Permit CITY TIGARD SEWER CONNECTION PERMIT
, 1 . DEVELOPMENT SERVICES PERMIT #: SWR2000 -00237
Ai- s.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/15/00
SITE ADDRESS; 12370 SW 121ST AVE PARCEL: 2S103BA -01002
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: Connect existing residence to sewer lateral. Septic tank must be pumped, filled or removed and
inspected.
Owner:
FEES
MANSON, GARRY D
ROSALIE Type By Date Amount Receipt
12370 SW 121ST AVE PRMT DEB 8/15/00 $2,300.00 0004492
TIGARD, OR 97223 INSP DEB 8/15/00 $35.00 0004492
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 m_a a • - • ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issu by: p P ermittee Signature:
Call (503) 6 9 -4175 by 7:00 P.M. for an inspection needed the next busi ess day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639-4171
.L 0g /� 3v P '
Y / Date Requested v Q � `� '/ V -t5d AM PM BLD
Location t /2.1 Ai Suite ? GP MEC
Contact Person Ph J '- 7 &� ran 0e0'03G0
Contractor Ph 6 W/ 2 - 2 - VI►R —40a 3 7
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 _ .}- ��/� nth / Shear
Int Framing 1 .ins∎ C�`/ A I • ` d`'�
Insulation 4110 [fib /� -¢ Drywall Nailing 0 0 3 -7 \r�- Le_ �(/�
Firewall
Fire Sprinkler
Fire Alarm �f �--}. eLH n 0 6 - 00360
Susp'd Ceiling w`w JJlll s� f- l C.J�J V V
Roof
Misc: •
Final 1 k S5 •
PASS PART FAIL
G , \m CediC ( iv\ Cam- v f Q c
Post & Beam
Under Slab
Top Out
Service
• itary e
. Drains
PASS FAIL
MECHA
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 7 H 0 D l_J' VGA L 9
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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INVOICE
2523
P.O. Box 2349
T I G A R D Oregon City, SAND & GRAVEL, INC. . Orego y, OR 97045
nCit -� = - .
TONQUIN AND STAFFORD QUARRIES II Complete
1 •
P.O. BOX 413 • TUALATIN, OREGON 97062 New Installations Industrial
Repair Existing Systems .. .. . .. W . 10 Waste
PHONE 692 -1800 Sewer Connections .... ...,' . wo . .. gr. . . Removal I.
Drainfields • .. • _ . . ion . NE TICKET NO.: . .. I. . ■ I. .. . . Septic Tank Cleaning
DATE: 11 58 3 Cesspools Sump
SOLD TO: T IME: `� / e } ' x:171 Excavating Line Cleaning
h! 1 �[ COD
JOB NO.: 7 214 Richmond Construction Ent., Inc.
JOB:
TRUCK NO.: Btwn. 8:00 -10:30 a.m. (503) 253 -7587
ORDER NO. :aYIZ• C'i�47
DELIVER TO:
MANSON 597.1- 7 BOO ; Fvt:J i. w �M 00 3c,o
12370 SW 1 ,RT or i.�lrL.I� 1L t=R �/L Z D� 00eR
Customer P.O. # Date 8/29/00 Tues.
WEIGHT QUANTITY AMOUNTS Billing Name Garry Manson
GROSS TARE NET TONS CUBICYARDS MATERIAL DESCRIPTION UNIT PRICE TOTAL
Address 12370 SW •
361ilizi 1 ,:'•6olz ' 1 2400 6. 20 ;'a,. CIO I- 1 L I_ SAND $ t. J. b. :,. 9: / a / 4Y v-e__
Job Site #
3, a„ -° Net Metric Ton E, Job Tot ; . $ i. l 00 City Tigard State OR Zip Code 97223
. RECEIVED BY: r _ , _�, " -~ - _ - ' Ordered By Ga Phone # 5 9 0 - '7800 Date 8/25/00 . ..
WE MAKE DELIVERIES INSIDE THE CURB LINE AND ON THE LOT AT THE CUSTOMER'S RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR DAMAGE .
Job Location same -X -st. Walnut
RESULTING FROM SUCH DELIVERIES. ALL CLAIMS FOR SHORTAGES MUST BE MADE IN WRITING WITHIN 5 DAYS FROM DATE OF DELIVERY. FREE UNLOADING TIME ,�
OF 10 MINUTES FOR A SINGLE TRUCK AND 20 MINUTES FOR A TRUCK AND TRAILER IS ALLOWED. EXCESS TIME WILL BE CHARGED AT EXISTING RATES.
CUSTOMER COPY 1
Service Call $
Labor $
Pumping septic gallons 1000 $ 275.00
Misc $
C LH C) 6
$275.00
Conditions of tank/Distribution Box C cm-lw\ .S
TOTAL CHARGES
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n. Enviroclear is in no way responsible for damage to the septic tank or lids on the system.
TERMS: Net 10 days. 1 -1/2% per month will be charged on past due accounts. (18% per annum).
Customer's Signature: A I C -7
`
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Service Driver's Signat re / 3:31 Time /O %. CYO Date '' 2 /- dr)
TERMS AND CONDITIONS ON REVERSE SIDE REDEEMABLE IN ALL COUNTIES
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