11625 SW HAZELWOOD LOOP a
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OF T IGIARD
OREGON '•' 1-:,.
Owner:.....8ob.. Smith..... . . .Pi•►•mitNn. 1130 . . 'r' • :
11525 SW Hazal6jid Loo
r F Building Address.............. _.. .... . .. ..... .......
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J _ I Certificate is hereby ,i%•(,n this.......11 ...day of.....February ...... 19....??. •
that said building nay be ocratited and
that it culnplies Nvith all requirements of _
the Auflding Code for the City of Tigard, ,
as approved by the Tigard City Council. `) �, ;
• Building lospector
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City of Tigord
INSPECTION REOUEST
for
4-1,Lut IL
I INSPECTION TIME :-j0— PERMIT NO. : --
DATE:
O. : _—DATE: 02- !� DATE ISSUED:—./ I
O W N t•.R S NAME . 910.0/ "5' -11 4< _--
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ADDRESS :
CONIRACTOR :
TEST: Air 0, Water [3 , Visual ( Laboratory p
RESULT: Approved Disapproved p Pending p
SKETCH:
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INSPECTOR DATE
N0TE Attach supplementol test data hereto)
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. : ___
DATE: DATE
OWNERS NAME .' si- .� -d --
ADDRESS :
CONTRACTOR :
i TEST. Air 0, Water p , Visual, Laboratory p
RESULT: Approved Diaappproved I7 Pending J s
SKETCH: }, >>���,f;�� r? /�cs/'fc�7os
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INSPECTOR DATE
[NOTE. At och emen'n test data hereto]
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UNIFIED SEVVIERAGE- A61A` CY NO,
WASHINGTON COUN I-Y DATE -10-13-76
---
CITY 0F--L1 9 a r
APPLICATION FOR SEWER CONNECTION PERMIT
Bob Smith
OWNER:
--
OWNER'S ADDRESS:
$TREET
CITY
STATE zlp
BUILDING SITE: I-OT-----.— L3LOCK ,--.----- ADDITION
'TAX LOT NO. TYPE OF OCCUPANCY
ADDPESS .
DWFLI-ING UNITS' FIXTURE UNITS
SURCHARGE IF
25, 00 U00. 00
PERMIT FEE - INSPECTION FEE TOTAL DEPOSITED
(NEW) (E X 16-1 1 N C-) BUILDING SFWFR SYSTFM
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'The Applicant agrees to comply with all rules erJ regulations of the Unified Sewerage Agency.
APPLICANT.
SEWER PERMIT
THIS PERMIT AUTH,)R'?ES CONNECTION 1-0 THE SEWER -JYSTFM.
LINE SIZE — INSTALLER -
RECEIVED BY. .....
(AGENCY OR ITS AGENTI
COMMENTS:
This Applic,-.ttion and permit expires in one hundred and twenty (120) days.
The amount paid will be forfeited should expiration occur.
Now
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APPIR0VED FOR CONSTRUCTION
CITY fir' 1 K�Ai7D
PERM; NU.// .3 Q SITE ADDRES:::-//Z2.,)_.
BY -
C- a--1
_ DATE
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,«:'^.^Y"r�,y.'!Y+1.w.w..nn,p�yy �u�.,,:.H�rny,yT�r —+-w•v�. rr..ka.z,ves^a�'C1n'n:M{�t�+b,?�++'y'�IAIA!!�nl,M�y�...
BUILDING PERMIT APPLICATION 1OF
1T TIGARD DATE 10-13A4- is "
\ THE UNDERSI(j ,D HEREBY APPLIES FOR APERMIT "OR THE WORK HEREIN INDICATED BUILDER PHONE _
OR AS SHOWN AND APPROVED IN THE .k000MPANYING PLANS AND SPECIFICATIONS. OWNER PHONE _
LOT NO.—�__
Ytr�l� a ms th 1162b U Fiays1woud Lo.:II:�
OWNER JIUB ADDRESS HOME ADDRESS _
ARCHITECT
�Elt7ll: ENGINErR
BUILDERCC--;11 ADDREfrS,S_ DESIGNER
STRUCTURE ONEW ❑REMODEL LIADDITION ❑REPAIR��--11 ❑RENEWAL ❑FIRE DAMAGE❑DEMOLITION
Q RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ORELIGIOl._I
US❑PATIO CAR PORI ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND [:]MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED C-SIGNS
)CCUPANCY--l—LAND USE ZONE Fi-�j _BLDG.TYPE----2-4F I FIE "LONE! PLAN CHECK BY' �` HEAT_ .
caret}t.. single Parni.ty dwelling w/a taLhed garage 3 bedroom 2 betki —_
1 1408 •
OCC.LOAD FLOOR LOAD ____ HEIGHT ,NO,STORIES______ AREA NO.BEDROOMS VALUE _.._
BUILDING DEPARTMENTSEI'BACKS FRONT 2u REAR 48 LEFT SIDE RIGHT SIDE b6J
Permit :L:.i �.010 —_�_.�----- --------— --- —_
1Uo� THis PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINEn IN THE BUILDING CODE, 70NING
.
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THF PLANS AND SPECIFICATIONS AND IN I;OMPLIANCE WITH
Subtotal ALA- APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DnFS NOT WAIVE
RESTRICTIVE CGVENANTS .C'NTRACTOR AND SUB CONTRACTORS TO HAIrE CURRENT CITY FUSINESS
State Tax 4*66 LICENSE. SEPARATE PERMIIS ACOUIRED FOR SEWER, PLUMBING AND HE/,PING.
Total _ 150*08
Flyr
------- - APPL.I�ANT OR AOL NI
Approved I Receipt No 1
ADOA555 — FI
DATE INSP• TYPE INSPECTION REMARKS PLUMBING DATE
/a-(�--76 < —_� _ Contractor
/c- - -- ,J
Permit No. (9 /o
Rou h-in --
Fixture
Final -- --—
HEATING
Co_n_ ctor _
-- --- --- Permit — $ J ` . :�
-- -- — — --' _ Gas or Oil "4"a
--- - ----- - rlough-in — - ---- --
_
Final _
— - ___-----—_—_—_�__.-- -- - -- --- SEWER - Ole_
Final
— -- ---_ DRIVEWAY _ 4 G
Final
Storm Drainage
- -- --- ..-- _ (Rain Drain) Final — ---
Sidewalk
Curb&Street Final
- — --------------
Approach i1G
BLDG DEPT.FINAL TEMPORARY CERTIFICATF OCCUPANCY Final -
7� CERTIFICATE OCCUPANCY
/ ( ( Landscaping
} Zoning Final
Ar'dr9 s Permit No.
Permit charge 77 c_') 62
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Owner ;:�-�:,.�� Connection fee
Paid by
Type of buildingDate connected _
Service rate AN Inspection fee
Contractor _ Paid by Date
Size of cunnection Assessmont. paid