Permit 4: CITY OF TIGARD SEWER CONNECTION PERMIT
- . �i�, DEVELOPMENT SERVIC z A I D ATE SSU 62g/gg - 00084
13125 SW Hall Blvd., Tigard, OR 97223 1 :) 6 [GIN H
SITE ADDRESS; 14155 SW 120TH PL PARCEL: 2S110B6 - RED02
SUBDIVISION: REDWOOD VISTA ZONING: R - 4.5
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: FOUR D CONSTRUCTION
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 a new single family dwelling.
Owner:
FEES
FOUR D CONSTRUCTION
PO BOX 1577 Type By Date Amount Receipt
BEAVERTON, OR 97075 PRMT GEO 6/28/99 $2,300.00 99- 316445
INSP GEO 6/28/99 $35.00 99- 316445
Phone: Total $2,335.00
Contractor:
G + B PLUMBING
PO BOX 1269
HILLSBORO, OR 97123 -1269
Phone: 640 - 5770
Reg #: LIC 00000199
PLM 34 -44PB
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.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987 /
Issued by: b
i/f
Permittee Signature:
Call (5• ) 639-4175 by 7:00 P.M. for an inspection needed the next b • siness day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST Iggq /
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested &j S44 AM PM BLD
Location 12.0-1/^- Suite MEC
Contact Person C` G Ph (LID - PLM
Contractor Ph SWR I Y4 DO& `I®
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 ) 1 t:; C5? �-✓�
Insulation �QQ
Drywall Nailing 1V�►1/�_ C�� �� ' d--d
Fire wall v ✓l
Fire Sprinkler ��, tv�
Fire Alarm
Susp'd Ceiling � � ■U■ •
Roof
Misc:
Final
PART FAIL
KILMEDiq
Post & Beam
Under Slab
Top Out
Water Service
Fin �.�-
{ al PART FAI
ICAL ry;
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
l'CN\11\
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 . - 7/ l \ 7`r 1 Insector `� " Ext
Other
� L?
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.