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11870 SW LINCOLN AVENUE N 1� 6. ADDRESS: 1. 5. h LA:& 1� I:vccords\microfilm\targets\building.doc r �ar�id.uta��k�y�S 1 1� y, f?..'ITS G� 4. � ��..•��' y.. 1. ' r City or Tigard Buildlog p srtne t 13125 BW Nall B1.vd. Tigard, Jr6gon 97223 Inspection Line (Rec-O-Phone): 639-41.7:i Susinese Phone: 639-4171 Inspect;.,ns Y � Pontin __.._ y Plbg. Underelab M h. Rough-in Appr/Sdwlk P,,und. P1119. Top Out. Gas Line Poet/Beam Struct• San. Sewer !coming -Bldg. - Foet/Beam Hoch. Rein Drain/ Insulation Plbg. Linda'-floor cater Lina / gyp. Bd. -Mach. - rate Requested: le)/2 �p Time: AM PM Address: l ---�a Pec•mit f/�T Builder: THE FOLLOWING CORRECTIONS ARE REQUIRED: a I / -------------- Ins tor:_ APPROVRD DISAPpq��pgp --- AppROVRD SUBJECT TO ABOVE Call For Reinep. 1 1 INSPECTION NOTICE City of Tigard Building Department 13125 UK Ball Blvd. Tigard, Oregon 97223 Inspection a (Rec-O-Phone): 639-4175 Busines Phone: 639-4171 s ' t, Inspection:. AFooting Plbg. Underelab Mech. Rough�J,I_., Appr/Sdwlk .: r Found. Plbg. Top Out Gau_yir+w FINAL: Post/Bean Struct. San. Sewer ._ / -Bldg. �.. Post/Beam Mech. Rain Drain ( Insulation Plumb. ' Plbg. Underfloor Winter ne / Gyp. Bd. -Mech. Date Requested: L _Time: Lj___AM PM + }duh Addreee: 1 CCS Permit }pt V k� iF� rr'y ` Builder:_ THS FOLLOW".NG CORRECT ONS ARE REQUIRED: 1 k I '1 1 I I Inspector: //APPWMD DISAPPROVED APPROVED SUBJECT 4'0 ABOVE Call For Reinep. L u c INSPECTION NOTICE City of Tigard Building Department 13125 SK Ball Blvd. Tigard, Oregon 97223 Inepection Line (Rec-O-Phone)s G39-4175 Bueinene Phone: 639-4 11 Inspect inn:__- -_-- Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk O Found. Plbg. Top Out Gas Line FINALS Pont/Beam Struct. San. ewer Framing -Bldg. - Poot/Beam Mach. Rain Drain lIation -Plumb. Plbg. Underfloor Water Lino G• Bd. -yech. Date Reyuent`e>ds +�- Times _ AMPM Addrenn: ��a �U � 1 .s � _� a Permlt fs 5� '"O2! ems/ eA Butldar:� b� THE FOLLOWING CORRECTIONS; ARE RE UIRED: Pio 3.za yw v JI J vY i q t. t\ Yt -` ?w: J r' Inepectir: _�..� -- Dates a � r� APPROVED DISAPPROVED APPROVEb 8UW8CT TO ABOVR Call. For Reinep. Y a° t , � lf'1rxkst>tr� iH;rif ':r't.,..r, L__ INSPECTIOii NOTICE �7^ City of Tigard Building Department ` ��• 13125 SW Ball Blvd. Tigard, Oregon 97223 Inspection Linc. (Rec-O-Phone): 639-4175 Bunineas Phone: 639-4171 Inspections Footing nlbg. Underslab �;sch. Rc,,jh-in Appr/Sdwlk - Found. �Plbq. -Top G+t G4ta Line FINAL: Pont/Ream Struc San. Sewer �- Framing Bldg. Poet/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mech. Date Requested:_ /� —Time: y--AM __�PM Addraees_ - 7,,/ 7�(J — f S/ e'// Builder:--2j71a 3 THE FOLLOWING CORRECTIONS ARE REQUIRE6, Inspector: �� Date:: ------�C�—L _APPROVED DISAPPROVED — APPROVED SUBJECT TO ABOVE — __Call For Rei.nsp. 1� J1"li r't INSPECTION NOTICE i Ti City of gard Building Department .. P,O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 N4 �sS t L Type of Ins-Pec tion Ysgarh+ j,,`�air 9� Date Requested_ siw3Ta crux --- _ Time A.M. P.M. Address _ _ y 7 J Z 2 �' "'�--•. Pert it _�' Owner Lot #_- Builder The following Building Code deficiencies are required to be corrected: - Presented t-,) _ ❑ Approved Inspector -- ❑ Disapproved Date CALL FOR REINSPECTION C� YES C] NO t INSPECTION NOTICF. City of Tigard Building Departaent 13125 6V Hall blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspections Footing Plbg. Und3r.elab Mach. Rough-in Appr/Sdwlk Found. P1bg. Top Out ..as Line FINAL: Beam Struct San. Sewer Framing -Bldg. Poet/Beam Piech. Rain Drain Insulation -Pli b. Plbg. Underfloor Wator Line Gyp. Bd. -Mach. Date Requested:_ j Times ,l� AM PM Builder: THa FOLLOWING CORRECTIONS ARE REQUIREDt I Innpertor: — ---------"---._-_-------- _ Dahl: APPROV.6D DISAPPROVED APPROVED SUR,.TFr-T TO ABOVE `Call For Reinsp. \ �J y: r INSPECTION NOTICE City of Tigard Buildin7 department 13125 HU Bell Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-417F Business Phone: F39-4171 Inspection:— Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk i • I Found. Plbq. Top Out Gas Line FINAL: i Port/Beam Struct. San. Sewer Framing -91dg. Post/Beam Mach. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. --Mach. Date Ro guested:_ 4 --12-' 1_ .L Titre: _ AM PM Address: Permit f Builders �` "- -- �► THE FOLLOWING CORRECTIONS ARE REQUIREDs - — I Insper_tort_ ��__- — Datet�f - ,12 -22 {+ X �-APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE t, —_Call. For Reinap. ;k i t t 1 INSPECTION NOTICE Building Dc.partwont City of Tigard Orvigon 97223 13125 SN Ball lilted. Tigard. � r Inspec-,tLon Line (Rec-O-Pher.3)i 639-4175 Rujineee Phone: 639-4171 Mkfi n . .ah-in F.ppr/Sa:1l;: Hoch. Rough-L" Footing plbg. Underslab 9 Pltg. Top Out Gas Line BINhLi founj L -Bldg• poet/Beam gtruct, Ben. Sewer Fraw-'ng -Plumb. Post/eea.n Mech. Rain Drain Insulation -Mach. L, a Flbg. Underfloor Water Line Gyp. Bd. ime i AN _PM � Date Requestleed:_ Addrene:%/J � ` � �Lldre-Ltai' �� --• _ Builder:_LiAAM 1I THE FOLLOWIN3 CORRECTIONS ARE RE4UIREDi Ir r ; 1 r Z� Inspectors ✓� APPROVED DISAPPROVED ✓ APPROVED SUBJECT TO ABOVR dr Call For Reinsp. 1 6►x " , i i r w t MASTLR f, RMITCIIYOFT117 CYOIWAD MT') ­02 COVMUNFTY DEVELOPMENT DEPARTMENT �13125SWHWIBd. P.O.Box2397,T�gM,OogDn C1220(6p)609-4175 1ATE P') ISSUED: Ot:'Z/07/9,�' ,�i,rE A )CHE_._P'�'. 1,871D SW L I NCOLN P V E PARCEL- IS131,35DC-0070171 �IUBDIVISION. . . . TIGORDI. ILLE PARK ZONING: R-12 I-tLOCk•.. .. . . . . . . . . L OT. . . . . . . . . . . . .. .8 OUILDING REISSUE-, DWELL I NG) UN I TC-3: I BASEMENT. . . . . . . . ;it i5F CLASS OF WORK. .ADD BEDRM9: 1 BATHS: 1 GPRAGE. . . . . . . . . . :0 Sf rYF:,F' OF USE. . . :GF FLOOR PREAS-­­­­­ REGIUIRE'D l'Yf-'-'E OF CONST. :5N FIRST. . . . -.500 sf i.EFT. . :42 ft R I GHT. t 8 ft !'_)CCUPANC)' GRP. :R3 5ECOND. . . .O S f SRC.,4 1'. :0 (=t REAR. . : IS ft; • 3TORIES. . . . . . . . I THIRD. . . . :0 5f REQUI HIEN GH1.. . . . . . . . : 15 ft TOTAL.- 300 7 f SMOKE DETECTORS. LOOR LOAD. . . . :40 Dsf VALUE. . . . . 23000 PARKING SPACES. . :'A Remz,rks : 500 sq ft addition one batIn r-oom and one bed I'l-lom PLUMBING 51 NKG. . . . . . . . . . 0 FLOOR DR'4IN5. . . . .0 BACKFLOW PREVNTRS. . :0 i....AvATORIES. . . . . .1. WATER HEATERS. . . -.0 TRAPS. . . . . . . . . . . . . . .0 TUB/GHOWERS. . . . : 1 LAHNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0 WATER CLOSETS. . : 1 SEWER LINE (ft ) . :0 GRFASE TRAPS. . . . . . . :0 DISHWASHERS. . . . .0 WATER. 1-INE. (4-t ) . -0 OTHER FIXTURES. . . . . :0 GARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :O WASH ING MACH. . . -0 SF RAIN DRAINS. CA MECHANJCAL FEES FUEL TYPEc3----­--­--­ UNTT HTRS., 0 tyFie amootnt by date I- /GAS/ VENTS :2 BPRT $ 158. 50 PLL.. 02/07/92 9F::_. MAX I14PUT :0 PTU VENT FONS.. . 1 8r-',LC $ J 03. 03 J1_1 4 12/31/91 221•,,79 FUm\J ( 100K . . :0 HOODS. . . . . . :0 s 5 P(11 $ 7. 93 PLL 02,/17/9; 92-, FJFN ) =100K Q., WOODSTOVES. :0 Jyj r)R T $ 25. 00 PLL 02/07/9_' 9 2 - FLOOR FURN. a . . :0 CLO DRYERS. : 0 MPL'_' $ 6. 25 PILL 02/07/92 921- BOTL/C1lr' ( 31-117.1.kv OTHEN UNITS:0 msr,c s 1. 25 PLL 02107/9= 92-- GAS ouTLETS:0 P=IRT $ i?5. 00 PLL 02/07/92 92- Owner. J5PC $ 1. 25 PLL 02/07/92 9E., KRAIG NASS 11,670 SW LINCOLN AVE TIGARD OR 97223 Ptione #: 503-684-3089 CONTRACI-OR NOT ON I7-TA.F' Phf)ne #- e 14 t 328. 21 TOTAL This permit is issued subject to the regulations contained in the REQUIRED TNSPEC,'TiC)N5 Tigord Municipal Cod_, State of Ore. Specialty Cod,.s and all other Foot/foL(Tld Insp Gyp Hoard Insp applicable laws. All work will be done in accordince with approved Post/spam St-1.1c't Rain drain Insp plans. This perrit will expire if work is not started within 18@ Post/Beam Meehan Mechaniczal Final ddvs of issuance, or if wnrk is suspended for more than 180 days. PLM/Underfloor, Plumb Final Mp''haniral. ln,;p 111.ti1dinq Fiyjal 'Jev,m i t:t ee Si.qnat Ut-P P11-tmb Top 01-rt Er,osIOTI (_'(Jnt✓-01 Framing Insp Crawl Drain Issf.(PCI By - 111 S 1A I At i 0T) I TI S P Call for inspecti 639-4175 C17YOF71FAKU 'A �CQTYOFTWARD BUILDING PERMIT COMM'INITY DEVELOPMENT DE?ARTMENT \� oaEoo►a L Pt I 1 #. . . . .. . . . ms,m 1..-Oal,;7,9 13126 SW Hdl BMd. P.U.boar 2J397,l Owl.Urpon 97223(W)ON4176 \ / ^ __ �✓ ITE ADDRE55,. . , : 1187O SW i_INOOLN AVE. PARCEL: 151.35D(.'--OO7Q1O � "UBLIVISION. . . . TIGARDVILLE PAPK ZONING: R--12 BLOr.K. . . . . . . . . . .. LOT. . . . . . . . . . . . . :18 RE ISSUE: 1 0 0 0 0 F=LOOR i"IrEAS---__ _....._._..__�- EXTERIOR�WAL'_ CONSTRUCTION-` C;LAE,S OF WORK. :ADD FIRST. . . . : 0 s,f N: / S: E:: W:OOO TvV-E OF USE. . . :5F SECOND. . . :00 ;f PROTECT OE='1=NING,81_-.,_........____- 'I YF-'E OF CONST. :5N TH.T RD. . . . :0 0 s f N:0 S,:0 E:0 W: - OCCUPANCY (EIRP. :R; TC]-, lot___.___.___..04 rj SF ROOF CONST:2 FIRE RE r?: G(-'CUPAh!i:Y L r,A;l: t 15 4• EASEMENT. :015 s f AREA SEP. RATED: 1 0 STOR. :0 HT. - , I ft GARAC:rr. ,. . ; sf OCCU SEP. RATE:D:O 0 BSM7 ?: MELZ9:5 RE OD SETIBACKa--._._._.._..--- REC7UIRED--_ rL.00R LOAD. . . . : 1 p<s f LEFT:S/ ft RGHT: ft: FI R SPKL: SMOK DET. DWELLING UNITS: 50 F'FRNT: / f't REAR: ft FIR AL.RM: HNDICP ACC: SED RMG:0 BATHS: 0 IMP SURFACE:O 0 0 1 PRO C:ORR: PARKING: /bA V A I...U E . 4• : �c;5171491T f Remarks : '5021 sq ft addition one bath room and one bed roam Owner: _..._..._.__.__-...._._._.__---...---___-........._-_----_._.._._.._._.. _ FEES_ __. ._.___......_._._._ KRAIG NASS type amoatr.t b elate reept 1. 187O SW L_IN(-,0L.lu AVE IBPRT $ 158. 50 f='I._L 02/07/92 92- FPLC $ 1O3. 03 JLH 12/31/91 ;_;x1;3'79 HEARD OR 97223 B9PC $ i. 93 PLL 01 '/07/92 90'•- Phone 0: 5O3-684--5O89 MPR't $ 25. O0 RLL 02/07/92 92•- MP1__C $ 6. 25 PLL_ 0,2/07/91;' 9�'- Contractor; -___�.___.__.___._._ ._.____...__. ___. . M5PC •$ 1. 25 F'LL.. 0.^•,'O7/1)2 92 - CONTRACTOR HOT ON FILE;' PPRI $ 25. 00 PLL 02/07/92 9c'- P51F'C $ 1. .=:5 PLL OE-../07/92 92- Phonq 328. 21 TOTAL Rey - - -- RE:LIU I RED I I ISPEL F I ONS --This pervit 1s issued subject to the regulations contained in the Font/foLmr_i Insp >Br-tildin.q Final Tigaro Municipal Code, State of Ore, Specialty Lodes and all other Post/>Beam Str �-tet Erosion Control applicable laws. All work will be done in accordance with Post/Beam Meehan Crawl Drain approved plans, This permit will expire if work is not started V11-10/1.lr1ciet-f 1 aor within 180 days of issuance, or if work is suspended for pore Mecl-lanic al Insp i than 180 days. Plr.tmt3 Top Or_tt JII.nll.11ation InspBoard Insp^ermittee Siclnc-rt>11 � n drain In., 1 rp Meehanical Final _._... s s r_t a td R y : 4„� .._....... ..... .___... F' F i r 1 a.t Call for inspection - 639-4175 i r ,�,J .�{^ l'�1k,F.,•....:..... .-... ,.: .. ,.-.. ..E..,,. ... . :.w.vw.H.y..:Miir.DYK'-!1'F&41'tphNV.TpM 1• 13125 SW Hall Blvd. PLNCK/RECT OTY OF TIGARD a-jx23397 PERMIT DZL COINiINtUINIM' Onpraofc3«,97:'J y (soy)63"171 DATE ISSUED ;;2 JOB ADDRESS: I I EZ7y SLj L U2.p l n, TAX MAP/LOT SUB: r �s��•'lv 47n70e4- LOT: _ er ._AND USE: VALUAT I ON;�Y,.;-, OWNER SPECIAL NOTES NAME: a ; _- _ REISSUE OF: - • ADDRESS: X 70 Sc J11�.�I,a��._� �� e __ LAST REISSUE: r g 7 FLOOD PLAIN/ s P H U N E SENSITIVE LAND: CONTRACTOR APPROVALS REQUIRED NAME: i .- ---- _� PLANNING: ADDRESS: �_s� 1_�r.-ter !r ATS_ _�_ ENGINEERING: _ +CJS 97Z� FIRE DEPT: _ PHONE: 's 4, �1 OTHER: CONTR. BOARD a:' EnP DATE: ITEMS REQUIRED SUBCONTRACTORS: PLUMB: . _Gr v _— LIST/SUBCONTRACTORS: MECH: Cr7,V->-Lo-,LBUS TAX: _ ARC►LNGINEER CALCULATIONS: NAME: TRUSS DETAILS: ADDRESS: OTHER: PHONE- - — -- - -- — PROPOSED BLDG. USE: COMMF?ITS: APPLICANT NAT RE Received By: _._ Date Received: i • 1 j ' PERMIT ACCT DESCRIPTION AMOUNT A,'10UNT P�. BA.C. DUE m •d2Z t 10-432 00 Building Permit Fees / /S8• Sy �?1 ' I i 10-431 00 Plumbing Permit Fees _;�SL�•� ___ 5 4 ' 10-431 01 Mechanical eermit Fees � f" • _. �S•�� 10-230 01 State Building Tax (5%) 20, 3 Building Plumbing Mechanical 1,z r,, 10-433 00 Plans Check Fee lJ :2 D-2> �•Z S Building L��= 3 i • Plumbing j . Mechanical 10-230 05 Fire 30-202 10 Sewer Connection 30-444 00 Sewer Inspection 25-448-02 Commercial TIF Fees 25-448-04 Irdustrial TIF Fees 25-448-06 Institutional TIF Fees 25-448-03 Office TIF Fees _ 25-448-01 Residential Traffic Fees I 25-448-05 Mass Tran-it TIF Fees 52-449 00 Parks System Dev Charge (PDC) 31-450 00 Storm Drainage Syst Dev Chrg i (SSDC) 24-445-01 Water Quality (Fee in lieu of) 24-445-02. Water Quantity (Fee in lieu of) TOTAL_ 03 nm/3587P.WPF f(�e lD L� I r �l *s, f Permit No: �r�. . •• Address: - - __ ------ - - --- -- . �I F- • I Date: N�:• . : t Issued by:_-- --- _. - -- ----- ---- \•+ ��''§ ' ----_ --_ . _FOR OFFICE USE ONLY- STATEMENT: NLY _--. ------I STATEMENT: oil INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES i Note: Oregon Law, OP ; 701.055(4), requires residential building permit applicants .r who are not registered with the Construction Contractors Board to sign the following statement before the huilding permit can be issued. Licensed Architect and Engineer applicants, exempt from registration under URS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the applicable blanks, and ir+iti; I box 1 and either box 2A or 2B: 1. i 1 own, reside in, or will reside in the completed structure. 2. A. I= My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Corti actors Board. OR BI will be my own general contractor. If I hire subcontractors, I will hire only subcontractors regi3tered with the Construction Contractors Board. If I change my mind and do hire a general contractor, I will contract with a contr-actor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. i S gnature 07 erm t Applicant Date -1.1— CONSTRUCTION CONTRACTORS BOARD 0244) 1190 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT t p, d p LI I 1 i , . , 5!4F..'�M1i.'1"",h" ,1 INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners About Construction °- Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you ars citing as your own contractor to construct a new home or make a substantial Improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYED RESPONSIBILITIES: If YOU ilre persons not registered with the Construction Contractors Board to do labor in constructing or .scisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an "employer" and the people you hire will be "employees", As the employer, you must comply with the following: Oregon'sWithholding Tax Law: As an employer, you must withhold income taxes from employee wages at the —eemp oyees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department of Revenue at 378.3390. ' Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages o a employees. For more information, call the Oregon Employment Division DHR at 378.3224. •4 Workers' Corn pensation Insurance: As an employer, you are subject to the Oregon Workers' Compensa- tion Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and wi!I be liable for all claim costs if one of your employees is Injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7434. U.S. Internal Revenue Service: As an employer, you must withhold federal Income tax from employees' wages. ou will be liable or the tax payment even if you didn't actually withhold the tax. For more informa- tion, call the Internal Revenue Service at 221-3980. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: 1 Cade Com Iiance:.As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have edequate insurance coverage cidents an omissiuns such as falling tools, paint overspray, wat,�-r damage from pipe punctures, fire, or work that must be re-dor e. „ ,f Time to Supervise Employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions. write to: Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503.378-4821 0244J 10/24/89 . .yy �7V�� `'! ��° ,$� ,�., �YM�1A1;�� `M �'.'H' "�,'' + ,w..K,}�• "'>NWv °'YF•h*'N�'' "�1'�`7�ft!�°HF l�grt. C.'I TY Cif' "f'I liAitUC;E: T vi-r Cit- F�IIYME N C RUC:E'I t't T NO. a '�'�.V�4r G•I IE-,CK AMOUNT 8 NAMEi NA`ifi, KftAlr A. CASE] AMOUNT �• +x�' Y ' � G�UL)Ri E3Ei c NAGS,, l.ti'NN M. PoYME"NY L'!i-rc. Chc /1h'J/QDs� 51IE3DlWI:3Y(]Id �' 1 1 a7 rX► -.��W I_I NC:UI_N S t R E T ' `-JURP(JSE OF' FIMMEN"T (.1MCJLIN'I PALI) F'Uf*POESV: OF PAYME.NT WOUNT 1-10ID I iALJ .DIN[J� >+ERMM -MSf�i1-0�: '�� !:a�', 50 PL.IMBING f FRM 215. 00 Ii �tf f HEiNICAL P!_: 00 ST. B011-1) PEM 10. 43 � r:% IN CHECK FF 6. ;.a3 i i :a 1 � i I I TOTAL- OMi11!1'17' PAID � '�"�• 16 , I .-..rr..�.....�.�.....�...�•.�....r...�.r.w..+.r•.rr•_.�.-.......,ar.-_.r_..�• .rr�r.ww..w.•..�...,-..__:_.....� ,_;..,.,�. �. U I1 Y W- T I C;0fel) RE:C'E.I VIT CIF F'AYMEN"I" R CE:I p,r ND., ,'?t ='1379 CHECK AMOUNT 10:3. 03 INIAME a NW31i, K PA I C CEaSH AMOUNT 0. 00 ADDRESft $ f=tAYME_N'r UA T F- SC13D f t1 I G 0N PURPOSE OF' PA'YME::N T AMCIUI,41, PAID PURPOSE Of- PIAY114k;NT AMOUNT VIA I L) .........._..__..__.._.. ._._ ..._...,. _._._........._...._.__._.AI_.f�N Ct•tLCE' F w 1��,. U3 I� 1 1.n'i 0 4iW L_I NC 01.14 E:„'r TOTAL. AMOIJINT PAID 10 14. 0 31 ( :,•,� H9” m=,'R�'!'nt"'''I��4$it MIMVI r�nt,y ar I l /1 Address � __ (i2ldL�2I Permit No. Name of Occupant____-_ Permit charg- ConnectionUa�t�_1-ate- +�atit�t Paid liy - - -- - —- - -- _ Date connected Type of Budding InFpeutior, fee Service Rate 2 it �._ _✓ —_ Paid by _ Date r'antractor Assessment, Maid,_.______ Size of connection—(./--! —___ _ IT APPLICATION FOR SEWER SERVICE � The undersigned agrees, in consideration of the sewer service connection by the Tigard Sanitary District, to abide by and comply with the ordinances, regulations and rules of the Dist• .r rict presently in effect or hereinafter enacted and to pay sewer service charges as the sam^ may be Am posed from time to time when due and before such charges become delinquent. I fully understand that all unpaid sewer service charges become a lien upon the w property served os stipulated in O. R. S. 224.220. Connections to the District's system must be made by bonded contractors and/or bonded and licensed talumbers. Owner i APPROVED BY i Superintendent TIGARD SANITARY DISTRICT 8841 S. W. Commercial St. Tigard, Oregon .nruwmrww.urtnnw,ar. ,,rrv:;.e. •.r;rn:ma+*nwnn tir..awr......,•»..,. —.-.. .. -_...___..«..,w 1 4 f Appr. � t.: