Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
;4f DEVELOPMENT SERVICES PERMIT #: SWR2001 -00273
�' �� 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/2/01
SITE ADDRESS; 11990 SW ROSE VISTA DR PARCEL: 2S103CC -01700
SUBDIVISION: COLONIAL VIEW ZONING: R -4.5
BLOCK: LOT: 012 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect existing residence to newly installed sewer lateral. Reimbursement District #20 fee paid.
Septic tank must be pumped, filled and inspected.
Owner: FEES
ZIMMERMAN, LIN A
KATHERINE L Type By Date Amount Receipt
11990 SW ROSE VISTA DR PRMT CTR 10/2/01 $2,300.00 27200100000
TIGARD, OR 97223 INSP CTR 10/2/01 $35.00 27200100000
Phone: Total $2,335.00
Contractor:
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 •
Phone: 939 -5246
Reg #: LIC 110314
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" Perm
•P cli Is ued by: i�.� %._� %,I� G �4k Permittee Signature: \\\K"%sz.----.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD BUILDING INSPEoTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /b - 3 AM &V 2 1�l. PM BLD
Location ii ' 91) rill Suite MEC
Contact Person ter' .t I--2_ Ph 7.7 S ��p PLM CO 417 (
Contractor Ph SWR 0
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing ACC ss:
Foundation
Ftg _ I s .e U f cka FPS
Ftg Drain �,�¢ n E V
Crawl Drain Inspection Notes: SGN
Slab j /1! 1 , SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
'Sanitary Sew er
Fain Drains
t PART FAIL
• ANICAL
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
Other Date/ /
0 / d / Inspector � � // � v�-- Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
invoice
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NOT RESPONSIBLE FOR DAMAGES P.A' GLIR'il L NE 0.'-i _I ANDSCAPING i
.
• A service charge of 1 .5°...v I, be !e or: el r; .-it iii ;c"w s
ircitai: i , ...1 1 . .,.)
• Returnea check fee is $20 00
• In case suit, action or arbitrat!cx is icy'lt.I.,' ::, - -Ii!hc .:,:iff,. ' , i t'-' ich. '.i t.
provisions herein, the court sma'l im,ir -. t.• 1- • 4',Itlk. (1 , Ie, •i ,i: ft- t , .c.)-Thi t0
i prevailing par trol ^r . Il - -,7 ,
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By ...
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Custorne.r Stcinalure
: _____S- _(___
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PO BOX 1136 ,. Canby. OR 97013 DEOfr 37464
Thank You CCB# 104320 (503) 263.-2087 or (503) 632-6138
.
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