Permit n
CITY T I GA RD SEWER CONNECTION PERMIT
0, I A , DEVELOPMENT SERVICES PERMIT #: SWR2004 -00202
�� 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/18/2004
SITE ADDRESS; 15152 SW 94TH AVE PARCEL: 2S111 DB KE216
SUBDIVISION: KESSLER ESTATES NO. 2 ZONING: R - 4.5
BLOCK: LOT: 016 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF.
Owner: FEES
BUENA VISTA HOMES
6932 SW MACADAM #C Description Date Amount
PORTLAND, OR 97219 [SWUSA] SwrConnecti( 8/18/2004 $2,500.00
[SWUSA] Swr Connectii 8/18/2004 $0.00
Phone: 503- 443 -6033 [SWINSP] Sewer Inspeci 8/18/2004 $35.00
[ SWINSP] Sewer Inspeci 8/18/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
•
Required Inspections
•
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued by: < : _ ;' /; _ Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
J �
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line :. (503 , • ' 175 _66 263
INSPECTION DIVISION Business Line: (5,4rr 1
BUP
Received Date Requested / AM, PM BUP
Location /5 / 5 7 - /-' - -- Suite MEC
Contact Person Ph ( ) 7/6 F ( //5 _ PLM
Contractor Ph ( drrOaaa rOd "
BUILDING. Tenant/Owner -jam `ifs
Footing Qr Li (J)
Foundation Access:
Ftg Drain ELR
Crawl Drain
- Slab Inspection Notes: f 44r c k/ To Q . SIT
Post & Beam
Shear Anchors l v
Ext Sheath /Shear / +!
Int Sheath/Shear
Framing
Insulation Af k CAA_ CA./A
Drywall Nailing
FirewallM C VV\C2;/, /��
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FA).
.P
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain -
Shower Pan
O
Fin�►�
PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE n Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA '" —
Approach/Sidewalk Date ��� b Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL