11575 SW HAZELWOOD LOOP 11.575 SW HAZELWOOD LOOP
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BUILDING DEPARTMENT, TIGARD
PLUMBING PERMIT
}t 3�,,.IY� _ holder of a valid plumbing contractors license is Hereby '
authorir.d to cause p Ing ork as herein noted to he installed in accordance with the plumbing code of
Tigarc:, Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are reedy for inspection. Citi/ of Tigard Business License requirEd
for all contractors and sub-contractors.
Jeff'. -- dib _ �v
Owner_ >_ --1�4=--- ----.___— �.ddressl) � _� Gl IWG01?� —_11 Date - �4t�(
TYPE OF NUl.19cR OF r A ����_
PEnim r ITEMS FEE N
-- _ O EACH AM1UNT
- ---
Singla Family-1 bsth—each
2501 — —
D.�I�x�En h 1 bath unit --- �r
Adeitiunal bathrooms—each _V— 10 00 Y — s�f
Mobila Home Space—each
15_00 "• �},.
INDIVIDUAL FIXTURES C0f1MEFlCIIiI
1 to 50 Fixtures In 1 building—each '
3.00
51 to 100 Fixtures in 1 building-tach 2.50
101 to 200 Fixtures in 1 building—each
_ 2.00
201 or more Fixture; in 1 building—each — 1.50
M—IS 11ELLAIJE0US-
-ewer—each nr14Wona1 100 ft. —
_ �10.10 _
YJ r Service to bui►ding � $,00
r (S crit 1• ' L111 14
--- '
—--
[7P:EEMIT - UQ PorPlr�mbinglr.spectionPhone G33,';71
atre rj — Plumbing Contractor By
1.OTAl. – RECEIPT NO. Issued By 1
�W..N� ''\/ .� l,V S��/ !- ;\���I�.' ?'y\•�`�j. S S:�� ��, 4fQ',•,�� K4•: �`��i vi...
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UP
CITY OF TIGARDOREGON
i)«-ner•.....K. & W Homes P 1268
. ................... .... ........
I3itildin 11575 � � ......-....-...Permit No............... --......
Hr I
g Address.................. •W Hazelwood Loop Lot #97
.... ............ 4•
Certificate is hereby given :his of
s? i , 1.)......
} that said building may be occupied and
that it complies %vith all requirements of
t; the Building Code for the City of Tigard, 'I
as approved by the Tigard City Council.
> b ry
.............. LJ
Building Inspector f,
1
.A,, �
Iu.en m u,^•
City of Tigard
I NSFIECTI ON REQUEST
T
for
INSPECTION TIME: � M PERMIT NO. :
DATE ' - DATE ISSUED :— I
OWNERS NAME * _
ADDRESS Le
CONTRACTOR : � r tea►^.
FEST : Air p, Water[] , Visual 0 , Laboratory U
RESULT: Approved d
PP P',,, Disapproved L7�,- PendingA
SKETCH.
X44. ,4A.Ae
41
INSP TOR DATE
FYOTE Attach supplemental test data ber t.+ I
C
City of Tigard
INSPECTION REQUEST
fo ,
0-1
1- MSPECTION TIME: PERMIT
DATE : DATE ISSUED .—I Z
WNEPS NAME '
ADDRESS: 1-5 7S
ON TRACTOR Zo 9 _.----------
F ST '. Air 0, WotgrD , Visual El , Laborolwy
'ESULT: Approved Disapproved E7 Pending p
SKETCH.
YJr
1SPECTOR DATE
[OTE : Attach supplemental test data beret a]
UNll- lk D SEWERAGE AGENCY NO. - 11622 ---
WASH I NGTON CO(! NT`! DATE - 1-27-77
CITY O F T_i 9_a_L d____ -- -- -- ------
/APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Homes-- --- ----
OWNER'S ADDRESS: _---�— __.--___-- ----_--.
STREET
CITY STATE 71P
BUILDING SITE: LOT ___.-_._ BLOCK ADDITION
TAX LOT N0. _ __--____ _ FYPE OF OCCUPANCY resindF;nce
ADDRESS 1.1575 SW Hazelwood I_uvp
DWELLING UNITS --1 __. - FIXTURE UNITS _
SURCHARGE IF APPLICABLE-.__-_ - --- —
PERMIT FEE ._575_. ..-_ INSPECTION FEE .._25,4-01AL DEPOSITED r E'i�(�•
(NEW) (EXISTING) BUILDING SEWER SYSTEM
The Applicant a,arees to comply with all rules and regulations of the Unitied Sewerage Agency
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO T►!E SEWER SYSTEM.
LINE SIZE --._--- _-.- INSTALLER
RECEIVED BY _./.�'- _2t_e_?-c�__........_.__ - - ---
(AGENCY OR 17s,,A15ENT1 j
COMMENTS: Bldcq. #12611 (�
This Application arid permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expi ation occur.
.naw�:..:r+.+r_.. ,.,........w,,..,.......iv+•r..ampn<�.�,w...�.s........wwrn.r..r:.w..N...� +1�+ anrr:'�'q'^"mIf(^lw�." '.:rrw.:n+7�np�Ic!sar±ryA.
BUILDING PERMIT APPLiU`r%TION 11TTIGARD DATE— 1-27-7? afaJ—NAB
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE %A'r)RK HEREIN INDICATED BUILDERPHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
(/ LOT
OWNER /\ Al (d HOM" JOB ADDRESS11575 SW ('duzalwoud L WOME ADDRESS
ARCHITF_CT
ENGINEER
BUILDER _ IMBRIa.t _ ADDRESS _ —r)ESIGNER
STRUCTURE Q W ❑REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
CjAESIDFNCE ❑COMIII ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAR ❑FENCE
_ ❑BOND ❑MOVING ❑CONDI TIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED_ ❑SIGNS
OCCUPANCY_y__LAND USE ZONE R—t,BLDG.TYPE_ —FIRE ZONE 3 PLAN CHECK BY._ ! � _ HEAT t��UL'•
const. single Pemily dwelling w/alt.t ached yaraye b L edroom :3 U aC,_
aaracae i5;' k�clee�:lgnt 946 __ ---
NO.STO IES _2 RqL l2rrJ 3� `►i
BUILDING DEPARTMENTSET BACKS FRONT REAR 37 LEFT SIDE 12— RIGHT SIDE J
Permit 169 . 00 -- ---------__---------_=--.---
-- THIS PERMIT IS ISSUED SUBJECT TO THE REGULA"TIONS CONTAINED IN Thl BUILDING CODE, ZONING
Plan Check 84.50 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 1) IS HEREBY AGREED THAT THE
-- WORK WILL Br DONE IN.ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
— RESTRICTIVI COVENANTS. CONTRACTOR AND SUPS CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 7.60 LICENSE SE'ARAI'F PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total 26.1•10
By � � 1
ARICAN?OR AGENT
Approved Rect,q)f N)./_. 7 i I :. ,
ADDS—
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i
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
;
I ^ Permit No.
RouIh in
S ti *7 Fixture
61 Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
[Fn
l__
DRIVEWAY
l --
- m Drainage _
—A— n Drain) Final
walk
b$Street Fival
roachBLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCYCERTIFICATE OCCUPANCY ldscaping
ing Final
A
ADDRESS �/ �`>S �1 PER�II i NO. 1
-CZ-tial - L L/�))'f•- J� e
PERMIT CHARGE none
OWNER � i ( � '}<< CONNECTION FEE -1 J '
PAID BY = <<�
TYPE OF BUILDING _ y `1- _ _ DATE CONNECTED
SERVICE RATE %'{ IN
FEC -)-5
-
; ONTRACTOR PAID BY DATE
SIZE OF CONNECTION r ASSESSMENT PAID --
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