Permit CITY OF TIG4RD SEWER CONNECTION
COMMUNITY DEVELOPMENT DEPARTMENT PERM I T
13125 SW Hall Blvd. Tigard. Oregon 97223.8199 (503)1339-4171 PERMIT # SWR94 - -0389
639 -4171 DATE ISSUED: 1`/05/94
PARCEL: 18134DB —TE004
SITE ADDRESS. °.: 11170 SW TORLAND ST
SUBDIVISION,,,, TORLAND ESTATES ZONING: R -4.5
BLOCK LOT.,,,.,,..., 004
TENANT NAME
USA NO ° FIXTURE UNITS...:
CLASS OF WORK. .. :NEW DWELLING UN I TS. . : 1
TYPE OF USE °SF NO. OF BUILDINGS:
INSTALL TYPE °BUSWR IMPERV SURFACE..: :sf
Remarks: CONNECT EXISTING HOUSE TO SEWER. SEPTIC TANK MUST BE PUMPED, FILLED,
INSPECTED.
Owner: FEES - - --
B. STORM type amount by date recpt
11170 SW TORLAND ST PRMT $ 2200.00 KS 12/05/94 —
INSP $ 35.00 KS 12/05/94 —
TIGARD OR 97223
Phone #:
Contractor:
GVS CONTRACTING
PO BOX 760
SHERWOOD OR 97140
Phone #: 625 -6332 $ 2235.00 TOTAL
Reg #. ° : 54340
REQUIRED INSPECTIONS
This Applicant agrees to cooply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The peroit expires 180 days froo Septic Tank Fill
the date issued. The total aeount paid will be forfeited if the
peroit expires. The Agency does not guarantee the accuracy of the _ —
side sewer laterals. If the sewer is not located at the oeasureoent
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° Peroit and the Agency will install a lateral.
Permittee 5ignatur ^e: —
Issued By:
Call for inspection — 639 -4175
SL 5 93 0 -
.
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
Jobsite Address: ///-7,/ 6—`11/ fr/ irk.
Subdivision: 0 Lot #
Valuation:
Corner Lot? Y N
Flag Lot? Y N e Sue D
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Owner:
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Address:
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Contractor:
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Address:
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Phone :
License Contractor's ce se #
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Architect/Englneer:
Plumbing: Address:
Mechanical:
(attach copy of current OR Contractor's License)
Phone:
JOB DESCRIPTION:
Applicant Signature & Phone number
Received by: Date Received:
N: \W O RD\CO M DEV \R E SAP P
Permit # Account Description Amount Amt. Pd. Bal. Due •
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA) VRoZ, 0 0
Sewer Inspection (SWINSP)
Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
Office TIF (TIF -O)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: