Permit CITY TIGARD SEWER CONNECTION PERMIT
�i�� PERMIT #: SWR2000 -00033
DEVELOPMENT SERVICES DATE ISSUED: 02/29/2000
I 13125 SW Hall Blvd., Tigard, OR 97223 (5031639-4171
b 6
SITE ADDRESS; 08930 SW PIPPEN LN 1 N A L G PARCEL: 2S111 DA -15300
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R -7
BLOCK: LOT: 146 JURISDICTION: TIG
TENANT NAME: LEGEND HOMES
USA NO: FIXTURE UNITS: 0
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for a 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 02/29/200C $2,300.00 00- 321889
INSP GEO 02/29/200C $35.00 00- 321889
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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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 OAR 952 - 001 -0080.
You may obtain co • ies of these rules o • irect questions to OUNC by calling (503) 246 -1987.
Issued by: , `/� // Permittee Signature:
Call (503) .39-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST ZDCO SO
24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
2 q/ Cr) BUP
Date Requested 3) "1 AM PM X BLD
Location d 1 D Y i e , [ c Suite MEC
Contact Person f , 6e, Ph /(Dq I PLM
Contractor Ph (g'J - g q_c SWR 2tC0 0 6033
�UILDIN9 Tenant/Owner ELC
Retaining Wall EL R
Footing Access:
Foundation FPS
Ft, Drain SGN
ravel Dr ' Inspection Notes:
S a SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PART FAIL
BI
Post & Beam
Under Slab
Top Out
er a •'
�I Illr_1••�.T3��
Final
PART FAIL
171 HANICAL
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 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 Dat , /it Ins
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.