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CASCADE PHILLIPS Co.
SANE-POT
P.O Box 47
OPS GON CITY, OREGON 97045
656-9415 X45.9009
1 800-452-8379
7E �'
UAt
901D 9V CABH C O.D. CHARGE ON ACCT. MDB�'.gCt'D. PAID OUT T—_
Y. DESCRIPTION PRICE AMOUNT
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TAXIRECEIVE)Rv - --
TOTAL 1
All Clalrns and returned goods
1 0 7 MUSK be accompanied by this bill "Aank `You
INSPECTIs i MOTT
City of Tigard Building ..epartaent
13125 s11 Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-•4171
Inspections _ — ---
Footing Pl.bg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mach..
/ S e-1L
Date Requested: l Ti',c° Ali --PH
Address: �- _ Permit #:_
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
-7
Inspector: �i'� �` -- Date•-- �
APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIFA -FTMID SEWER CONNECTION
'COMMUNITY DEVELOPMENT DEPARTMENT 0109M PERMIT
13125 SW Hell Blvd P.O.Bac 73307.Tigmid.Oregon RM(503)639-4175 _7 'ER11TT #. . . . . . . . SWR 92-01 6 i
DATE IGS�3ED: CA6/05/92
SITE ADDRESS. . . : 13535 SW FERN ST PARCEL% 26104BD-01100
SUBDIVISION. . . . : OBRS HEIGHTS ZONING: R--6
BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . : 12
TENANjr NAME. . . . .
USA NCI. . . . . . . . . . : FIXTURE UNITS. . . .
CLASS OF WORK. . . :ADD I)WF[-.[-I NG UN I TES). . 2 1
TYPE OFUSE. . . . . :SF NO. OF BUILDINGS.- I
INSTALL TYPE. . . . :BUSWR fMPERV SURFACE. . : " S1
remarks: Conner-,t existing SFD to Sewer. Hoose constrcicted prior to 7-1-70.
17P()tic tank mi.tSt he pl.%Mped fil.it and filled with sand or gra-vel.
Owner: FEES
ROD KVISTP. type amol..tnt by cl<At L? recpt
135otj SW FERN ST PRMT $ 300. 00 JLH 06/05/92
INSP $ 35. 00 JLH 06/05/92
TIGARD OR 97212-31
UTIOne #:
Lont ract or:
OWNER
-----------------------------------------
0-,one $ 335. oo tol-AL
g 00000
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unifita Sewage Agencv. The permit expires '180 days from Septic lank Fill
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency dot not guarantee the accuracy of the
side sewpr laterals. If the sewer is not located at the measurement
givtn, the installer shall prospect 3 feet in all directions from
the disto, i given If not so located, the installer shall purchase
a 'Tap d Side Sewer' Permit and the Rafftrrrill stall a lateral.
Permittee Sign atLtr
Call for inspection 639-4175
—A
7 OF `113115 sw liaa Blvd. PLWCK/RECT #CIr IY TIIJARD lOBox 23397 PERMIT # �JC�./�9?� " C>-le
COMMUNITY DUVELOPMENT DEPARTMENT Tiprd.Oregon 97213
(503)63"171 DATE ISSUED
JOB ADDRESS: /.3-5" 3 ,5 `5 Rn_/ TAX MAP/LOT c7
SUB: LOT: _ — LAND USE:
VALUATION:
OWNER _ SPECIAL NO FS
NAME: p REISSUE OF: _
ADDRESS: LAST REISSUE:
FLOOD PLAIN/
PHONE: _.;S " 76' SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: PLANNING:
AF—ESS: ENGINEERING:
FIRE DEPT:
PHONE: OTHER:
CONTR. BOARD #: EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ _ _ LIST/SUBCONTRACTORS:
MECH: BUS TAX:
ARCH ENGINEER CALCULATIONS:
NAME: TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE: --7--
COMMENTS:
COMMENTS:
APPLICANT ,tdNAFURE y V
Received By: __ — Date Received: __ ,_
PERMrT # ACCT # DESCRIPTION AMOUNT AMOUNT P0. BAL, DUE
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10-431 01 Mechan;,:ai Permit Fees
10-230 01 State Buil,'ing Tax (5q)
Building _
Pl umbi ng
Mechanical
10-433 00 Plans Check Fee
Building
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection -3C> _
30-444 00 Sewer Inspection 3 �{
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (POC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of) _
24-445-02 Water Quantity (Fee in lieu of)
TOTAL_
nm/3587P.WPF
CITY OF TIGARP RECEIPT OF PAYMENT RECEIPT NO. sge--228059
CHECK AMOUNT ;3:3:x. 00
NAME KVISTAI)v C. RODERICK CASH AMOUNY 0. 00
ADDRESS 1,'-535 SW FERN RD PAYMENI DATE v 06 IQI 5/9 '
TICARD, OR 97223— SUBD I V I G,I ON
PURPOSE OF PAYMENT AMOUNT VIA I I) PURPOSE OF PAYMENT AMOUNT PA I'D
SEWER USA 300. 00 SEWER INSPECT 35. 00
SEVIER PERMT'(
TOTAL. AMOUNT MAID 335. 00
'(X' SEIYU INTERNATIONAL
SE(YU
TEL: (503) 245-4090•(503)245-4435 FAX(503)245-4351
date:
To whom it may concern;
_i�dC�elCr _ L� __ of
has contributed to our satisfaction on the public sewer line that
we have installed on 135th Avenue , Tigard .
Project 1( 89340
Summit at Bull Mountain , Phase I
This letter is to serve as a "Letter of Participation" concerning
the above public sewer line project .
Sincerely ,
l
Kurt VanVolkenburgh
General Manager
Lincoln Center • 10220 S.W. Greenburg • Suite 450 • Portland, Oregon 97223