Permit CITY TIGARD SEWER CONNECTION PERMIT
I DEVELOPMENT SERVICES PERMIT #: SWR2003 -00001
'` Ali'
SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 1/2/03
SITE ADDRESS; 07565 SW HERMOSO WAY PARCEL: 2S101AB -01502
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 022 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: Connect exisiting residence to sewer lateral.
Owner:
FEES
ANDERSON, ROY W ESTATE OF
7565 SW HERMOSO WAY Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connect 1/2/03 $2,300.00
[ SWUSA] Swr Connect 1/2/03 $0.00
Phone: 503- 639 -9328 [SWINSP] Swr Inspect 1/2/03 $35.00
[SWINSP] Swr Inspect 1/2/03 $0.00
Contractor:
Total $2,335.00
OWNER
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
•
•
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" Perm
Issued b Alt 4 . /� / ., if Permittee Signature 7 0.,,,,izz4.„ �r�or��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGA 24 -Hour
BUILDING Inspection ` :e: (503) 639 -4175
INSPECTION DIVISION Business I. x(503) 639 -4171 MST
BUP
•
Received Date Requested AM M BUP
Location 5 CL� Suite MEC
Contact Person Ph ( ) PLM a
Contractor Ph ( ) ' 7 , '13 : a - •:lac --moo
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: N ELR
U f ' %�
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm c jo7 / 4 rr Y
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service i ,�
Rain l� t—/VI\
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
0;`,' `"PART FAIL
ANICAL
Post & Beam •
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line <—
ADA
Approach /Sidewalk Date v / ! � J �` I 6 ) Inspector Ext
Other: /!!!
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL