Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2005 -00033
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/3/2005
SITE ADDRESS; 14465 SW 114TH AVE PARCEL: 2S110AB -02500
SUBDIVISION: COLE'S ACRES ZONING: R -
BLOCK: LOT: 011 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: Sewer connection.
Owner: FEES
MOSER, ROBERT & CHERYLYNN
11465 SW 114TH Description Date Amount
PO BOX 230716 [SWUSA] Swr Connectic 2/3/2005 $2,500.00
TIGARD, OR 97281 -0716 [SWUSA] SwrConnecti 2/3/2005 $0.00
Phone: 503- 443 -2278 [SWINSP] Sewer Inspect 2/3/2005 $35.00
[SWINSP] Sewer Inspeci 2/3/2005 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. 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 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued by: A ct.e... Z , Permittee Signature: S• .
Call (503) 639 -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
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Re cei 0 r� BUP oqt
v ed P Date Requested g. ` is AM PM BUP
Location / LL L I ‘ 5 / / 14 4 � Suite MEC
Contact Person l Ph ( ) 'T 13 - 5 - a-7 PLM o' 06
Contractor Ph ( ) SWR 2 a s ,--0.6.
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: ,
Ftg Drain ELR
Crawl Drain
Slab Inspectio otes: i
1 t SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear t I) / j rillidi
Int Sheath/Shear
Framing ��
Insulation
D C'2
Drywall Nailing
Firewall
Fire Sprinkler , .-
Fire Alarm j
Susp'd Ceiling 1 ' - 4- ---- - i . ` J �� -
Roof v ' ✓
Other: �j - ���
Final /r // %`
P ASS RT FAIL / �
LUMBIC
-
Under ear 7 � , . ` # % . --
Under Slab _ 1-
Rough -In
Water Service -
, S`anitary 3
r_ i _ _---- Catc h Basin /Manhole _ i0017,7 � 411.0 Catch
Storm Drain
Shower Pan \ \\
0th � -_--'� % --�/'
I
E S � FAIL
----"
v
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL f
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA Approach/Sidewalk Date � - v Inspector / � Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL