12620 SW 135TH AVENUE 10-GAP SW 13.61 AOXMY-k-
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SEWER CONNECTION
C17YOF T' RDfirAPRMIT
COMMUNrrY DEVELOPMENT DEPARTMENT Cn 0R100N RD . . . . . . . SWR92-02LI
13125 SW HWI Blvd. P.O.Ekix 23397,Tioaml,Oregon 97271 (1503)439-4175
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`i;!TE ADDRESS. . . : 126c"'O SW 135TH AV PARCEL: 2S104BD--07-,70�i1
SUBDIVISION. . . . : HANDY ACRES ZONING: R-6
BLOUV.. . . . . . . . . . . LOT. . . . . . . . . . . .
TENANT NAME. . . . .
USA NCI. . . . . . . . . . : FIXTURE UNirs. . .
CLO,,13
13 OF AORR,. . . :(-',DD DWELLING UNI TS. . : I
Jyja�,L OF USE. . . . . ..SF NO. OF BUILDINGS: 1
INS:TALL TYPE. . . . :BUSWR IMPERV SURFACE. . :
Remarks : Connect existing GF'D to sewer-. Septic tank must be p4-imped and filled
with sand oi, or-ao.,el.
Owt er-- FEE'S .___________..___
CARVE BECKHAM type amol-int by date v,ecpt
126r`_'0 SW 135TH AVE PRMT f 300. 00 BCR 06/16/92 —
IN-SP
IN-SP .35. 00 LAI'.:R 06/16/9c'.: —
TIGARD OR 97223
phone #S
contr-actor':
QWNGJR
—
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Plionp #1 4 3315. 00 TOTAL
Req #. . : 041000 REOUIRED iNSPECTIONS
This Applicant ay,ees to com;�;v with all the rules and reg,Aations Sewer Inspection ...........
of the Unified Sewage Agency. The permit expirms 160 days from Septic Tank Fill
the date issued. The total amount paid will be forfeited if the - -----
.permit expires, The Agency dies not guarantee the accuracy of the
side sewer laterals. If the stwer is not located at the otasurtiert
riven, the installer shall prospect 3 feet in all directions from
the distance ei-en. If not si locLted, the installer shall purchase
a "Tap and Side Sewer" permit ajs!-M� '"pency wi.,I UV
Z; �811 a lateral,
Per in i L t La e ;3 i n f,tA t 1.k v*,P
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Ga I I far inspection 639-4175
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INSPECTION NOTICE
City of Tigard Building Department
13125 SN Hrll Blvd. Tigard, Oregon 9722?
Iraj)ection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4:71
Inspection:
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. P1
b9_.ToD Out Gas Line FINAL:
Poet/Ream Struct. Ban. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
P.lbg. Underfloor Water Line Gyp. Bd. -Nech.
Date Requested:__ l� _61Z-C'�t 'Timet / !1M PM
Addresses "4� L �!h �e,46s
Builders,,,,,
THE FO NO CORRECTIONS ARE REQUI'KEDs
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Inspectors _. Dates
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
CITY CIF" 7 I GARD -- RECEIPT OF POYME.NT REMPT PT NO. :1) 1
L";HrClti AMOUNT s 33T). 00
NFiMr s BrIC".I;I1AM, CARVE A. MARILYN CASH ;AMOUNT s 0. 00
AGDREF-1, a 11?620 GW 135TH AVEPAYMENT DATE 06o 16/92
SOBD I V I S 1 ON s
TIGARU, OR 972'.1;3--
PURPOSE OF F-'AYMF:N'r AMOUNT PA 11) F'URF''[]5f: OF POYMEN"r AMOUNT PA 11)
9EWER LISA ,:300. 00 SEWER INSPECT 35. 00
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PERMIT GWR92.-0221
TOTAL AMOUNT F'F1 I D 00
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CITY OF TIGARD 13125 SW 23397✓d. PERMIT ECT # _
1'O Box 21397 �
COMMUNITY DEVELOPMENT DI?I ARTMEN'I'
Tigard,Orcgon 972L3 PERMIT T #
(503)639-4171 DATE ISSUED
MAP/LOT
JOB ADDRESS:,, -� � '�? __ _ _—�.__—_ TAX /LOT
—
SUB: LOT: _ LAND USE: _
VALUATION: _—
OWNER SPECIAL NOTES
NAME: ���a < vG ��,.�?�ti.yi�/ REISSUE OF:
ADDRESS: — LAST REISSUE: --
FLOOD PLAIN/
PHONE: SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: _ _ PLANNING:
ADDRESS: __ ENGINEERING:
FIRE DEPT:
PHONE: OTHER: _
CONTR. BOARD #: — EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: �____ LIST/SUBCONTRACTORS:
MECH: --- - BUS TAX: — ---
ARCH ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS: _
ADDRESS: —_ OTHER:
PHONE:
PROPOSED BLDG. USE: _
—!
COMMENTS: �z
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APPLICANT SIGNATURE
Received By: — Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees -
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing
Mechanical
10-433 00 Plans Check Fee —
Building _
Plumbing _
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection } -
25-448-02 Ckni-,,ercial TIF Fees _
25-448-04 Industr;al TIF Fees
25-448-06 Institutional TIF Fees a _
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dei• Charge (PDC) _
31- 450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
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2.4-445-02 Water Quantity (Fee in lieu of)
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TOTAL
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nm/3587P.WPF
06/16/92 14:34 SEIYU INTERNATIONAL COP.P. 001
�-' SEIYU INTERNATIONAL
sEIYU
TEL: (503)245-4090 • (503)245-4435 • FAX (503) 245-4351
June 16 , 1992
Mr . Garve Beckham
12620 SW 135th Av(,�nue
Tigard, OR 97223
To whom it may concern :
Mr . Carve Beckham, owner of tax lot # 2F1-04BU- lot 3700,
Tigard, Oregon has contributed to our satisfaction in the sewer
construction work perf.oimed on 3I9 135th Avenue In Tigard Oregon .
sincerely,
Kurt Vanvolkenburgh
General Manager
CC : City of Tigard
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Linculn Center i0220 S.W. Crcenhurg Suite 3115 4 Portland, Oregon 97223
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