Permit •
CITY TIGARD SEWER CONNECTION PERMIT
44' ,I DEVELOPMENT SERVICES PERMIT #: SWR2000 -00355
' � II 13125 SW Hall Blvd., Tigard, OR 972 (503) 639 -4171 DATE ISSUED: 11/17/00
SITE ADDRESS; 10640 SW WALNUT ST PARCEL: 2S1026C -02002
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 024 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTP IMPERV SURFACE:
Remarks: Connection permit for existing single family residence. Septic tank must be pumped, filled or
removed and inspected. Reimbursement District #14 fee paid on this date.
Owner:
FEES
OLSEN, KENNETH E
OLSEN, SANDRA L Type By Date Amount Receipt
10640 SW WALNUT PRMT CTR 11/17/00 $2,300.00 27200000000
TIGARD, OR 97223 INSP CTR 11/17/00 $35.00 27200000000
Phone: V . 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 ma • • al •• • ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue • by: / Permittee Signature:
CaII (503) • • • -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 . Business Line: 639 -4171 MST •
BUP •
Date Requested AM PM BLD .
•
Location /bL SW Wec-e4 'd 3Y Suite MEC
Contact Person Ph S1/3 ' - (..6 PLM
—
Contractor Ph 5o3 �r �� 9y7f SWR t GU -3,5-1)
S C/�.0
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain _
Crawl Drain Inspection Notes: SGN
Slab SIT • -
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ■i � Fi re Alarm �
Susp'd Ceiling .. " /`�
Roof rr
Misc: _ . .
Final
PASS - PART FAIL ( - ' •
7 1/
Post & Beam -
Under Slab
TO Out
Water Service
Rain Drains
Fi g
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
PASS PART - FAIL _ V
SITE
Backfill /Grading • V • '
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 �Y/ Inspector )nird" Ext
Final
1
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. • .