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Permit CITY TIGARD SEWER CONNECTION PERMIT A400 DEVELOPMENT SERVICES PERMIT #: SWR2001 -00074 . - DATE ISSUED: 3/13/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4 SITE ADDRESS; 11510 SW 115TH AVE PARCEL: 1 S134DB -01800 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: 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 permit to connect existing residence to existing lateral. Failing septic system. Septic tank must be pumped, filled and inspected. Owner: FEES KALSCH, LAWRENCE P Type By Date Amount Receipt 4441 SE WITCH HAZEL RD HILLSBORO, OR 97123 PRMT CTR 3/13/01 $2,300.00 27200100000 INSP CTR 3/13/01 $35.00 27200100000 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" 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. Yo - nay obtain copi- of these rules or direct questions to OUNC by calling (503) 246 -1987. ed by: / �'��, p /h2��2'���' P erm itt ee Signature: /� /� u Call (50 • ' 175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 6 • r l /6/ BUP Date Requested - 1 1 4 AM PM X/ BLD Location 11510 5t-.0 115 Suite MEC Contact Person ��. Ph 519- 57 / q PLM Contractor !h sA)44 01•2/ 2b Ph v,p.06!- 74 / BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: �' n f — /J Slab ,6? - /L/ i'J �l P� SIT Post & Beam n Ext Sheath /Shear �I O A_ -r /�tp l v st Int Sheath /Shear Framing Drywall on 4?A i I k V \ s �� Drywall Nailing vV. l Fire wall T (� ` Fire Sprinkler tiv V � CC) `J V Fire Alarm () _ n 4ve 4 VV Susp'd Ceiling f�l Roof Fi Final PASS PART FAIL � ° PLUMBING Post & Beam Under Slab Top Out Wa er Service anitary Sewer rains Fin AS PART FAIL MECHANICAL 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 1 ` Other Date 3 t ��� \ Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • .. . ALOHA SANITARY SERVICE P.O. Box 309, BANKS, OREGON 97106 644 -2797 * 648 -6254 * 639 -5188 NAME: ADDRESS: CITY: STATE: ZIP: HOME: /�s' WORK: CELL: _JOB SITE: / /J � J ( � r P.O. #: PAID BY CHARGEKtfr CHECK ❑ CASH ❑ CREDIT CARD ❑ DATE 073-7-13"-" c1 I DRIVER LAI (Lk:, 7414i %l AMOUNT ©` PUMP SEPTIC TANK -ZZO ❑ LINE OPENING ❑ INSPECTION FEE ❑ SERVICE CALL ❑ LABOR, LOCATING, DIGGING & BACKFILL ❑ MATERIAL 2ez,462 /4(c-op -- -THIS IS NOT A SEPTIC SYSTEM INSPECTION REPORT-- TOTAL Z.Z �` - - REMARKS - - TYPE OF TANK: STEEL ❑ CONCRETE ❑ PLASTIC ❑ HOMEMADE HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ OTHER SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 1000 ❑ 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑ LID LOCATION: INLET ❑ OUTLET ❑ MIDDLE ❑ ENTIRE TOP ❑ TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑ FITTINGS: BAFFLES ❑ CONCRETE ❑ CAST IRON ❑ PLASTIC ❑ NEEDS NEW LID? ❑ YES SIZE GROUND COVER OVER TANK COMMENT ON CONDITION OF DRAINFIELD ETC. SIGNED "( �f w DATE BUP - Building Permit ELC - Electrical Permit - 4 Inspection Description Date Passed By 4 Inspection Description Date Passed By Footing /Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls Electrical rough -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing J Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final Masonry /Reinforcement Framing MFG - Structure set -up MEC - Mechanical Permit Insulation Drywall nailing 11 Inspection Description Date Passed By Post/beam mechanical Suspended ceiling Gas line Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical final Structural observation Final inspection PLM - Plumbing Permit 4 Inspection Description Date Passed By BUP — Fire Protection System Permit Plumbing underslab Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer Fire alarm final Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final Sprinkler supply lines Sprinkler underfloor /slab O d 0 -7 ci Catch basin /Manhole S - ewer Permit Engineered soils 4 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection "A 4/6 INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC SIT PERMITS