Permit CITY TIGARD SEWER CONNECTION PERMIT
I�
DEVELOPMENT SERVICES PERMIT #: SWR2004 -00033
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/2/04
SITE ADDRESS; 15965 SW AVON PL PARCEL: 2S112CC D0021
SUBDIVISION: DURHAM OAKS ZONING: R - 12
BLOCK: LOT: 021 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 for new SF
Owner: FEES
BUENA VISTA HOMES Description Date Amount
6932 SW MACADAM #C
PORTLAND, OR 97219 [SWUSA] Swr Connect 3/2/04 $2,400.00
[SWUSA] Swr Connect 3/2/04 $0.00
Phone: 503- 443 -6033 [SWINSP] Swr Inspect 3/2/04 $35.00
[ SWINSP] Swr Inspect 3/2/04 $0.00
Contractor:
Total $2,435.00
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" Perm
Issued by: cat- Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next siness day
CITY OF TIGARD 24 -Hour ,.
BUILDING Inspection Line. 03i 39- 4175 -S
INSPECTION DIVISION Business Line (' • . 171
BUP
Received Date Requested e0 � AM PM BUP
S �
Location f S _ 4 vY1 PL-- Suite MEC
Contact Person Ph ( ) 7/0— PLM
Contractor Ph ( ) � ® y-'00D33
BUILDING Tenant/Owner ELC 3 /1� -d OJS)
Footing
Foundation ELC
Access:
y#g Drain �� � � ELR
Crawl Drain
Slab Inspection Notes: j SIT
Post & Beam l V �/
Shear c � —S � / O ,
Ext • �®
Ext Sheath/Shear
th/h /Shear /
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
P
P PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA z
% 1
Approach/Sidewalk Date / ' 1 � L( Inspector Est
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL