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Permit CITY TIGARD SEWER CONNECTION PERMIT A.040,,,, DEVELOPMENT SERVICES PERMIT #: SWR2002 -00235 il 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/5/02 SITE ADDRESS; 14365 SW 114TH AVE PARCEL: 2S110AB -02700 SUBDIVISION: COLE'S ACRES ZONING: R -2 BLOCK: LOT: 013 JURISDICTION: TIG TENANT NAME: PHAM USA NO: FIXTURE UNITS: 1 CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Connect to public sewer Owner: FEES PHAM, LAN N + NGUYEN, PHUONG BICH Type By Date Amount Receipt 14365 SW 114TH AVE PRMT CTR 8/5/02 $2,300.00 27200200000 TIGARD, OR 97224 INSP CTR 8/5/02 $35.00 27200200000 Phone: Total $2,335.00 Contractor: Phone: Reg #: Required Inspections Sewer Inspection 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' Perm Issued by: j / Permittee Signature: Call (503) 39-4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTIOR DIVISION Business Line: (503) 639 -4171 Received Date Requested 2, ° � AM PM BUP Location / � 3 ? ( l� L f Suite MEC Contact Person Ph ( )/ _ '98 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear C 6- .?0,0z;Z Uo © q Int Sheath/Shear Framing Insulation Drywall Nailing Firewall 4e ae [ S � Fire Sprinkler Fire Alarm V � �� Susp'd Ceiling Ot Roof Other: J Final / z - - w PASS PART FAIL ' - h 48'5 PLUMBING 30 3 / Z pQ . Post & Beam Under Slab Rough -In Water Service unitary Sewrej Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Oth- • F al PASS PART FAIL ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL / ELECTRICAL %/i1OW Service Rough -In ' UG/Slab Low Voltage Fire Alarm Final Reinspection -e of $ required bef• - next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call fir einspe.tion RE: El Unable to inspect — no access Fire Supply Line ADA • i Approach/Sidewalk Date Inspector _ j Ext Other: Final D i NOT • EMOVE this ins ; = ction record from the Job site. PASS PART FAIL 08/27/2002 07:21 503 -848 -6832 HOLLENBACH & HURD PAGE 03 i I . ALOHA SANITARY SERVICE _ INVOICE NO. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 6543 503 -644 -2797 * 503 - 648 -6254 • 503 -639 -5188 NAME: fiddia PACK II u e d ADDRESS: CITY: STATE: �j} ZIP: HOME: 6 nn WORK: J Y/ S i CELL: Y 3 .S Z2 JOB SITE: 1 L A - 30-r - , 91 ,i4 [ 1 4 -1'1.- L 117-1 _ P.O. #: n PAID BY CHAR CHECK 0 CASH ❑ CREDIT CARD ❑ DATE 6K • z 6, zoo 2 DRIVER �J du( '� / AMOUNT PUMP SEPTIC TANK OZ 0 / 1 A' ■ CIO Et LI LINE OPENING LI INSPECTION FEE ❑ SERVICE CALL ❑ LABOR, LOCATING, DIGGING, BACKFILL , ❑ MATERIAL li e 1 1 TOTAL $ - - THIS IS NOT A SEPTIC SYSTEM INSPECTION REPORT - - - - - - - REMARKS - TYPE OF TANK: TEEL ❑ i CONCRETE ❑ PLASTIC ❑ HOMEMADE ❑ HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ ❑ OTHER SIZE OF TANK: 350 O 500 ❑ 750 ❑ 1000 ❑ 1250 • 1500 ❑ 2000 ❑ 3000 ❑ LID LOCATION: INLET ❑ OUTLET ❑ MIDDLE ❑ ENTIRE TOP LI TANK CONDITION: GOOD ❑ FAIR ❑ POOR • FITTINGS: BAFFLES ❑ CONCRETE LI : IRON ❑ PLASTIC O NEEDS NEW LID? YES ❑ SIZE GROUND COVER OVER TANK I r COMMENTS ON CONDITION OF DRAINFIELD • C. . i ‘ // / Nit I ^ 1 . SIGNED BY DATE , Zb-d2 08/27/2002 07:21 503 - 848 -6832 HOLLENBACH & HURD PAGE 02 HCCen.ba.ch & Herd 3000 S.W. 174th Ave,, EXCAVATING AND UTILITIES Office (503) 591 -5987 Aloha , OR. 97006 OCCB #121807 Fax (503) 848 -6832 RESIDENTIAL SANITARY SEWER AS- BUILT Date: 15 - s2 6 ' CIA Building Permit # ENS a? DD. d Cod Building Contractor ( `F N _NL r4". Subdivision: Address: I'/ lo5 ,�.. ..__ q Depth of Connection to City Stubout: � / Distance off curb to City Stubout: _ . _ -_ _ Type of Pipe: /I P Size of Pipe: _ Type of Connection: _ e-O _ Inspection Date: 'OZ to l c o T b 0 LA) t e,we /V(