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Permit C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2002 -00018 ` VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/23/02 SITE ADDRESS: 08260 SW HUNZIKER ST PARCEL: 2S101BC -02100 SUBDIVISION: ZONING: I -P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: FLOOR DRAINS: 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: 2 TUB /SHOWERS: 2 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: New fixtures: (1) backwater valve, (1) lavatory, (1) sink, (1) water closet, and reverse plumbing. Capped fixtures: (1) tub, (1) shower, (1) washing machine. Replaced fixtures: (1) 2" drain, (1) primer. Septic must be removed or pumped /filled & inspected. FEES Owner: • Type By Date Amount Receipt ANNAND, JOHN D II + EDNA N PRMT CTR 1/23/02 $99.60 27200200000 8260 SW HUNZIKER RD 5PCT CTR 1/23/02 $7.97 27200200000 TIGARD, OR 97223 ' Total $107.57 Phone 1: 503 - 620 -8668 Contractor: EARL WISDOM 3966 NE GARFIELD PORTLAND, OR 97212 REQUIRED INSPECTIONS Phone 1: 503-528-9551 Sewer Inspection Reg #: LIC 122960 Rough -in Insp P Top -out Insp LM 26 -620pb Misc. Inspection Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. • .a. Issued By: .. - Permittee Signature f , � � • ...rte �• Call (503) 63. 4175 by 7:00 P.M. for an inspection need - e next business day if l City Plumbing•Permit Application ' , �. i , Date received: � '. Z z d z Permit o.: �Op2007- - 0,90/ c7/ � ;z, Cit of Tigard n : _ `�J Tigard Sewer perm o.: -per /3 Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: • TYPE OF PERMIT . ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address:g2 £ s,+y,/ H ti ?.3 Ll k< w_. t''T , Description Qty. Fee (ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: Tax map/tax lot/account no.: 2 S 1 O i €L — 021 (S FR (1) ft. foreachutilityconnection) SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: ' SFR (3) bath City /county: " t a I ZIP: q 1 223 Each additional bath/kitchen Description and location of work on premises: /1/4"...4:10.113e) Nd Site utilities: i' i G. 4 c-45-/ Ns EG."T - ro 5 .)( l't Catch basin/area drain Est. date of completion/inspection: Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: 0172..L 4,/ /5;D p t.,..., Manholes Address: 39e4 6 c i Rain drain connector City: e I Staterie[ ZIP: 97 -/ d Sanitary sewer (no. lin. ft.) Phone Z -51. 9S J I Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: 49-3960 9r,U I Plumb. bus. reg. no:,G,- 490 P.5 Water service (no. lin. ft.) City /metro lic. no.: / Fixture or item: Contractor's representative signature: ki / r Absorption valve Back flow preventer • Print name: ..1,- SD i Date: / as --COP.. Backwater valve / CONTACT PERSON Basins/lavatory / Name: -A ® iJ 4 s: ,,.. Clothes washer Address: Dishwasher Drinking fountain(s) City: R e I State: I ZIP: Ejectors/sump Phone: 503402- Fax: E -mail: Expansion tank _ OWNER Fixture /sewer cap.- Name ( print):.J d'.1 i....1 ". ti.i a s A Floor drains /floor sinks/hub address: Garbage disposal Mailing C�32.( S' . H. L. I I� l!� Hose bibb City: '"T l /ct•IL 0 I State° , I ZIP: q 1 2.2.3 Ice maker Phone:5%5- ,2z s8 ' I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) / _ will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower, pan -- Urinal Name: Water closet / Address: Water heats City: State: I ZIP: Other: (-l i2 we,12s P 1 f - Phone: Fax: I E -mail: Total 7 Not all jurisdictions accept credit cards, please call jurisdiction for more information Minimum fee $ ! ' -5-o N otice: This permit application Plan review (at %) $ S, R'L� ❑ Visa 0 MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) $ Expires TOTAL $ `l 8 ' — Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount • 440-4616 (6/00 /COM) PLUMBING PERMIT FEES: \.... ' 't ''3:-., ,., : s; .r ^ i • efriv:'dWeilio r sroR ' . . " '; 4 t �';%., `'f ? �,:� �-. ,�- e � t € � -°� "�'. aPRICE •.4 ' ' TOTAL � E'New „1� °and 2fa.. Y< 9 Y ° ��E t. , . � 4. FIXTURES,:.(individual)' " °' . QTY �v # AMOUNT` - '(includes ail plu � 0 4PRICE y TOTAL -, Sink / 16.60 / , 40 Nthe,Iclyielling'aricyhe1i,M1,00., ft: ' . ,QTY 4,(ea) �,AMOUN, T- ,for each;utility:connection) '! '` 1 ' „•, 1 .- , Lavatory / 16.60 /6 D One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath • $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet / 16.60 / 6 , ‘,U SUBTOTAL Urinal 16.60 8% STATE SURCHARGE '_, aM.: t•, ' _ Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL 7 � ' - ;'; -∎ ` "'_ Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE 4" 16.60 ,,. , •1 - Y i , § ', - -,. , •- -' vQuantity b yY " oitmed • Water Heater 0 conversion 0 like kind 16.60 �_, �+ �..x , ,;� �� � AA Gas piping requires a separate mechanical 'Fixture Type:w-:,;; : ; � M�Ne\n['`''' . ; Replaced ', permit. ,, ... P« . " • -, pei$ 7 p - t, .: Capped MFG Home New Water Service 46.40 Sink / - ' MFG Home New San /Storm Sewer 46.40 . .to • /.. i Tub lr Tub /Shower Hose Bibs 16.60 - .mbination / Roof Drains 16.60 Shower Only - / . --' / , - Drinking Fountain 16,60 Water Closet / - -„2 L � 1 / Urinal , Other Fixtures (Specify) A�wa I(p ) 16.60 /6 , too Dishwasher P R I M ER I / ‘ kD J 6, to 0 Garbage Disposal Laundry Room Tray Washing Machine / ' / i Floor Drain /Sink: 2" .," ' / • v ,/: Sewer - 1st 100' 55.00 3 „ Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Ot Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 • �� e �,�, - Storm .& Rain Drain - each additional 100' • 46.40 `�+ Commercial Back Flow Prevention Device 46.40 St /"irMI' . / f / Residential Backflow Prevention Device' 27.55 • Catch Basin 16.60 Inspection of Existing Plumbing or Specially - 62.50 • Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 • Grease Traps 16.60 QUANTITY TOTAL t' ; ! pz z,R k " ' . Isometric or riser diagram is required if ' ` :.` ' >, ,* !' ' . ': m Quantity Total is > 9 _ ° '' a K`�r' , , *SUBTOTAL 7,7,y' ?; 0 • 8% STATE SURCHARGE 2, 97 ""'PLAN REVIEW 25 °/. OF SUBTOTAL ` � S " 4 //2 3 D Z w Required only if fixture qty. total is > 9 � 1 11:{n} <_x p;Q TOTAL 4 - <:, ;= ; .. ./d 7, s7 Ar e l E s /ET�M - ,vT /°/24 LJ /.©c- fr7,7742 - CO - anJ 7 * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25•+ 8% state surcharge. re ,t e ete /e.- .%)/N.- "All New Commercial Buildings require 2 sets of plans with isometric or riser -e � � diagram for plan review.] PV . Cc 4-?T g &72. eOA N Al i=esZs • i : \dsts \forms\plm - fees.doc 12/26/01 • . . 18625 . WORK ORDER - P.O. Box 30087 Complete Portland, Oregon - . - Industrial Waste 97294 Removal : in , A [IV A ©OT/ Septic Tank Cleaning • Sump — Line cieaning , , • V V V V ENVIRONMENTAL INC: - t . • . . • . • ' LIQUID WASTES DIVISION • • . --) r— . . (503) 252-6144 C,-. 7- '"1----- --D \,.-) Customer P.O. # Date 3 . Billing Name 3 (3\C‘N i i : ‘ Nil■, ) PIN\ Av, - v : 4. .., Address k, r 41 Asir MB 1 AL 4-- ...... , - si- Job Site # i t'I', ,-- .:• City §ti4 - nk: , Zip Code 9 7,3„.....3 , Ordered By TS ;;:,; `:z-,p::: nf Phone#` ' - .-- Date ,,;., -.: ', -'.' '• Job Location , v.„ _...._.-,, Q, j \'S,r\-\0 • 1 — , - • ,..--. ..,-,,, - • , • . . Service Call , :;!4 . : , ,„., •-: V Labor $ ..,____ i -A41 Pumping gallons ,=-.1 WIt $ — 1 . 0 Misc ,.,\ / / // $ — L' ? u L . % k r' '''' , • Conditions of tank/Distribution Box „ 0 ._, t ( L” 7 .,. tri /2 TOTAL CHARGES (--- t t v p River City Environmental Inc. is in no way responsible for damage to the septic tank or lids on the system. TERMS: Net 10 days. 1 per month will be charged on past due accounts. (18% per annum) ..- Customer's Signature: .--. 1 , ,, , . fl. 1 f ,A / f fl:f :It fi t \ ) f t A / : T --, Service Drivers Signature = / Ai , q - -- If :v‘ ', ' Time i. U` Date --)` crs (- TERMS AND CONDITIONS ON REVERSE SIDE REDEEMABLE IN MULTNOMAH COUNTY. titidittA g _.ra9'i 4141 igiAgil W.WV.if . ir=11 .V.1■IV:0 . . . . Invoicc 04/08/02 GARCIA CONSTRUCTION CONTRACTOR: Armando Garcia 6427 N. Princeton St, Portland, Oregon. 97203 Service for: Jhon }7. Annand Project located at: 1.Retn.ave le tank. $450.00 Total amount $450.00 i�ratb 4`B /cam This price include all the material / labor and dean - up. Thank you. GARCIA CONSTRUCTION CCB # 117329 6427 N. Princeton St. Portland, Or. 97203 Phone (503) 286 -3268 Fax (503) 289 -7816 Cell. Phone (503) 309 -2069 • I Inv J CItY CiF TIGARD 24 -Hour Ar BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM PM BUP Location g '2 - 66 Suite � f)61 - Z ~a c// Contact Person Ph ( ) 62R 0 -- S - 66e / PLM fit+ Contractor Ph ( ) SWR ' 2 2 - 00013 BUILDING Tenant/Owner ELC Footing Foundation ELC cess Ftg Drain ELR Crawl Drain Slab Inspe lion Notes: g, SIT Post & Beam Shear Anchors /) ; 6 Ext Sheath/Shear / Int Sheath /Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof ,— (/" Other: Final PASS PART IL PLUMBING Post & Beam Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: c:=1; zi-LJII - 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 F PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 111 Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line ADA Date $ Inspector 7 0 o �- Z ' � +� Q - Ext Approach /Sidewalk P L, Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL