Permit CITY TIGARD i� SEWER CONNECTION PERMIT
. i, DEVELOPMENT SERVICES
PERMIT #: SWR2000 -00119
, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 6/5/00
SITE ADDRESS; 14830 SW 104TH AVE PARCEL: 2S111 CB 01302
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R -3.5
BLOCK: LOT: 020 JURISDICTION: TIG
TENANT NAME:
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 of sewer lateral. Part of Reimbursement District #16. Reimbursement fee of $8000.00
paid on 4/18/00. Septic tank to be pumped, filled or removed and inspected.
Owner: FEES
FRY, HERMAN W JR + BETTY JU NE
14830 SW 104TH Type By Date Amount Receipt
TIGARD, OR 97224 PRMT KJP 6/5/00 $2,300.00 0002683
INSP KJP 6/5/00 $35.00 0002683
Phone: Total $2,335.00
Contractor:
Phone: ORIGINAL
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 Utilit Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain ««iiii of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: K, Permittee Signature:'(9 Est),
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
AAFFORD
. 4 ' SEPTIC SERVICE
P.o.eoX 1130
WILSONV'ILLE, OR 97070
A - (503) 682.1829 FAX (NM 1#700778
CUSTOMERS ORDER NO. PHONE DATE
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NAME
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ADDRESS •
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- SOLD SY CASH C.O.D. CHARGE ON ACCT. MDSE. RET D. PAID OUT
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TAX
RECEIVED BY
TOTAL
All claims and returned goods MUST be accompanied by this bill
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�,__ THANK YOU
'CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -11our Inspection Line: 639 -4175 Business Line: 639 -4171
W-7/00 BUP
Date Requested AM PM BLD
Locaton A-CJ`c-. Suite MEC
Contact Person (94fl) IA Ph D 2 (-/ PLM 21:100- 00/ 7
Contractor Ph SWR Zt)Cp -b ON ( 7
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
Firewall / / ` � —
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof < C "7 /6 _
Fina
Final
PA§A --A�PART FAIL
tl.UMBINV
Post & Ieam
Under Slab
Top Out
Water Service VtiC
- a1 ..
at
4 , f,71 'ART FAIL
' ANICAL
'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
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] 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
Other Date I 0 � Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.