Permit CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2000 -00071
M DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 04/19/2000
SITE ADDRESS; 08850 SW PIPPEN LN PARCEL: 25111 DA -15000
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R -7
BLOCK: LOT: 143 JURISDICTION: TIG
TENANT NAME: LEGEND HOMES
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USA NO: C ^ FIXTURE UNITS: 1
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF O� `v NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for a new single family dwelling.
Owner: FEES
MATRIX DEVELOPMENT CORP Type By Date Amount Receipt
6900 SW HAINES ST STE 200
TIGARD, OR 97224 PRMT GEO 04/19/200C $2,300.00 0001542
INSP GEO 04/19/200C $35.00 0001542
Phone: Total $2,335.00
Contractor:
•
Phone:
Reg #:
Required Inspections
`i
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 cop' of s rule direct questions to OUNC by calling (503) 246 -1987.
Issued by: i %`' - Permittee Signatur _ _�i /' —• �L�
Call (503 .39-4175 by 7:00 P.M. for an inspection needed the next busi ess day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST 7.000 -00/0
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/, , / BUP
Date Requested 5 /1 /0 3 AM PM �c BLD
Location O gSO el - Suite MEC
Contact Person l r,e, Ph V I - $'0 S PLM
Contractor Ph SWR f le0VOL,C0 (
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
awl Dr�n Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Fi
PART FAIL
UM BIN
Post & Beam
Under Slab
Top Out
iIfira
c41 rrra
Fin
A 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
Other Date Inspector 1, 7 2 2 Ext
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.