Permit CITY TIGARD SEWER CONNECTION PERMIT
Ati„,„,,,, DEVELOPMENT SERVICES PERMIT #: SWR2001 -00191
! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/15/01
SITE ADDRESS; 12320 SW TIEDEMAN AVE PARCEL: 2S103AA -01906
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 009 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: Sewer connection.
Owner: FEES
MARTIN, RICHARD E Type By Date Amount Receipt
12320 SW TIEDEMAN AVE
TIGARD, OR 97223 PRMT CTR 6/15/01 $2,300.00 27200100000
INSP CTR 6/15/01 $35.00 27200100000
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 copi- of these rules or direct questions to OUNC by calling (503) 246 -1987.
i �
Issued by: / ; �� / � J Permittee Signature 411 11
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day
• CITY OF TIGARD BUILDING INSPECTION DIVISION
4-Hour . pection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested / u Z 3 AM PM BLD
yr-
Location ) 3 Z 0 ` Suite MEC
Contact Person 1 ) Ph (o (� g'Z ?_( PLM r C O /
Contractor Ph SWR n / - GO l q
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Slab
Crawl Drain Inspection Notes: ` f �� SGT
SIT
Post & Beam •
Ext Sheath /Shear inn/ • '
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final •
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
tart ary ewel)
Rain rains
Final
PASS 4, FAIL Aia � /�
/ ` S � 0112 1 c4 7:c2A 4 Fy I
MECHA L .4
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 Date /O/ / Inspector X /� ' E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
WY.OF TIGARD 24 -Hour • -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested L7 AM M BUP
Location ? 3Z-6 T Suite MEC
Contact Person fit . Ph ( 8= ? PLM Of
Contractor Ph ( ) SWR Zoo f —ct7 ( 7i
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: .�- SIT
Post Beam �
Shear r 1ae
Anchors ��// •
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART AIL
PLUMBING
Post & Beam
Under Slab
Rough -In $�
Water Service
arntar ewe
am rains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
��' mss? PART FAIL
CHANICAL
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 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 6 7////6 7- Inspector 1 ,, ' `� Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL