Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
�4( DEVELOPMENT SERVICES PERMIT #: SWR2004 -00212
�� ' �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/3/2004
SITE ADDRESS; 12950 SW OXALIS TERR PARCEL: 2S104BC -08500
SUBDIVISION: HILLSHIRE CREST ZONING: R -
BLOCK: LOT: 007 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: Sewer connection for new SF
Owner: FEES
RIDGECREST CONSTRUCTION CO Description Date Amount
6600 SW 92ND AVE SUITE 210
PORTLAND, OR 97223 [SWUSA] Swr Connectic 9/3/2004 $2,500.00
[SWUSA] Swr Connectic 9/3/2004 $0.00
Phone: 503 246 - 8808 [SWINSP] Sewer Inspeci 9/3/2004 $35.00
[SWINSP] Sewer Inspeci 9/3/2004 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
Required Inspections
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"
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 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued by: Permittee Signature:
✓ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 /4175 0 co ��_ Qb�( z
INSPECTION DIVISION Business Line: . 03/ 4171 ,.
BUP
Received Date Requested C f � ' q AM PM BUP
Location (- Suite MEC
Contact Person Ph ( ) — 7 aS PLM
Contractor Ph ( ) ��.- , ;0 ;0210 y 0 001 e7A—
BUILDING Tenant/Owner ELC
Footin.
oundati ' n ELC
g Access:
rai ELR
Cra II rain 1
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing d
Firewall J
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
pr
a
ASS PART FAIL I/ MBING
Post & Beam
Under Slab
Rough -In
'Y yTlr.�.Y1!RT�
•f11i/ ,TF�R�
Catch Ba • Manhole
orm Dr. •
Shower Pan
Other:
Final
PASS PART
MECHANICAL
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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line y
ADA Approach/Sidewalk Date �� / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL