Permit • CITY OF TIGARD
SEWER CONNECTION PERMIT
i' DEVELOPMENT SERVICES PERMIT #: SWR2000 -00077
' - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/14/2000
SITE ADDRESS; 14805 SW 103RD AVE PARCEL: 2S111 CB -00500
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 004 JURISDICTION: TIG
TENANT NAME: MUNHALL, WALTER
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for an existing dwelling. Spectic tank to be pumped, filled and capped or
removed. Reimbursement fees for Dist #16 paid.
Owner:
FEES
MUNHALL, WALTER F JR AND Type By Date Amount Receipt
JEAN B
14805 SW 103RD AVE PRMT GEO 04/14/200C $2,300.00 0001438
TIGARD, OR 97223 INSP GEO 04/14/200C $35.00 0001438
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
F o.em i in,oeer7
ORIGINAL
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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 -0080.
You may obtain copies of these rul- or direct questions to OUNC by calling (503) 246 -1987.
/�'.
Issued by: � �� Permittee Signature: U3allei\
Call (503 • 9-4175 by 7 :00 P.M. for an inspection need the next business day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested 1 BUP
// VOO AM flf2 PM BLD
Location i `" O S / 03 Suite MEC
Contact Person (Alfilb4 / U Ph zap $ M tcarobl ZZ
Contractor Ph SWR Zt )
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall pr7/ n i? , y�
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS FAIL
Post & Beam
Under Slab
Top Out
Water Service
S .`r
Rain ' rains
Atop ART FAIL
C ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for r ' nspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk u0
Other Date / Inspector d 7 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.