Permit CITY TIGARD SEWER CONNECTION PERMIT
,t I { DEVELOPMENT SERVICES PERMIT #: swR2000-00050
'�' jl 13125 SW Hall Blvd., Tigard, OR 97223 (503) 1 G N In g ISSUED: 04/13/2000
SITE ADDRESS; 14176 SW 128TH PL
� PARCEL: 2S109AA -ER016
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7 1
BLOCK: LOT: 016 JURISDICTION: TIG
TENANT NAME: MASTERPIECE 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: New SF - Path 1
Owner: FEES
Type By Date Amount Receipt
PRMT KJP 04/13/200C $2,300.00 0001412
INSP KJP 04/13/200C $35.00 0001412
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.
You may obtain copies ese rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: / �J Permittee Signature:SC
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
- CITY OF TIGARD Residential Building Permit Application Plan Check# 3 - 3 r 131.25 SW HALL BLVD. New Construction / Rec'd By
Date Rec'd ✓ - / 7 - 06
TIGARD, OR 97223 Single Family Detached k V Date to P.E. h"
V 503 - 639 -4171 Date to DST 4 (1 o (Zu'(9 Re
F 503 - 684 -7297 i Permit # ( j7 - OM
Print or Type Called
Incomplete or illegible applications will not be ac epted .� - ' D
Name of Project 1 9� C IL STEw
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Contractor AN A Sr X_ pc fi n( t: Ca> / w(, Describe work New Addition 0 Alteration 0 Repair 0
Mailing Address to be done:
Prior to permit i\ C L i S k (c` ti Additional Description of Work:
issuance, a copy City /State ip Phone
of all licenses / tit p Lk OK_ c 12u( '1- 0`7 -L7 3 u
are required if Oregon Const. Cont. Board Exp. Date �` PROJECT
expired in COT Liy.# c O 1 b 0 1 _ = VALUATION $ 3 b ° (v 0 0
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Mechanical Name r - NEW CONSTRUCTION ONLY:
Sub- 3 (- - -}k cA I u- `1 Sq. Ft. House: Sq Garage
Contractor Mailing Address // 3
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Prior to permit 3 toZ Indicate the restricted energy installation by the electrical
issuance, a copy i ty /State Zip Phone subcontractor in the following areas
of all licenses 5„iq) e-N. Dr- ''7 303 1-e 00 ' GS y -0 O Restricted ./ Audio /Stereo
are required if Oregon Const. Cont. Board Exp. Date Energy System Alarms
expired in COT Lic.# 2 Installations Vacuum Irrigation
database 3��1� ,5 O / System System
Plumbing Name + (check all that s Othe R ti' '�
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Sub- L P te' V kb ( 1k1 apply)
Contractor Mailing Address Number of Units in Building I Unit Number Designation
1 il l n 7 c c lt, SV ", r r 6 i Has the Subdivision Plat recorded? N/A YES NO
Prior to permit ity/State Zip Phone
issuance, a copy Jeer- Lor't T7 ly 0 kZ '- 0 ld'
of all licenses are Oregon Const. Cont. Board Exp. Date
required if Lic.# 7 0 813 3 b I- ft--Z,- 0�.
expired in COT l •J
database Plumbing Lic. # Exp. Date I hearby acknowledge that I have read this application, that the
information given is correct, that I am the owner or authorized agent
3 221 eb 1 -3, -, 6 I of the owner, and that plans submitted are in compliance with
Nirge Oregon State laws.
Electrical i k LZ CA.76 Ir . Pk .s e S Signature of Owne gent Date
Sub- Mailing Address CI X Qck-�" 31 6, 6u
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Contractor
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City/State Zip Phone
Prior to permit (t�Ll op_ 0 i L ! ^Ol C 9 �
issuance, a copy l ( l C FOR OFFICE USE ONLY:
of all licenses are Oregon Const. Cont. Board Exp. ate
�� ,- Plat #: 7 Map/TL#:
required if Lic.# tt /
expired in COT l L - 1 / / O/ 17C D `,�n ,t-1 l � oc Sl �� & �dilO
database Electtical Lic. # Exp. Date Setbacks: Zone:
3- (9-6 L - !b -I - -Cl,l 7
Electrical Supervisor Lic. # Exp. ate (�i Engineering Approval: 'landing Approval: TIF:
IRS /Ls aii 10 CAA -20 _t 't. 3 70- 4F.
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