Permit CITY TIGARD SEWER CONNECTION PERMIT
* DEVELOPMENT SERVICES. PERMIT #: SWR2000 -00072
1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/19/2000
SITE ADDRESS; 08870 SW PIPPEN LN PARCEL: 2S111 DA -15100 ,
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R -7
BLOCK: LOT: 144 JURISDICTION: TIG
TENANT NAME: LEGEND HOMES
USA NO: N,\0 FIXTURE UNITS: 0
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF (0 NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new single family dwelling
Owner:
FEES •
MATRIX DEVELOPMENT CORP Type By Date Amount Receipt -
6900 SW HAINES ST STE 200
TIGARD, OR 97224 PRMT GEO 04/19/200C $2,300.00 0001543
INSP GEO 04/19/200C $35.00 0001543
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 co ' s of these r les or direct questions to OUNC by calling (503) 246 -1987.
Issued by: /2� Permittee Signat : A At. //
Call (503) 6 -4175 by 7:00 P.M. for an inspection needed the next business da
� ) Y P day •
CITY OF TIGARD BUILDING INSPECTION DIVISION Msr 'C'-
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested s f I AM PM BLD
Location t'�i te
b Y peei� (( r Suite MEC
Contact Person 01 F--7 Ph Co s r / - gbh S PLM
Contractor Ph SWR (IOI °' 2
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drai • SGN
ravel Oran Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
�• PART FAIL
�
Post -& Beam
Under Slab
Top Out
a ater - - '*_*1
Fina
ior PART FAIL
CHANICAL
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 Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA v
Approach /Sidewalk Date Inspector Ext /
Other
Final
PASS PART FAIL D N tri
NOT REMOVE this inspection record from the job site.