11430 SW GREENBURG ROAD 114.30 SW Greenburg Road -
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PECT ON NOTICE
City of. Ti.gare Building Department
13125 Sw Ball Bleu. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-41.75 Busineas Phone: 639-4171
Inspection• _._ --
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Mg. Top Out Gas Line FINAL:
Poet/Beam Struct. Ran. Sewer , Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date Requested: / I I ( __TLme: _._AM _PH
Addresat ^1'Cy�
Builders
TRE FOLLOIIIVQ OORRRCTIONI; AIIE PEQIIIRF.D:
�. t
Inspectors /� _ _ Date:
APPROVRD DISAPPROVED APPROVED SURJ*CT TO AI:OVE
Call For Reinap.
C'N OF TIGO RD SEWER CONNECTION
CJFIY Im PERM I T
Mi
COMMUNITY DEVELOPMENT DEPARTMENT 01"ICKM PERMIT ff. . . . . . . . SWIR91-0050
131268WHWI Blvd. P.O.Bar 23397.7_i9@rd,OrWW 97223(SM)k-4176
6 49-it I /.T- URIE 03� 13/01
ITE ADDRESS. . . : 11430 SW GREENBURG RD PARCEL: IS135CA-01403
3USDIVISION. . . . : GREENBERG HEIGHTS ZONING- R-12
1_-I,LULK. . . . . . . . . . LOI•.. . . . . . . . . . . . .
ENANT NAME. . . . .
�JSA NO. . . . . . . . . . ..43199 FIXTURE UNITS. . .
CL-A!;S OF WORK. . . :ADD DWELL T 103 UN I TS. . :
TYPE OF' USE. . . . . :SF" NO. OF' BUILDJNGS: l
INSTALL TYPE. . . . '.BU32WR IMPEPV ')'URFACE. . : -sf
Heniav-ks : Connect existing house to sewer-. Septic tank must be Pl-imped And fillec.l.
An inspection of ti-le filled tank is v,equit-ed by the City.
Ownpr. ----------------- FEES
RANDY ROBERTS type 'AMclunt try dat e r-ecrit
11430 SW GREENBURG RD PAYM $ 1535. 00 JL.H 03/13/91
1 IC ARD OR 97223
)one #.- 294-3269
f-INTRACTOR NOT ON F:ILE
0. 00 TOTAL
------- REQUIRED :NSPECTIONS
This Applicant agrees to coeclv with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 121 days trot lbeptic lank Fill
the date issued. The total asiunt 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 to locate,', the installer shall purchase
a "Talo and Side Sewer" Permit and the Agency will install a lateral.
mittee biqnatui e :
Call for inspection 639-4175
/////j��Jf///I� • Y .. ...._....... .........................
CITY
........__... .. .'
C,TTY OF TI GARD RECEIPT OF PAYMENT RECEIPT NO.
CHECK AMOUNT 15315. Olt,
NAME s ROBERTS, RANDY CASH AMOUNT 0. 00
ADDRESS a 11430 SW "ErENBURG RD PAYMENT DATE' s 03/13./141
SURD I V IS I(IN
T T GARD, (IR 97223—
PURPOSE
122:3•AURPOSEE OF' PAYMENT AMOUNT PA 1 D PURPOSE OF PAYMENT AMC"IUNT PAID
SEWER UBA_. _ ._SW RC) 1 - 00501_ i T,00. 00 SEVER �I NBPFCT' 35. 00
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1"CI I AL. PMOWIT PAID - 113 . 00