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Permit . j CITY OF TIGARD SEWER CONNECTION PERMIT l DEVELOPMENT SERVICES PERMIT #: SWR2001 -00077 All ' --- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/6/01 SITE ADDRESS; 12930 SW 113TH PL PARCEL: 2S103AC -07600 SUBDIVISION: FONNER WOODS ZONING: R -4.5 BLOCK: LOT: 012 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF detached dwelling. Owner: FEES PINE VALLEY BUILDERS INC Type By Date Amount Receipt 1052 TROON ROAD LAKE OSWEGO, OR 97034 PRMT CTR 4/6/01 $2,300.00 27200100000 INSP CTR 4/6/01 $35.00 27200100000 Phone: 503 - 358 -7667 Total $2,335.00 Contractor: Phone: Reg #: Required Inspections 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 952 101 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. 1 Issued by: P ermittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next ' u -4es say CITY OF TIGARD BUILDING INSPECTION DIVISION MST r . 24 -Hour Inspection Line: 639 -4175 Business Line: 6 -4171 / BUP 1 Date Requested / ( AM PM BLD Location /, - f 2' Sw / #3 /Lf• Suite MEC Contact Person Ph - 3 730 "' 7b PLM Contractor Ph SWR 006 77 BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL MBMN Post & Beam Under Slab Top Out l Water Service ani - - ain Drains 1 / W O 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 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 Date / / / / ( Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.