Permit r c.
CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
_Al. Ail 13125 SW Hall Blvd., Tigard, OR 97223(503) 639.4171 PERMIT #PERMIT • SWR99 -0001
DATE ISSUED: 02/22/99
PARCEL: 29110BA —RED14
SITE ADDRESS...:11867 SW TREEHILL CT
SUBDIVISION •REDWOOD VISTA ZONING: R -4.5
BLOCK LOT °014 JURISDICTION: TIG
TENANT NAME •
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: 0 sf
Remarks: Single family detached, Path 1. To possibly be used as a model home.
Owner: FEES
FOUR D CONSTRUCTION CO type amount by date recpt
PO BOX 1577 PRMT $ 2300.00 B 02/22/99 99- 313141
BEAVERTON OR 97075 INSP $ 35.00 B 02/22/99 99- 313141
Phone #:
Contractor:
OWNER
Phone #: $ 2335.00 TOTAL
Reg #... •
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
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 95201 -0080. You may obtain copies of
these rules or direct questions to OUNC by calling (503)246 -1987.
Issued by: Permittee Signature: _Z y
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
NOV 10 '99 15:16 FROM: T-909 P 01/04 F -118
Grinnell Fire Protection
Portland District Office
5921 N. Marine Dr.
"Innovation, Quality, & Portland, OR 97203
Service Since 1850" 503 / 289 -9080
503 / 289 -9062 (Fax)
Confidential Urgent Call On Receipt
Fax Cover Sheet
To: /2 ?1f , !/e
24 Hour Emergency Service
Attn: 4 t/
From: A ce' e,, 4S
Automatic Sprinkler Systems
Re: it 5
Installation
Date: it - 10-9 f
Inspection
Fax No:
Repair
No. of Pages (Including This Page):
Backflow Preventors
Fire Alarms & Detection
Inergen & CO2 Systems
Fire Extinguishers
Over 100 Offices in Principal
Cities Throughout North America
A tyco INTERNATIONAL LTD. COMPANY
NOV 10 '99 15:18 FROM: T -909 P.03/04 F -118
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130902
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PNW9 -AWWA BACKFLOW ASSEMBLY TEST IZEPORT REMOVED
.7.•.:-,-. . • . PROPERTY ❑REPLACEMENT
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'`'" s ASSEMBLY P. V.B. A. / S.V
•
; ,, ' : - .•K'` • ••• �.' - RE ASS DL Y INITIAL TEST
' . A ' i, + % f' s? i ce:• 54 , . * . . .: 5 ....
Y - a.. ,,, I � z = .v , '' r�; s II CHECK ( DOUBLE CHECK AIR CHECK PASSED Q}
: ' f'; • ' -.::,a . _ ( l INLET FAILED ❑
4 J - , ►f,'1 ,,y w' ` ,. PRESS DROP A CHECK tl.
' L�•�� ,;: "+. r' "i ' , t INITIAL. RELIEF VALVE
i - i. .I+: ` wa w r ,-4 v. "r - � 1 -• k , r_ TEST O PENED AT MIN 2 PSID • (B)�T(GHT Q�� ? �,� OPENED AT. PRE D ROP
•' -w• ,- - ' 4. . . . . DATE:
. . r• -Y,,� ,-`; •'..0, _P.. � . - • ": RESULTS LEAKED Pslu -
,. Sjri. c' RESU BUFFER ❑ / i �y�
'tir 9aw`- + " �.. � ( "•. ... • 'o .... ! _ I PSID PSID !'
• , I✓+ i hu .� ;.•1 • ;.' 'ipF. • .:r :.l`,: c a. i .ij A • B MIN 3 PSI CHECK M2
. . 11.„1-6 m r .:• % TIGH n 1..'i DID NOT FAILED SYSTEM
r:, :• .wcr. J •• T'. -+. 4 : RELIEF VALVE `'� ❑
i PASS ❑ FAIL Q�LEAI�ED� D9a OPEN 1:1 PSi ' COMMENTS
`� .• L - :':i'".` REPAIRS
PARTS
•
t REDUCED PRESSURE ASSEMBLY
•.' fA . .;e'r :h ,.' ••••: r. ,y _ NI CHECK P.V.B.A/S. AFTER REPAIRS
- ..: ' , ; V.7',; . .1 : •,:.-:.;, ... . ; TES PRESS DROP cA) [ CHt: Dr CHECK J/l V.A. DATE:
...- ,41._:,;...-• - . ••••3,,:,-• r +f t : RELIEF
"`'+T.y� ' ,•,_.,;''...,•- ; -;j, AFTER I n OPENED AT PRESS DROP
_,r. . OPENED IB) TIGHT I J Pia /
'' • REPAIRS .m cap
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`. • ..7.;6.1 y : ' - f ; y; 'ice R ° terr TIGHT 0 PSID PSID PASSED ❑
' ' PSID
IN COMPLETING AND SU
? Y ". , ';, . - "''' "'^ K• • • ,: r, BMfI11NG 1}115 TEST REPORT. 71•10 TFA7ER CERTIFIES THAT THE
a
"' ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
.r_r - RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
OAUOE CALIBRATIQ• DATE / L " DETECTOR METER READING
- r CRT
TESTERS NAME PRI D '"/ - •
_ ow •_
TE &A.DDRESS ; -
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•
fr (.SERVICE RESTORED
REPORY RECEIVED BY' (REPRESENTATIVE OF owNER)
WHITE • Water System Copy PINK • Customer Copy YELLOW • Tester Copy
.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST 1 D (DO
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested 1111D-- AM PM BLD
Location I Va tP" Suite MEC
Contact Person Ph t 7U0 74L PLM
Contractor Ph SWR c 7
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation s _ FPS
Ftg Drain -G SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam , �
Ext Sheath /Shear r w/I Q Q_ (71
Int Sheath /Shear
Framing
Drywall on 3 /�yl
Drywall Nailing �J ! [�
Fir
ire Sprinkler r _ ' A rm., _ = pr • CAA- r ' • •4 -c.-•
Fire
Susp'd Ceiling
Roof
Misc:
le g) PART FAIL ie Cfreciivy
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
S i. • .e Dampers
4 g• S 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 / / — / � — 7� Inspector E
Final
PASS PART FAIL DO NOT ',EMOVE this inspection record from the job site.