12210 SW MAIN STREET 1 22J0 MAll
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City of Tigard
INSPECTION REQUEST'
for
INSPECTION TIME : PERMIT NO. : —
DATE:
O. : _DATE: / ►'/ LL DATE ISSUED:___Z
OWNERS NAME : U V _
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ADDRESS : _ 'y -S%-
CONTRACTOR :- 2� -t_ `�7ev—S-
TEST. Air D, Water ❑ , VisulaXl Laboratory ❑
RFGULT: Approved Disapproved ❑ Pending 0
SKETCH: .0/)
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INSPECTOR DATE
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City of Tigard
INSPECTION REQUEST
for
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INSPECTION TIME. PERMIT NO. :
DATE: K /IY/257 DAT ISSUED : _L_L_ i
OWNERS NAME : ``AA��,,,, S, S,
ADDRESS: L"1[rN _
CONTRACTOR :
TEST . Air ❑, Wnter❑ , Visuolx, Laboratory p
RESULT' AoDrfaved Disapproved r1 Pending p
SKETCH:
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INSPECTOP DATE
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APPLICATION — STREET IMPROVEMENVEXCAVATION COPY TO:
H
(WHITE)-FILE
ORDINANCE NO. 74-14 H (BLUE) INSP.
(INSTRUCTIONS ON SEPARATE SHEET) [i (YELLOW) -OTHE't AGENCY
4K) - APPLICANT
APPROVED ❑ APPLICATION NO.:
NOT APPROVED ❑ CITY O 'IIGARU, OREGON FEE AM–.: S_—
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO,:
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT 9Y DATE—_ I I
PENDING AGENCY "OK" ❑ Application and Progrcas Record – – –
ANCE
PENDING, INFORMATION
FOR STREET IMPROVEMENT/EXCAVATION MAI AS REQU REDOND
ANNUAL ri
PENDING VAF2IANCE _ ❑ EXPIRATION DATE':
PERM':T NU.: ... DATE ISSUED: __----1--_LBY: —
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INS FALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICAN F
NAME— � '----_TADDRESS CITY PHONE
CONTRACTOt'__—___
__� --- --_—_ --- ---- _-�_T ----- — —__
NAN:7 ADDRESS CITU -PHONE
PLANS BY
NAME -- ADDRESS "-�--- -- ---- CITY -- ---- ---'---PHONE �-
LSTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ _
DOLLARS
(2) EXCAVATION DATA: FOR OFFICE USEi CIMIN._ o oz x S �—
STREET DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CU'r CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE By
TYPE LENGTH WIDTH DEPTH ITEM A QUANTITY
STREET
–~–-- – P
_ – — INSP C-
R TION
Q
ESTIMATED STREET OPENING DATE:– / / E
3
ES-rw^TED STREET CLOSING DATE:_ / / �E _
_ $ �W
(3) SECURITY N . —_` SECURITY AMT: CLOSED
C'
SURETY CO.: FINAL
_ CERTIFIED CHECK C7CASH_0 MOND' IN$PEC.
(4) PLOT PLAN INDICATE SITE PERTINENT PHYSICAL y SPECIAL PROVISIONS/CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
t '
CURE) � . — - - � — - — - — —
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(5) NOTE THE CITY OF TIGARD DOES NOT, 4ERE13Y, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR 'rFiE STATE OF OREGON.
rHE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO CnMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
APPLICANTS SIGNATURE: DATE
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City of Tigard I
INSPECTION REQUEST
fr
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OPECTION TIME: PE!:*AIT NO. :--,-
DATE :
O. :DATE : ! I !s_ ()ATE ISSUED :--I--/--- ( �,
?W N E RS NAME : C0 -
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ADDRESS: a-L' �_
;ONTRACTOR : k&XA✓�' _ ' =� .. 4. _�- i
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I-EST : Air ❑, Water[] Visual, L.ahoratory p I
3ESULT: Approve Disapproved ❑ Pending p
KETCH: I
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INSPECTOR DATE
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Ity of
INSPEECTION REQI,,.
for
INSPECTION TIME : PERIV-T
LD A T E
�.e/ 75 DATE
OWNERS 14AME .*
ADDRESS :
k A V
TV.RT* AirO, Water Visual La�nrnlo
RIF5ULT: Apc roved [Asapproysd rl
SKETCM: 4 - t--7 S
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UNIFIED SEWERAGE AGENCY NO. -- 501.2
WASHINGTON COUNTY DATE _ 10-15-74
CITY OF --. -. Tigard_
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APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: U. S. Post Office
OWNER'S ADDRESS: -------_-
STREET
97223
CITY STATE 11P
BUILDING SITE: LOT_ -__ _-__ BLOCK . - ____------.___ ADDITION
TAX LOT NO. - - _ TYPE OF OCCUPANCY _ Post office
ADDRESS - - __ _12210_ S-.W. Main Street
DWELLING UNITS-- - _._ - _____ FIXTURE UNITS
SURCHARGE IF APPLICABLE ---____--- ._.__ __
PERM-T FEE ___2625 - INSPECTION FEE50 ____. TOTAL DEPOSITED ___2675_____ _
(NII- (EXISTING) BUILDING SEWER SYSTEM -_ - Fenno Creek
The Applicant agrees to Comply with all rules and regulations of the Unified Sewerage Agency.
'
APPLICANTI!__�J._-� .- ��
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE __ -_ - INSTALLER
RECEIVED BY--
(AG CY OR ITS AGEN
COMMENTS: - i � tQ'L'r►, �� c c. c�. Z- -7
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
September 1974
Sewer pernit has not been paid for. . . . . . . . . . . . Do not final. . . . . . . . .
41
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : i PERMIT NO. . _,._.._.._
f DATE: /7 4 DATE ISSUED:
OWNERS NAME :
1
ADDRESS : P12, �
I CONTRACTOR :
ITEST: Air ❑ , Wa'rer ❑ Vietin Laboratory p
RESULT: approved � bisapprovcd C1 pending, j
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CNOTE Attach Supplemental test data heret]
A L)wF5,5 0 PERmiT NO.
PF1111IT CHARGE none
OUNER CONNECTION FEE
PAID BY
TYPE OF BUILDING DATE CONNECTED 7
SERVICE RATE INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT PAID
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ciTr OF 6-7 N° 0047
BUILDING PERMIT APPLICATION TIG ARD DATE- _ -: 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE —.--
OWNER- Ue So Government Post puff 6 ----__—_--- S � ' BUILDER PHONE
lock & Son Const, ENGINEER
BUILRAR.QHITgCT DESIGNER
S ��JJ((TRUCTURE — I�JNEW —❑_ REMODEL ❑ r t ADDITION L 1REPAIR — ❑RENEWAL — ❑FIRE DAMAGE [:]DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL []GOV'T ❑RELIGIOUSOPATIO ❑CARPORT ❑GARAGE EISTORAGE❑SLAB []FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY—LAND.. _ USE ZONE -_BLDG,TYPE ..FIRE ZONE_ PLAN CHECK BY _ _ HEAT- _
C,ongtruct, Fast ofrica G ull.ding AMINI !: „ccurdiri�4 —
01ane on File ---
_ —.— -- ODncratO -----r
Q(:C LOAU FLOOR LOAD HEIGHT _ NO.STORIES_-1 AREA VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LE:F',"SIUE HIGHT SIDE
Permit
-- —"'— THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-�---- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-- RESTRICTIVE COVENANTS. CONTRACIJR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1I State LICENSE. SEPARATF PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total
By -- ---_ ---- - --
- --- APPLICANT OR AGENT
Approved Receipt No,
ADDRESS PHONE �� -
�[ ■lar awr a. wlr m
Ap
DATE
INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor111111
-/V Permit No.
Rou h in
— Fixture
— —— --- ---- --- Final —
HEATING
Contrpctor
_— —� — Permit No.
Gas or Oil
_ Rough-in
— _ Final _
_— SEWER
_--
Final _
—DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk IRON 57;/-1 �.C.
Curb&Street Final °�
!L__
A roach _ �►. �r c ,�
9LOf,.DEPT. FIrJ+L TEMPORARY CERTIFICATE OCCUPANCY — -
CERTIFICATE OCCUPANCY Final _
11 Landscaping
Zoning Final
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Address f / �I/• 7J,a Lyt, Permit No.
Name of Occupants Y'' Permit charge
Connection fee
--- — Paid
Date connected
Type of Building c�-tom a Iaapection f"-
Service Rats .;S, 0 D Paid by
Cc ntractor�yZ � art ta-c,a B.. Aeee�ement__ Paid
Size of connection $4
ilawKwr,
Address---- �_1' L —.1�� (!)�j Permit No.
Name of Occupant—ef
Permit charge
Cis Je4
Pa"d by_
Date connected
Typr, of Building Cij,
Inspection fee
Seivice Rate—, i Paid by
Contractor Assessment —Paid
Size of connection-