Permit CITY TIGARD SEWER CONNECTION PERMIT
N DEVELOPMENT SERVICES PERMIT #: SWR2000 -00234
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/9/00
SITE ADDRESS; 14790 SW 104TH AVE PARCEL: 2S111CB -01301
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5
BLOCK: LOT: 021 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: Reimbursement district #16
Owner: FEES
BANFORD, ROBERT D Type By Date Amount Receipt
BETTY R
14790 SW 104TH INSP RCP 8/9/00 $35.00 0004378
TIGARD, OR 97223 PRMT RCP 8/9/00 $2,300.00 0004378
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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 rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: , e/ryl Permittee Signature:
Call 5 3 639 -4175 by 7:00 P.M. for an inspection needed the next [fusiness day ) Y Y
...e.
14) A - AF F ORD ABLE RECEIVED
- SEPTIC SERVICE
PO.BOX 1130 AUG 1 4 2000
WILSONVILLE, OR 97070
' - (503) 582-1929 FAX ($03) 57
05/6 DEVELOPMENT
CUSTOMER'S ORDER NO. PHONE DATE
- 6' /l ° 0 -
NAME
ADDRESS -
3
• SOLD B_Y (' CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
•
QTY. DESCRIPTION PRICE AMOUNT
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TAX
RECEIVED BY
TOTAL
At claims and returned goods MUST be accompanied by this bill.
'cam }? ,To r THANK YOU
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested e- AM PM BLD
Location /V 7 Q0 5 r / U 1 Suite MEC
Contact Person s— Ph 310 - Z 2' PjaI / 2vi?s4"- C C 2 9 y
Contractor s � A,8 Ph ll/5`WR 2e-e41 :' f b 2 3 c f
BUILDING Tenan r l h /A 4 /r s .0(1 ELC
Retaining Wall ECR
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
Fire Sprinkler
Fire Alarm
Silsp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service \\\(
Rain Drains
F'
PASS PART FAIL
MECHANICAL
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date ( ( Q a Inspector � — - — or•,` Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.