Permit CITY TIGARD SEWER CONNECTION PERMIT
Ak � DEVELOPMENT SERVICES PERMIT #: SWR2000 -00076
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/13/2000
SITE ADDRESS; 10585 SW WALNUT ST PARCEL: 2S103AA -01901
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION: TIG
TENANT NAME: GARRY L & GWYN HELMER
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: ADD DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer permit for single family dwelling. Sewer re- imbursment fees paid. Plumbing permit to be
issued at later date.
Owner: FEES
HELMER, GARRY L BARBARA S Type By Date Amount Receipt
10585 SW WALNUT
TIGARD, OR 97223 PRMT GEO 04/13/200C $2,300.00 0001410
INSP GEO 04/13/200C $35.00 0001410
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
ORIGINAL
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" 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 952 - 001 -0080.
You may obtain copies of these or direct questions to OUNC by calling (503) 246- • 87.
Issued by: / / / �� Permittee Signature: _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi ess day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested (0 7/ C OO AM C r NM BLD
Location L O S p S (/� J AT Suite MEC
Contact Person ZLQ /
Ph �7 ?jq���p PLM 2.00 - 0v /i
Contractor Ph SWR t a" 000 - ? (O
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling • 1
Roof
Misc:
Final
PASS PART FAIL
UMBI
Post & Beam � �
Under Slab
Top Out
Water Service
anitary Sew
Rain rains ��
Final
4 A PART FAIL
NICAL
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 E. ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA -
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL N O N • T REMOVE this inspection record from the job site.