Permit CITY TIGARD SEWER CONNECTION PERMIT
a. DEVELOPMENT SERVICES
PERMIT #: SWR2000 -00106
+L '- 13125 SW Hall Blvd., Tigard, OR 97 (503) 639 -4171 DATE ISSUED: 5/19/00
SITE ADDRESS; 14905 SW 104TH AVE PARCEL: 2S111 CB 01308
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5
BLOCK: LOT: 015 JURISDICTION: TIG
TENANT NAME: LAPIDUS
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection permit for existing residence to a newly installed sewer lateral. Septic tank is to be
pumped, filled and inspected.
Owner: FEES
LAPIDUS, DAVID J /KAY W Type By Date Amount Receipt
14905 SW 104TH
TIGARD, OR 97223 PRMT DEB 5/19/00 $2,300.00 0002327
INSP DEB 5/19/00 $35.00 0002327
Phone: Total $2,335.00
Contractor:
°MINI P
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 rules or direct questions to OUNC by calling (503) 246 -1987.
Issued b • �� /! I Permittee Signature I _
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b si ess daY
ro
I LE
....: , RVICE
,O. •■ 1130
IN '' -1 ..:+, • tLLE, OR 97070
' (9114 4824929 FAX (503) 570.0779
CUSTOMERS ORDER NO. PHONE DATE
OO
NAME
ZIPO (-f -
ADDRESS
i 9 05 S, >/0 4 ,
,
SOLD BY ASH C.O.D. CHARGE . CCT. .MDSE REPO. PAID OUT
t . . OT I DESCRIPTION PRICE AMOUNT
I
I S id C.. - 6% k � V 4
1 ,. y . ' TAX
RECEIVED BY i v
l l TOTAL
All claims and returned goods MUST be accompanied by this bill.
/, THANK YOU
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested c ' Z AM PM BLD
Location / I /l � 5/d f19 yam'` Suite MEC
Contact Person Ph 330 '2 y PLM 2a &OJG,
Contractor Ph SWR J 7 - ex)/ D
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling /ice
Roof
Misc:
Final
FAIL
� MBING
o st & Imam /
Under Slab
Top Out , ,
,1 / Water Service ` /L
Sanitary Sewer /
Rain Drains
Fin.
PART FAIL
HANICAL
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
Backfil - • ing
• • rain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk �}'1
Other Date Inspector //' ! Ext, frr''
IY
Final
PART FAIL ' 0 NOT REMOVE this inspection record from the job site.