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12.121 SW Lansdcwne L"e
�esa�
INS I')N NOTICE
City of Tigaid Building Jepa ent
P.O. Box 2,3397
Tigard, Oregon 972;
Phone: 639-4!75
Type of Inspection
5- Time
Datp Requested
C1 G
Permit
Address
Lot #_—�--
Owner _ --
Builde, -
1-he followingIding Code dafieiencies are required to be corrected:
;/Approved -
Presented to
.........
� T)isapproved
Inspector G Date
CALL
L--�-- — ------— --
CALL FOR REINSPECTION
N ES i7 NC
sr:.:WER CONNECTION
P ER 1111
sWRI)0-0321
GITYOFTIOARD ( ../c�r�rycf TwAim . . . . . . .
COMMUNITY DEVELOPMENT DEPARTMENT one" SWR90-032).
a(,- Tj- If-91.JED: O�/" 31, 90
,M97.Tigwi,orsgon 97
tM#0),6.fgi4176
13125 SW Hyl 6W. P-1
SITE ADDRESS. . . 1.21pi SW I-AH)N&SDOWNE LAA V)ARCF.J.: IS,103BC-01.3140
33 ZONINGv
SUYDIVISION. . . .
B I OCK. . . . . . .. . . .
TENANT NAME. . . . . : FIXTURE UNITS. . . I
LISA NO. . . . . . . . . . :42 3 7#7, DWELLING UNITS— '. I
CLASS OF WORK. . . cNEW NO. OF BUILDINGS'.*1
TYPL OF USE. . . . . vSF -1
IMSTALL TYr,E. . . . i BUSWR 1111"ERV SURFACE'. - f
Gonrlect c:?xjsjt)ig SFD to tank nlU-St be pLtinped and filled
4-1,avel-
FEES
y P e! amoLtvit by date P
MILTON FYRE:*. P R 11T 15(ffl-00
1.2.021 SW LONDS)DOWNE LN III S I., $ 35- 0 0
T'IGARI. OR '.'3-7223 (.1 Y M 1i ].:'`.i
1:11 h 0 1*1 e 0:
Contractor
OWNER/CONTRACTOR
lr�535. 90 TOTAL
111 h a n 0% #
Reg to. . : OWNER REOUIRE.1) INSPECTIONS
This Applicant agrees to comply with ail the rLICS and requlationS viewer lits qiectiren
of the Unified Sewage Agency. The permit expires 120 days from
)CIF 'Tank. Fill
the date issued. The total Amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accljr8-y Of the ..........
side sewer laterals. it the sewer Is not located at the measurement
ections f"N
,,v,,n,, the installer shall p7ospect 3 feet in all dil
the distance given. If not so Wed,--thk-installer shall purchase ........... .......
a "Tap and Side Sewer" Per and the Agency Ili ins
a I I ills
79 .......
A e ii .............
Ik.1 e ti I.,y C .................. ...................
Call fo-r iiisPeCti011 6,19-4175
CITY OF TIGARD rjC-.Uv-.jp'r OF PAYMIF.:NT r�ECEIPT No. 90--204299
r 35.4)()
,HED.-I n- MOUNT t 5'
G,)SH AM0UN,r a 0.
PAYMENT DATE
AODRFSS I V 1.G I ON
F,URr,',(]F:)r-' OF: PAYMENT A)IIOIIMT FA 10 t,,,jjr4',OG(-- OF' AMOUNT PAID
"')5.00
SEWER INSPECT
r �
121121 sw LANSDOWNE
_ _ 153x...,5 I
TUIAL AMOUNT PAID i,,
OF
71FA.
13+25.Bo "ill lova. PLAN CHECK APPLICATION
ON
2.1391 PT AN 11Ir7.SC IC17Y _
RD Turd Oreton 97223 PEId'= # __
(503)639.4171 — -
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED
JOB ADDTZ? S: /";C x5 w �ivI I 5 r TM MMP/ m _
:EJB: _ IDT: LAM USE:
VAUIMON: _ _---
OWNEk: SPD( I11L NOTES
NAME: �d ��. -�..,'� REISSUE: OF:
ADDRESS: LAST REISSITE: --
- — ITOM PLAIN/
_— — --- SENSITIVE LAND:
PRONE: !.~.. -
I --- APPROVAT� REIQUIItE7�
LMt?McrC1_1 PLANNING: —
NAME: — — _ ENGINEERING: _---
ADU'FSS: FJRE DE.1TP -----
011fER:
ITEMS RExTII2ED
BUILDERS BOARD #: — -- EXP DATE: _—_— LSST/S[
I= TAX:
ffl2Mff kGII�t CATICtK ATIONS: —�
NAME: — THU3S DETAILS: _
ADDRESS, —_— _—. OnMR:
PHONE:
PLT IMT3: - —- - -- MW I:
P3!LTT if ACCT # DES'Z rIGX AMO(W AMOUNT PD. BAL. GUE
10-432 00 Bu.ildirrg Permit Fcx,--
10-431. 00 Plumbi-g Permit Fees --.--
10-431 Ol Me(,banical Permit. Fees —
10-230 01 State Building Tax (5%) __—_--
Building _
Plumbitr__{ _
Moc31 _
10-433 00 Plans Check Fee _
Building
Plumbing
Wch
_ 30-202 00 Sewhr Cbr►Tx3c.-tion
30-444 00 Sewer Inspect-ion __3�.
51-448 00 Stt�et System Dev Charge (SDC) -
52-449 00 Parks System Dev Charge (PDC)
31•-450 00 Storm DrainvNe- Syst Dev Chrg (SSUC) -
10-230 OG Fire
RDC
APPLICANT SIGNATURE --
RIN7eived By: -------.-------- Date Received:
of/3587P.WPF