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INSPECTION NOTICE
City of Tigard Building Depar.ment
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
A'f
Type of Inspection M -- —
Date Requested -7
Time A.M. P.M.
Address
Permit 4z_
Owner Lot
Builder
The following Building Code deficiencies are required to be corrected:
Presented to Approveii
Inspector Disapproved
Date
CALL FOR RFINSPECTION
YES 4'NO
SEWER PERMIT _
f -7h
Unified Sewerage,4g
ancy �2 .h
of Washington County ��CIT--Y OF —Apd- DATE
OWNER: pa"12, %A PHONE : 6140 '.258(
OWNER 'S ADDRESS: .� }32542, :QQ�u•Q�
TYPE OF INSTALLATION:
0 SIDE SEWER ❑
LINE. TAP AND SIDE SEWER ❑ LINE TAP
T((((YPE OF OCCUPANCY:
❑ NEW ❑ EXISTIN13 VSINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR Tn 7-1-'70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS___4�f4m__
ADDRESS OF STRUCTURE : A&e__ —
Permit Conditions: The applicant a4lrees to comoly with all rules and regulations of the Unified Sewerage Agency.
When calling for inspection, please refer to the Permit Number. The Application expires in one hundred twenty ('120)
days. The amount paid will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer Is not located at
the measurement given, the Installer shall prospect three feet in all cirectlons from the distance and depth given.
If not so located, the Install:, shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency
will Install a lateral at the location specified by the installer.
I
FEES: �•-
PERMIT FEE $ •
CONNECTION CHARGE �Ob•
LINE TAP INSTALI ATJON
ISSUED BY
OTHER --
TOTAL s -3 3V
APPLICANT _ DATE
SEvVER PERMIT
ADDRESS OF STRUCTURE `�s "L��C 10%W
TAX MAP MAP _.� TAX LOT —��Z^- _ SYSTEM _ MND_�_�_ _
LOT BLOCK --- OF
APPROVED BY DAT-F"
_ ISSUED BY DATE
KN, • <-. A^# sr 7 Q �7wd__— REMARKSD. U. 'S
AP
I C{( Y I I G A R U
DATE 14
BUILDING PERMIT APPI_ICA I iC�N OF
THE UNDERSIGNED HEPEB'y APPLIES FOR APERMIT FOR THE WORK HEREIN INi11GATED SUILDERPHC,N/
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNERPHOr+f ��•�/
LOT NO_.�. ,. ...
'-" '-'•" - ARCMITEGT
ENGINEER
BUIi_DCRu� _��
STRUCTURE _KNEW �FlIMf7DEl 77 QAODITION �REPAIR_..._ .__RENEWAL._____ []FIRE DAMAGE ^iltl`
ttESIDEN COMM CIEDUCATIONAL C]GOV'T _RELIGIOUSOPATIO [3CARPORT ❑GARAGE TOSTORAGE_` U
L7r.Gt PANCr ^' I A" ��� PLOG TrpE.. ..�• „FIRE XONF. P PLAN CHECK By �.J�./ .µ HEA`
__ sir_ w
adasi vt A 1043ei 04
wl ► `�-Qom. • _._ ___.__ ._�__ _ _ _ ________ _
SEWER . PERMIT
UCC LOAD FIOOF.LC.'D HEIGHT--_._._ . . N�. �TgR1E5 NO RrDROCV15- ._V?:wli
9UiL01":.j1)EPAHTI.IEI,I BACKS FRONT FlEAR LEFT SIDE ^ RIGHT SIDE
Permit Jbh r
-0._- iS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE iiilvl
(P-1A ChrCk .. "tiI.ATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 'T 15 HEREBY AGREED 1!if.' Ii
- .IK WILL SE _ONE IN ACLuRUANCE WITH THE PL NNS AND SPECIFICATIONS AND IN CONIPLI G,Ni r
Spy-total APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PEHYIT !)UES Nf)) ti
_.--. -- ;RICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY pii
gale Tax ��0 14SE. SEPARATE PERMITS REOLlIRED iOR SEWER, PLUMBING AND HEATING
Total /� (� —
#
CIA AGENT
t"f,l No
L _ - -
SDC
,rWER ; 0NNt.ET10N_$ _�
SEWER INSPECTION
SEWER_SURCHARGE
Comment8: _ __ --_--
1.'TTIGAR� DATE_
-1/30
BUILDING PRI MIT APPLICATION of
THE UNDERSIG„ a I0-RE BY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE ---- _
LOT NO.�. ---
Pta'tw ,�kfl" sc; '.,i�` 0 SW i�!C:gpf�c lt.$ fit .
OWNER JOB ADDRESS HOME ADDRESS
— ARCHITECT
LICIt L!I?<� ENGINEER
BUILDER ADDRESS DESIGNER_
STRUCTURE ❑_NEW ❑RI MODEL. [I ADDITION ❑REPAIR
rr t� (–]RENEWAL ❑FIRE DAMAGE _ ❑UFMOLITION
❑ RESIDENCE [:)COMM ❑EDUCATIONAL ❑GOV'T ❑RELI(;IOUS❑PATIO L_.1CARPORT^ ❑GARAGE ❑STORAGE❑SL_AB ❑FENCE
❑BOND ❑MOVING ❑GOND IONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY---LAND USE ZONE _BLDG.TYPE------FIRE ZONE— PLAN CHErK BY- HEAT_,
`.,tuckpilu upproved2W.1 sUL111C yerc - fill (jr1, 1:.. -parwa0 i,t�4 .3 11
+,J ue n vnypit,Msrw(i Pill ,)j prl:)Vr1c7e a aszilt,, report & irivst iciati�;._ r._.
p;,:z-r t �, Ar►y c-01115i:.!.'uCtson, __ _----
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Peri( !— ,�.�.{�•[)I:p =---.
THIS PERMIT IS ISSUED SURJFC-f TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT TkIF
--- - 1N014K WILL BE DONE IN ACCORDANCE WITH THE PLANE AND SPECIFICATIONS AND IN COMPLIANCE.WITH
Subtotal ALL. AVPLICABI_E CODES AND ORDINANCES. THE lc-ZUANC:E OF THIS PERMIT DOES NOT WAIVE
-- — RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTOriS TO HAVE CURRENT CITY BUS NESS
State Tax • LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMLING AND HEATING.
Total •rd
By�
App,oved Receipt No
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