Permit CITY TIGARD SEWER CONNECTION PERMIT
�I' DEVELOPMENT SERVICES PERMIT #: SWR1999 -00263
+ � I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 39 -4171 DATE ISSUED: 12/15/1999
SITE ADDRESS; 10530 SW JOHNSON ST PARCEL: 2S103AA 01915
SUBDIVISION: COTTONWOOD PLACE • ZONING: R -4.5
BLOCK: LOT: 014 JURISDICTION: TIG
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TENANT NAME: LAMBERT, ROBERT & GEORGIA
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection to sewer lateral as part of Reimbursement District #12. Reimbursement fee of
$5,597.82 paid on 12/15/99. Septic tank to pumped, filled or removed and inspected.
Owner:
FEES
LAMBERT, ROBERT A Type By Date Amount Receipt
10530 SW JOHNSON ST
TIGARD, OR 97223 PRMT GEO 12/15/199E $2,300.00 99- 320425
INSP GEO 12/15/199E $35.00 99- 320425
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
ORIGINAL
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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 O' - 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) - 87.
Issued by: - Permittee Signature: �� - � ►' emu
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
5&i:/vQ Pi —3
Invoice # 518
SANITATION SERVICES, 'INC. Date: h-/Z
#
P.O. Box 327 • Oregon City, OR 97045
Portland (503) 657-0219 Vancouver (360) 695-1021
Fax (503) 656-6945
—161
LIAL);
Address: 1 //6 , iruz/iA i.0
City: "Tv; Rio, 0- Sta te: Zip Code:
Billing Name: /C., 777/
Billing Address:
City: State: Zip Code:
Telephone: Area Code Number Fax Number
Ordered By:
Frequency: 2 Wk 6 Wk 1 Mo 2 Mo 3 Mo 4 Mo 6 Mo Year Other
Quantity Amount Unit Price Total
(---- L.__ ...Do 4 4 =is,
4
• SW WA Tip
Sales Tax
Total Due $
Remarks:
. •
• .
Must be notified 30 in advance to cancel regular services.. •
Serviced by: J/ Received by: 10.4_ A ...A (
• Please pay from this invoice. •
• Finance Charge of 11/2% per month, or annual rate of 18% is applied to past due balance.
"Thank you for your business." •
0 5 5
invoice
GRI ID'S SEPTIC SERVICE, INC.
Name ' '1 P fd' - /' Date /
Address �� o `) 7 / L) 3.J Phone 9 7
City / - Initial On Acct.
State � � Zip 'Code
Price Amount
�! �'� .
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i
® 1
)"b 4'-.7
NOT RESPONSIBLE FOR LANDSCAPING
A service charge of 1.5% per month will be charged on all past due accounts. Total:
Not responsible for attorney's fees. �V
A fee of $25.00 will be charged on all returned checks.
� Appro al
B � 1 g
Customer Signature
'Z an�ou P.O. BOX 1244. • Canby, OR 97013
(503) 263 -2087 or (503) 632 -6138 CCB# 70548
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CITY OF TIGARD BUILDING INSPECTION. DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST
BUP
Date Requested
y iy00 AM PM BLD
I-
Location ) , 0 3-di v S n_ S+ Suite . MEC .
Contact Person S4 Ph 9 - -s 45 tgp4_a
Contractor Ph SWR O.' — CC-T—t)
Tenant/Owner ELC lqqq
Retaining Wall ELR
Footing
Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: • SGN
Slab SIT
Post & Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall /
Fire Sprinkler ---
e
Fir Ala / • / i .#
Susp'd eiling _ / A .4
Roof -
Misc: ' ,
- ,
}OF
Final - /
PASS PART FAIL AK.1.6dedadill 4' ___ _ /. ..r
ttMBTF
,
Post & Beam - /
• Under Slab jikle - - - /
Adall" 1M ' i --- -eY
'Id -.."
Top Out f
lf
Water Service All A
TenitaDiaeAD r /72? J2 I r 'Al . /
R- Drains
id 2r* ' PART FAIL
HANICAL
Post & Beam
Smoke Dampers
Final'
PASS PART FAIL
1
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 Ext
Other Date 6 Inspector - 1 (1
Final .
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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