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12080 SW 116TH AVENUE ADDRESS: �I ! o —sw 11(*!'—',4v&vuE CL cl: L/-, T F- J i:\rcc�rrlslrnicrotirn\tnrgelsV)uil ing.doc cm W J SEWER CONNECTION ' CITY GF TIGARD (='ERMI"( #,. , , ,. . A. . . . : SWR96- 001'7 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 01/16/96 13125 SW Hall Blvd.Tigard,Oregon 97223.910 (503)539-4171 I41RCEL: 2S 103BA--v,0124 SITf_' ADr; EE-;S. . . 14060 F7W 116T1-4 AVE SUBDIVISION. . . . LE RON HEIGHTS NO. 7.0N I NG: R-4. 5 BLOL l.. . . . . . . . . . . LOT. . . . . . . . . . . . . ;38 TENANT NAML.. . . . . :GATED _ USA NO. . . . . . . . . . : FIXTURE UNITS. . . : O CLASS OF WORN. . . :AI. T DWELLING UNITS. . : 1 FYPE: OF USE. . . . . :SF NO. OF BUILDINGS: 0 TNSTALL. TYI:--E. . . . :LTPSWR IMPERV SLJRFP E: 0 sf Pemar,ks : Sewer- connection to residential sewer lateral owner'.. __-_____ FEE ; THURSTON GATES type wamo1-Int by date r•ecpt 1 ,7.080 SSW 116TH AVE PRMT 2200. 00 P 01/16/96 96---274943 INS ' 1; 35. 00 B 01/16/96 96-274943 'i ICARD OR 97223 Phone #: Cont Y^act ur, _--____-___---__ -_---_---_______ OWNER ph o 11 e #: # 2-2235. 00 TO rpl._ --- -- REQUIRED INSPECTIONS This Applicant ar,ees to tomply with all the rules and reoulations Sewer, 1 n a pest i on of the Unified Sewace Acency. The pewit expires 180 days foot the date issued. The total aonunt paid will be forfeited if the permit empires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the aeasureeen! '- - - Oven. the installer shall prospect 3 feet in all directions fros the distance given. If not so located, the st ll,r shall surchase a "Tap and Side Sewer" Remit and the Aeen w I ins'aii a 18 ral. e r m i t t e e S ' e a t!Ire : Ts s;!red B v s .._._..... _..__..._..._...._... _.._....., .___.._. _. _....._..._.._.....__.........___ Call far inspection - 639--4175 �t r- cn ti J t c.7 W J �� s �-7 el T I � rl I I � ,r ri r, I. r ! I E!7 Clt' t'1-11't�lt rd I I I I � I I f,lr r. A��r�. r � ;r tal•.•, I I I I;III.:; I I iil � � ,I 1 r 11~1111 It�l I I11, 41k7 Il lrl.,t I I Irr 1 A l I I r III I-IYI r 11i l'II':�1 fIt t!fIYI+�t hlI 111 I I 1'f I1' 1 'l I'I 'rI!,rk; 0i Ptlfflt 141 111'111111A 1'F11!t ,1. 1'11 1% 11':•I 1 1,11,1 1�d1? '3 fa 001 i - I 1n1.i41 !•.W 1 1 F, I I i 1 IVt Residential Buildlr.ct_ Permit Application City of Tigard 13125 5W Hall Blvd. Tigard, OR 97223 (503) 639-4171 Jobsite Address: 1-2 ' ' 9 0 Subdivision: < < ��� f-6+{ s Lot# � `s" Office Use On1Y I L -�,, ? Contact Date / / Initials Valuation: — Result New Construction Only: (Square Footage) Planck/Rec1# Permit # :�fiJ 14, -05)l House: Garage: Reissue of Corner Lot? Y N Flag Lot r Y N Map & TL# Zone Owner: L4 S'541)t+ C rf 1L �' I Plat # Address: O s•��• ;I (, t r, 'y�.f�'�1 _ approvals required Planning Setbacks Solar_ Engineering Phone: L `7 a-5 1 �'i u � b 9 � Oth.- Contractor: — Items Required Address: Subcontractors -- Truss Details _ Other — Notes Contractor's License # -- (attach copy of current Oregon license) Contact Name: — Contact Phone: ( ) Subcontractors: Architect/Engineer: _ Plumbing. Address: Mechanical: (attach copy of curreni OR Contractor's L..ense) Phone: ( ) iA J JOB DESCRIPTION: 1 .t.. _ 5qo X699 _ Applicant Signature Applicant Phone number Re;eived by: Date Received: ('D �b ..411opn1dh�w�pp •w Permit:t Account Oesc iptlon Amount Amt Pd. Bal. Due Bldg. Permit (BUILD) Plumb. Permit (PLUMB) Mech. Permit (NECH) State Tax (TAX) Bldg: Plumb: Mech: Plan Check (PLANCK) Bldg: Plumb: Mach: Sewer Connection (SWUSA) Sewer Inspection (S WINSP) Zl�' Parks dev Charge (PKSOC) Residential TIF (TIF-R) Mass Transit TIF MF-Mr) Commercial TIF MF-C) Industrial TIF (TIF-I) _ Institutional TIF (TIF-IS) Office TIF ;T1F-0j Water Quality (WQUAL) Water Quantity (WQUANT) F Fire Life Safety (FLS) �- Erosion Cntri Permit (ERPR.'VIT) J Erosion Planck/USA (ERPLAN) LD U.1 -' Erosion Planck/COT (EROSN) TOTALS: CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: Footing Susp. Ceilirg Sprink. Rough-in Appr/Sdwlk Foundation Plbg. Underslab Mech. Rough-in Fireolace Post/r3eam Struct. Plbg. Top Out Elec. Rough-in FINAL: Pcst/Beam Mech. Win. Sewer. Gas Line -Bldg. Plbg. Und0loor Rain Drain Framing -Plumb. Alarm Water Line Insulation -Mech. Underflr. Insul. Shear Wall Gyp. Bd. -Elect. Date Reguestcd: '� l�� �� Timle:__ AM PM Address: �.� �� �) l A Builder:_ Permit ?C' 7 THE FOLLOWING CORRECTIONS ARE REGU!CIED: a rs I- r H- J Vr �- W J Inspector Date: Date: /APPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE Call For Reinsp. A)'PLICATION - STREET IMPROVEMENT/EXCAVAI ION COPY TO: I (WHITE)•FILE ORDINANCE NO 74-14 ® (YELLOW)-INSP. (INSTRUCTIONS ON SEPARATE SHEET) (PINK)-OTHER AGENCY bldg (BLUE)-APPLICANT 74 APPROVED 99 APPLICATION NO.: NOT APPROVED 0 "I Y O 1IGARD, OREGON FEE AMT.: s 12.00 PENDING rz EE. PMT. ❑ CITY Y II,a►LL RECEIPT NO.`S, •�4' � .� PENDING SECURITY ❑ PUBLIC WORKS DF,°ARTMENT BY DATE��r " •l — — — — — — — — — — — — — NF.NDING AGENCY "OK'' ❑ Application and Progress Record MAINTENANCE BOND PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAVATION r — AS REQUIRED ANNUAL PENDING VARIANCE ❑ EXPIRATION DATE: PERMIT NO.: _ �" DA , E ISSUED: !f1—1`-`1-` �- , BY: i (1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND INSTALL SANITARY SEWER MAINLINE TAP (BLDG.) SERVICE LATERAL_____ AS DESCR113ED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS. APPLICANT William Dilworth 6533 SW 32nd Ave. PortlandOR97201 # 246-'7196 NAME ADDRESS CITY PHONE Wslliam Mons Constr. (satie as above) mobile # 706-0436 CONTRACTOR NAME ADORES CITY r PHONE PLANS L,' Per City Standards & Specifications - NAME ADDRESS CITY PHONE ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): E _. 300'00 DOLLARS FOR OFFICE USE: CMIN. (2) EXCAVATION DATA: 004 X S_ M•00 STREET DESCRIPTION PROGRESS & INSPECTION STATUS NAME SURFACE CUT ':UT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH W,DTH DEPTH ITEM AI QUANTITY STREET _ OPENED — sev cttdchuci INSI' C- R TION E U -- E ESTIMATED STREET OPENING DATE: S 'STIMATED STREET CLOSING DATE: E D STREET (3) SECURITY NO. SECURITY AMT.: S__300.00 __ CLOSED SURETY C.O.: -_ �_.-- -- 1 , , "' FINAL CFRTIFJ&UCHECK 1u — (,-k f7 BONDc INSPEC.I _ (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPEk.IAL PROVISIONS /CONDITIONS- FEATURES; EXCAVATION LOCATION AND EXTENT. MW work area - sQQ attached I � I I, I SITE: 12080 SW 116th Alre.1 i 1 — I S. W. 116th Avenue CC I^ J —.-_ _._.._,.�.,,r._w�_.-...�z--_�—�e•gM-_. ...-.... __..__. —'----ems��...,__..�_—_— _ (5) NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGHT-OF-WAY JURISDICTION IS THAT C+ WASHINGTON COUNTY OR THE STATE OF OREGON. THE APPLICANT AGREES TO DEPOSI F THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY n? DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS. APPLICANTS SIGNATURE DA rE_ I / Special ConditionsiProvisions: 1 . All work shall conform to City of Tigard, Oregon, Standards and Specifications. Note the attached Drawings and Details. 2. Notify City I-ispector Letha Thomas (#639-4171)24 hours before starting any work. 3. Access-to end egress-frum pa,cels of land adjacent to the work area shall be maintained at all times. Pedestrian safaty shall be provided for by the contractor at all times. 4. Romoval/replacement work and damage repair work shall be promptly initiated and completed to the City's satisfaction. No work shall be considered complete until it accepted by the City. The City reserves the right to cause testing and certification of work or repairs to be performed, to the City's satisfaction, at permittee's expense. 5. Erosion control shall be provided for by the contractor. 6. ORS 757.541-571 applies (pre-notification for location of underground facilities, etc.). 7. It is the sole responsibility of the permit holder to provide for proper right-of-entry (and/or easements) prior to starting work. Proof of right-of-entry (and/or properly execut%d easements) shall be provided to the City. The City shall in no way be construed to be liable for the permit holders failure to obtain or provide for proof of right-of-entry (or easements). 8. Q. A . 9. A sewer connection permit is required to be obtained from the City's Building Division prior to connecting to the City's sewer system. N 10. Utility relocations, modifications or repairs, which may be necessary, shall be performed in a timely manner at the permittee's expense. 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UpUZI 3GM aCn _ 3Gn 3Gtt tri _. - . - -----------� I n N an to �Q =_ LP J �- () Lv --- - I E-- N7O1IY7`' �•M� fir' '.9 Y) -'—/'� lVbi111,9 '1GI>~3 wwa.e I r IW�w dNo of �z D G 0 z 3nNand 'AVs �. 7 I BUILDING SEWER RIPE, SIZE AS SPECIFIED I I PLANT FABRICATED TEE FITTING ON SEWERS 18" AND SMALLER. BACKFILL 2X4 FIELD TAP ON EXISTING SEWERS AGAINST PWG TO AND NEW SEWERS LARGER THAN Pw.EVENT PLUG THAN 18". BLOWOFF S SECURE 2x4 IN PLACE WITH TRENCH BACKFILL. SEWER f+IWN OR LATERAL PLANI I EXTEND AT LEAST GROUND 12"A90YE SURFACE SURFACE MlNlMUM SLOPE FOR 6" PIPE= 0.010, FOR 4"PIPE= 0.020. CONNECTION MARKER: MAGNETIC TAPE— GREEN ,v/BLAM LETTERS (wASTEWATER) GREEN./BLACK LETTERS (STORM MAN) PLUG Y Y \ 0 • 3/40-0 PIPE ZONE MATERIAL SUPPORT TEE WITH AS SPECIrIED BEDDING GRAVEL. mmmuM to' wIDE Sl DE 0-ji L, DI NG SEWER Uf of%Var+I6 -elm ate. W. 300 I I rr--- PVC SADDLE (TEE) I I STRAP RETAINER RIDGES ► I _ I 1 . .. --RUBBER GASKET r , i I SZWER PIPE _ STA:`lr-$S STEEL STRAP PVC SADDLE SHALL 3E ASTM 3034 SDR 35 s PVC COMPOUNDS SHALL BE ASTM D1784 WITH CELL CLASS OF 12454-8/C OR 12364-C ■ ALL ELASTOMERIC SEALS (RUBBER GASKETS) SHALL BE ASTIJ F477 ■ STAINLESS STEEL SANDS SHALL BE 300 SERIES• FULL 9/16' WIDTH BAND, 5/16' SHOULDERED HEX HE'. • SLOTTED SCREW AND IS CADIUM PLATED, CARBON STEEL . INSERTION HOLE SHALL BE CORE DRILLED. J D U' W J PVC GASKETED unHWa MEW e SADDLE UfA QO DRAWING NO. 350 I COMF_ETE RUBBER SLEEVE (ASTM C-A43) J INCLUDES A MOLDED SEGMENTTHAT HOLDS IT IN PLACE. z. STAINLESS STEEL BAND (9/ 16" SERIES 300) SECURES UPPER HALF OF RUBBER SLEEVE TC PVC HUB. 3. PVC HUB (ASTM 3034 SDR 35) DRIVE INTO CENTER OF RUBBER SLEEVE AFTER SLEEVE IS PLACED IN HOLE. I 3 z CONCRETE PIPE NOTE: ALL INSERTA-TE" HOLES SHALL BE MACHINE DRILLED. J il -- undtled So"" I NSERTA — TEE a"ncY pRAWING N0. 360 MIN. 3' A.C. IN 2 LIFTS STREET AREAS I OUT OF STREET AREAS SAW CUT � 6' EXISTING SECTION-,, RESURFACING . ..• . / f . ..• e 0 0 0 0 opo / °o° ° .00 ° ° ° o ° ° ° 0 0 e o 0 e o °e o o / - 0 0 0 0 po pe ° 0 e BACKFILL ° CLASS A a ° ° o BACKFILL 2' _ 0. °e o 0 0 /j j/ F- 0 e o pO p W e °O O o 0 10 / O e / / LLJ GRANULAR BACKFILL ° °°°o° 0 e e ° / C 0 :0 10 • . • • W N •. .• a o t] . . z • •• o o I . PIPE BASE BACKFILL IN STREET AREAS 1. IF S/W IS AGAINST CURB, nu- ROCK ILLROCK TO BACK OF S/W. 2 IF S/W IS NOT AGAINST CURB. .. nLL ROCK 2' BACK FROM CURB. J W PIPE BEDDING AND J BACKFILL DETAILS REFn"CE APPRt1Vm BY DRAYM BY "—,°° c"°° CITY OF HARD SCALE DATE DWM FILE olmxm N.TS 7-9-23 a DETALSVVM!MJM