12120 SW 116TH AVENUE ADDRESS:
W- 114�VAVEAIY&
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ALOHA SANITARY SERVICE
P.O. Box 309, BANKS, OREGON 97106
644-2797 646-6254 639-5166
NAME: —
AUURESS: -
CITY: c�a� STATE: Z:IP:
PHONE: HOME: l��" is 1IIIORK:
JOB SITE; C mai. A P.O.#_-- -- ---
PAID BY CHARGE Cl p' CHECK S-t1 CASH ❑ CREDIT CARD ❑
DATE 1 DRIVER AMOUNT
." 13UMP SEPTIC TANK —
❑ lXrERIAL —
_ (-I INSPECTION FEE
❑ SERVICE CALL —
❑ LABOR, LOCATING, DIGGING & BAlKFILL —
$
---THIS IS NOT A SEPTIC SYSTEM INSPECTION REPORT--- TOTAL —
/ - -
REMARKS -
TYPE
TYPE OF TANK: l� TE ❑ CONCRETE Fl PLASTIC ❑ OTHER
HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ OTHER
SIZE OF TANK: 350 ❑ 500 r l 750 ❑ 1000 Fl 12501-1 1500 ❑ 2000 ❑ 3000 rl
LID LOCATION: INLET ❑ OUTLET ❑ MIDDLE F) OTHER
TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑
FITTINGS: BAFFLES ❑ CONCRETE ❑ CAST IRON ❑ PLASTIC ❑
rc
v~i rIEEDS MEW LID? ❑ YES SIZE _
GROUND COVER OVER TANK
COMMENT ON CONDITION OF DRAINFIELD ETC.
C.D — —
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SIGNED BY — DATE
CITY
GO"ARD
SEWER CONNECTION OF TI r.. .. rT c,' _
REf7h1iT #. . SWR �1:.4t3
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED:� 07/10/96
13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)039-4171
SITE; IaDDRESS. . . : 12120 SW 11.E+ rid AVE
SUBDIVISION. . . . : LE:RON HEIGHTS NO. 2 ZONING: R--4. 5
------------------
TENANT NAME. . . . . :HIHINTZ
UFIXTURE UNITS. . .
SANO. . . . . . . . . .
CLA:aS OF WORK. . . :NFW DWELL 1 NG UNITS. . : 1
1�/t='E OF USE. . . . . :5'r= NO. OF BUILDINGS: 0
1NS) AL.L TYPE. . . . :1.1`PSWR IPIr='ERV SUiar=ACF_: sf
Remart;s : Connect r-esidence to sanitary sewer
FEES
DONNA 14E:INTZ type aloount by date oecpt
AND EDWPRD V HEINTZ i-ImIT s 1 ,200. 00 JSD 07110/96 96-281",:.
i21co SW 11E+1'ri AVE: INSP $ 35. 00 JSD 07/10/96 96--::.81482
I- IC3ARD OR 9722,3
'trone #: 503-590-1,640
ontractor:
taNTRACTUR
NOT ON
'hone #9 4 2235. 00 TOTAL
�e p #. " REQUIRED INSPECTIONS
ih:s Applicant agrees to corply with all the rules and reguiatio•is Ins:pec:tion _.__.____ _.__,•____._,.___..___..
J the Unified Sewage Agency. Tt•e pe qit eypires 190 days from -.___ _____________ __ -•-_ - -- ----_-
the date issued. The total asoun., paid tui, he forfeited if thr. _�__ - __ _�_ _...__ _____-_--•_ — - ---
pereit expires. The Agency does not guarantee the accuracy of the _ __.____ __.------•— ---- -
si ! sewer later ,ls. If the sewer is rot located at the seasuresent ------
given, the installer shall prospect 3 feet in all directions frot ___-_.._.�_.______.___ -••-- --•-•
the distance given. If not so locatefi, the installer shall purchase v ___ -___ _-. ____.__ _•____- --- -_
a "Tap and Side Sewer" p,ereit and the Pgency will install a lateral.
I-`e r m).t t e e .133i g Ti a t l.r r e
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Call for inspection - (,39--•4175
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover
/Service FINAL: i
Foundation Water Lino Geiling Plumb.
Post/Steam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
a . Sew r � Gas Line App/Sdwlk Reins.
Other: .- _--
Date: tis¢ — A•l`/l./�/ Pt./M_. Entry:
Address:—l�__-1 0 Ut —
Tenant .— Ste:—_ MST: — --
Con/Own:_f 1 �- -- — --- MEC:_.
PLM:
ELC:THE FOLLOWING CORRECTIONS ARE REQUIRED ELR:
e.F6 o3
03
CL
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Inspector: '_ _ _ DateG.
CF/
APPROVED _DISAPPROVED/CALL FOR REINSP. O
Cl I ' OF I I WOO) - kLlt 1 1.111 tli 1110 IVIVAll $411,,F 1 t'1 141
Ct W"AA-11 01,401 N I lelo
I V..OW)R 1) V (AT"1144 1401014,41 s le), 00
I WA N I'i; D0t',IWI J.A POlYMI-NI 1441t, Oe' ,
lal :moo 1,04 1. 1 f t t 51,00)1,Wl f!31 IAN
PLJRV'OSA IF 1.-'P 01171,141 Orli'll ll,\l I PC 1) 1.) PL. P11 Uf PO (Ifil-A41 0"1111,11,11 111 1.10
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Plan Check# /j
:ITY OF TIGARD Residential Building Permit Application Recd By
+3125 SW HAL!_ BLVD. New Construction Additions or Alterations Date Recd
"IGARD, OR 97223 Single Family Detached or Attached Dale to O.E. N
503) 639-417"; Date to DST
Print or Tyre Permit# T4
Incomplete or illegible applications Will not be accepted Called h17-Cr
Name of Subdivisi t Lot# Name —�
Job eA'l4 �' (�� �� 5�,' —
Architect Mailing Address
Address Site Addres
r2_1 2LILLW' II I AW, City/State Zip Phone
a L,tx ol"I d V
Owner M�i�rlQ�d-, t I I I— A e —
pity/State )Zip pho a Engineer Mailing Address
I ►�C� 0)` 712- .-I City/State Zip Phone
NaWe
General Describe work new O addition O alteration O repair O
Cuntractryi Mailing Address to be doge:
Additional Description f Work:
City/State Zip Phones DID,
Attach Copy of Project
Oregon Const Cont. Board tic.# Exp Date Pr j
ect
Is
Current COT Business Tax cr Metro# Exp Date Valuation
Licenses y_ — NEW CONSTRUCTION ONLY:
Name _
Mechanical Sq.Ft. House: Sq.Ft.Garage:
$UI)- Mailing Address
Contractor Corner Lot Yes No Flag Lot YesNo
City/State Zip Phone (check ane) (check one)
_ Restricted Audio/Stereo Burglar
Oregon Cc ost. Cont. Board Lic# Exp. Date Energy System Alarm
Attach Copy of _ -
Current COT Business Tax or Metro# Exp. Date instalWion Garage Door HVAC
Licenses Opener Systems
Name (check all that Other
Plumbing apply) — --
Suh_ Ma rng Add,ess —� Will the electrical subcontractor wire for all Yes No
Contractor restricted energy installations?
City/State zip Phone "— Has the Subdivision Plat recorded N/A Yes No
Oregon Const Cont Boa u Lic# Exp Date RPissuP of MST# Solar Compliance
Attach Copy of (C2;culatioil Attached)
Current Plumbing Lic.# Exp. Date I hereby acknowledge that I have read this applicatic.n, that the
Licenses information given is correct.that I am the owns or au,horized agent of
CA: COT Busrress Tax or Metro# Exp Date the owner, and that plans submitted are in compliance w,'h Oregon
v~i State laws.
Name ' Si a re of Owner/ gent j Date
7 .7
Electrical
Con t arson am q � P ne
2 Sub_ Marling Address
Contractor FOR OFFICE USE ONLY:
_j CitylState Zio Phone Plat# Map/TL#:
Oregon Const Cont. Board Lie# Exp Date
Attach Copy of _ Setbacks Zone Solar:
Current Electrical Lic # Exp Date
Licenses
COT Business Tax or Metro# Exp Date Engineering Ar proval: Planning Approval: TIF:
s,mstapp doc `
Permit# A.,,:count e cription Amoun Aml, Pd. al. Lim
MST. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech Permit (MECH)
ELC/ELR Permit (ELPRMT)
State Tax (TAX)
Bldg:
Plumb:
Mech:
ELC/ELR:
Plan Check
MST- (BUPPLN)
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS)
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (Pi<SDC)
Resideniial TIF (TIF-R)
Mass Transit TIF (TIF-MT;
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Lij Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTAL 3: t_
i\dsts\mstapp doc
Rev 7196