approach
TEMPORARY C '--
CERTIFICATE OCCUPANCY Final
Landscaping
,� � ( Zoning Final
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