Permit CITY TIGARD SEWER CONNECTION PERMIT
;. i,_ DEVELOPMENT SERVICES PERMIT #: SWR1999 - 00261
- ' - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/9/99
SITE ADDRESS; 10490 SW JOHNSON ST PARCEL: 2S103AA -01914
SUBDIVISION: COTTONWOOD PLACE ZONING: R - 4.5
BLOCK: LOT: 015 JURISDICTION: TIG
TENANT NAME: .BADGER
USA NO: �� FIXTURE UNITS:
CLASS OF WORK: NEW \ � DWELLING UNITS: • 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection to sewer lateral as part of Reimbursement District #12. Reimbursement fee of
$5,597.82 paid on 12/9/99. Septic tank to be pumped, filled or removed and inspected.
Owner:
FEES
BADGER, QUENTIN J EUNICE Type By Date Amount Receipt
10490 SW JOHNSON ST
TIGARD, OR 97223 PRMT DEB 12/9/99 $2,300.00 99- 320283
INSP DEB 12/9/99 $35.00 99- 320283
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 Oreg ty Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You ay obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
lssu d by: aa / ;? Permittee Signature: •
Call (503) • 9 -4175 by 7:00 P.M. for an inspection needed the next busi ess day V
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Address
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City- /1;204111-"e-° Initial On Acct.
State 0 2- - Zip Code R2._
Price Amount
720-6 //9 0 1,1,_ 44/0/es ,g.a6
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NOT RESPONSIBLE FOR LANDSCAPING 0 .
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A service charge of 1.5% per month will be charged on all past due accounts. I Total:
Not responsible for attorney's fees.
A fee of $25.00 will be charged on all returned checks.
By:
Approval \ .
•-•
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Customer Signature • ,
Than_You P.O. BOX 1244. . Canby, OR 97013
(503) 263-2087 or (503) 632-6138 • CCB# 70548
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hou' Inspection Line: 639 -4175 Business Line: 639 -4171
f I BUP
Date Requested f�l `'r l C (, AM /�PM BLD
Location /0 `f QO rAS ./ Suite / 1 q - 00 L f
Contact Person 6. Ph 3 LMT( /'
Contractor Ph SWR /q q9 - 0 /
`BUILDING >' °n m /,�; Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation ce,,,Ceer S r C ' l FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear <J r ' 1
hit Sheath /Shear /J ( j� � (�
Framing ►/(�, �ll� "C�-/\ l�/ U t '2-
Insulation
•
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
I?LUMBINkF
Est & Bea ALl
Under Slab ry
Top Out -1� _,nQQ
Water Service } r
Rain Drains y�>T
PARf FAIL
li ar P ' CHANI ;CAL = `uR
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICALw a ` z _
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
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 / L 5
Other Date 4 / Inspector `2� Ext
Final
•
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.,