Permit CITY TIGARD SEWER CONNECTION PERMIT
,�; DEVELOPMENT SERVICES PERMIT #: SWR2001 -00192
"��� DATE ISSUED: 6/20/01
�' 13125 SW Hall B T igard, OR 97223 (503) 639 -4171
PARCEL: 2S 103RD -00200
SITE ADDRESS; 11710 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit to connect existing residence to newly installed sewer lateral. Septic tank
must be properly abandoned by either pumping and filling or removing the tank and then inspecting.
Reimbursement District #18 fee of $8,000.00 was paid on 6/20/01.
Owner: FEES
CAPPOEN, RAYMOND J
SUZANNE Type By Date Amount Receipt
11710 SW WALNUT ST PRMT CTR 6/20/01 $2,300.00 27200100000
TIGARD, OR 97223 INSP CTR 6/20/01 $35.00 27200100000
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
•
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" P it and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the O on Utility otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You y obtain copies if these r es or direct questions to OUNC by calling (503) 246 -1987.
Iss ed by: / / li.f . PP La Permittee Signature: '
Call (503) 6 -4175 by 7:00 P.M. for an inspection needed the nex usiness d
.4- -2
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
UP ,.
Date Requested 1 --/ U AM PM BLD
Location / ( 7/0 5 W h Gti Suite MEC
Contact Person Ph 6.5r 1(73 9 PLM
Contractor Ph - o /? L
BUILDING Tenant/Owner 40c
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Slab l Drain Inspection Notes: Zu - — (�. � SIT
Post & Beam -
1 � - . SIT
Ext Sheath /Shear \ z
Int Sheath /Shear -
Framing
D
Insulation g (DPV1 4 D all Nailin l�2- ���
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling \ QQ
Roof . 12 , w.�J�S -S-J\ ` ?J
Misc: .. •°
Final � �-- C �� v� IN.5 -.
- PASS PART FAIL
�I. WIABIQI6� •
Post & Beam -
Under Slab
Top Out
Water Service
Zuitary
Rain Drains
Fina _
41 PART FAIL
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 /�
Other
Date 7/ i 0 /0 Inspector ✓ ( Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.