Permit CITY TIGARD SEWER CONNECTION PERMIT
1;� DEVELOPMENT SERVICES PERMIT #: SWR2001 -00275
" '� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/3/01
SITE ADDRESS; 12055 SW ROSE VISTA DR PARCEL: 2S103CC -00800
SUBDIVISION: COLONIAL VIEW ZONING: R -4.5
BLOCK: LOT: 003 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 house to newly installed sewer lateral. Septic tank must be pumped, filled and
inspected. Reimbursement District #20 fee paid.
Owner: FEES
MCPHERSON, LORIN F/LAURA N
12055 SW ROSE VISTA DR Type By Date Amount Receipt
TIGARD, OR 97223 PRMT CTR 10/3/01 $2,300.00 27200100000
INSP CTR 10/3/01 $35.00 27200100000
Phone: Total $2,335.00
Contractor:
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220
r
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
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Iss -d by: v r/ i �! , . / /,� _i Permittee Signature: t'� �- N
Call (503) 63' ° 175 by 7:00 P.M. for an inspection needed the next business day •
CITY OF TIGARD BUILDING INSPECTION DIVISION ' ' ,•
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
/
Date Requested /0 O / AM / ,! 1 PM BLD
Location I Z 0 .S cu.) /"+Suite MEC
Contact Person Ph PLM 90 / - 04 I/ ?P
Contractor Ph SWR 2,90/ V
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain 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:
Final
PASS PART - • IL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
411r
S PART FAIL
MECHANICAL
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
BackfilllGrading
•
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 / /
Otheoach /Sidewalk Date /0 I s / ' / Inspector /,i I / e J T ✓- , Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
invoice
• GRIFF'S SEPTIC SERVICE ;�� -\ _
Name /
A C' E- � /v s ( • Date /v ^ `7 C /
A dfess /O0 5 1� , .�5' -a , ... Phone r J / 5 C /6 ,
City & ial On Acct.
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State - Zip Code
Price Amount
• ��1-,v o /0
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/^) kirejkr? X 76
NOT RESPONSIBLE FOR DAMAGES PAST CURB LINE OR LANDSCAPING
• A service charge of 1.5% will be levied on all past due accounts. Total: I mac 3, T
• Returned check fee is $20.00.
• In case suit, action or arbitration is instituted by either party for breach or to enforce any
provisions herein, • court shall award reasonable attorney's fees and actual costs to the
prevailing party at ri I or arbitration, or upon a appeal taken therefrom.
App v I
By: �;��
Customer Signature
r fhank You P.O. BOX 1136 • Canby, OR 97013 DEQ# 37464
(503) 263 -2087 or (503) 632 -6138 CCB# 104320