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Permit _ • CITY OF TIGARD ORLGINAL PLUMBING PERMIT sr� DEVELOPMENT SERVICES PERMIT #: PLM2000 -00246 �! DATE ISSUED: 6/28/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11525 SW WALNUT ST PARCEL: 2S103BA -00200 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of sewer service. FEES Owner: Type By Date Amount Receipt JENOVICH, M GLYNN MAXI NE PRMT DST 6/28/00 $50.00 0003329 11525 SW WALNUT AVENUE SPOT DST 6/28/00 $4.00 0003329 TIGARD, OR 97223 Total $54.00 Phone 1: Contractor: REQUIRED INSPECTIONS Phone 1: Sewer Inspection Reg #: 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. ' � / Issued By: L �r i Permittee Signature: ---- n4,1 1 -1 � jit Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bus' n ss day CITY OF TIGARD Plumbing Permit Application Plan Check # 13125 SW HALL BLVD. Commercial and Residential Rec'd By X 4 4 , TIGARD, OR 97223 Date Recd , 2, (503) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit # ?� - aaa y6 Related SWR # # g ) -c - Qa /70 Called Name of velopment/Project FIXTURES (individual) QTY PRICE AMT Job `ma, L; NDYt /'l Sink 11.50 Address / . Street Address 1 '' Suite Lavatory 11.50 ( (S •SW W - (L � f ` Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip Shower Only 11.50 Na a /J ,--1-,..!,‘,,, 4 a r' d 12 cf7 2 � Water Closet 11.50 1i VI (4 Urinal 11.50 Owner Mailing Ad Less , / Suite Dishwasher 11.50 L LS 25 5 L.I'/,LA r atxi Garbage Disposal 11.50 City/Sttaate Zip Phone Laundry Tray 11.50 v { v � ,/ ✓C� Washing Machine /Laundry Tray 11.50 _ i� a ' Floor Drain /Floor Sink 2" 11.50 Occupant Mailing ddress Suite 3" 11.50 4" 11.50 City /State Zip Phone Water Heater 0 conversion 0 like kind 11.50 Na �� et ' ��t Gas piping requires a separate mechanical permit. l tt ` / �f MFG Home New Water Service 32.00 Contractor Mailing AAddre s `( ite MFG Home New San /Storm Sewer 32.00 i 1,J am) } ,1, f l o fru- H ose Bibs 11.50 Prior to permit ity /re Aip Phone Roof Drains 11.50 issuance, a copy / r�� � (, ar Drinking Fountain 11.50 of all licenses are Oregon nst. on . oard L Exp. Date required if Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic # Exp. Date database Name Architect Sewer- 1st 100' / 38.00 or Mailing Address Suite 3� Sewer - each additional 100' 32.00 Engineer City /State Zip Phone Water Service - 1st 100' 38.00 Water Service - each additional 200' 32.00 Describe work to be done' Storm & Rain Drain - 1st 100' 38.00 New 0 Repair 0 Replace with like kind: Yes 0 No O Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial 0 Additional description of work. Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device* 19.00 Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No 0 Inspections per /hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I hereby acknowledge that I have read this application, that the information given is correct, that I am the owner or authorized agent of the owner, and Isometric or nser diagram is required if Quantity Total is > 9 that plans submitted are in compliance with Oregon State Laws *SUBTOTAL , ITC 0 ,1/1 ; t4 o wner /Agent ate 8 % SURCHARGE 141 IM �i � �oaB Y, TO Contact Pe n Name hone * *PLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178.00 Required only if fixture qty total is > 9 2 BATH HOUSE $250.00 TOTAL ,Sy go 3 BATH HOUSE $285.00 (This fee includes all plumbing fixtures in the dwelling and the first 'Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention 100 of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge "All New Commercial Buildings require plans with isometnc or riser diagram and plan review Q I \dsts \forms\plumapp doc 11/18/99 ✓ OD 35.az7, PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3" 4 " Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I \dsts \forms\plumapp doc 11/18/99 Permit #: ,4.No2e rera —0 O %2 ' of £Lbe .2 ere) —DO /7 O Ai �, Address: //5' Su) et) /9-4 JLL7 irrw ; ▪ " • •• Issued by: Date: lv /2P/D7) 1 = 5 — Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: roZif I own, reside in, or will reside in the completed structure. • 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale 17 before or upon completion. ll 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of t 1 is form. 4. - 0 ' 0 , ( gc,e,/ ig re of permit applicant) (Date (White copy to issuing agency permit file, pink copy to applicant) - lInformatio n Fi'hice to Prri perrity Owners ,_ About COnSfrLCti®L G esp ©nsobMM es Note: This In;orrnatjon Notice to Property Owners about Construction Responsibilities ' was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by, being aware of the following responsibilities and areas of concern. EMPLOYER RESPO JSi lLiTlES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 -8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378 -3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you.may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888. 1<J.. Internal Revenue Sersice: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1- 800 -829 -1040. OTHER RESiPONS98IiL ITIES AID*? AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If yoti have additional questions, write or call the Construction Contractors Board (PO Box 14140,. Salem, OR 97309 -5052, 503/378- 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem., prop- own.pm4 1 /94 �._.. .. — 1.0 I l2011JC/ - DEPT CoF`{ • TIGARD � ® ENGINEERING PERMIT CITY O PERMIT #: ENG2000-00046 'tu DEVELOPMENT SERVICES PRIM. PERMIT #: ENG2000 -00046 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/31/2000 SITE ADDRESS: 11525 SW WALNUT ST PARCEL: 2S103BA -00200 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: JURISDICTION: TIG PERMIT TYPE: SOP PUBLIC IMPRV QUANTITY LIN FT VALUE AGREEMENT DATE: GRA/EROS: ""`" ASSURANCE EXPIRATION STREET: " SAN SEW: ,, PERFORMANCE: STM SEW: " MAINTENANCE: PATHWAYS: " ALL OTHER: •' ** $300.00 TOTAL: $300.00 Remarks: STREET OPENING; TO INSTALL A 4" SANITARY SEWER SIDE SERVICE LATERAL, FROM AN EXISTING MAINLINE 'TEE', TO SERVE THE PARCEL. FEES Owner: JENOVICH, M GLYNN MAXI NE Type By Date Amount Receipt 11525 SW WALNUT AVENUE OPEN JSH 07/26/2000 $150.00 0004002 TIGARD, OR 97223 BOND JSH 07/26/2000 $300.00 0004002 Total $450.00 Phone: Engineer: . Phone: REQUIRED INSPECTIONS STM /SAN SEWER STREET Permittee / Applicant: MH /CB /CO CRB LINE & GRADE H & R UTILITY CONTRACTORS, INC PIPE LN & GRD SUBGRADE 2655 S.E. 39TH LOOP, STE. D BCKFLL & CMPCT BASE ROCK HILLSBORO, OR 97123 AIR & TV TEST LEVEL COURSE WEARING COURSE Phone: GRADING TRAFF & PED CONT CONTOURS MONUMENTATION DRAINAGE STREETLIGHTING Pe rm ittee/ P EROSION CNTL. WALK/APRON /RAMP Applicant Signature: : ", . / / A � REPR'S /ADJ'S PATHWAYS Issued By vU FOR INSPECTIONS, CONTACT THE CITY OF TIGARD, SPECIAL CONDITIONS: (SEE ATTACHED) ENGINEERING DEPARTMENT, AT: (503) 639 -4171 CI,';' OF TIGARD BUILDING INSPECTION DIVISION . 24 He Inspection Line: 639 -4175 Business Line: 639-4 71 . MST BUP Date Requested �� AM PM BLD Location / / 5 Z Scar L'�.G��'k,.,,f Suite MEC . Contact Person Ph 57f- 3 9 ! ) PLM o 2.®'t' - GU.Z Contractor • Ph y U f Z l( SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN • Crawl Drain ' Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler - Fire Alarm ` Susp'd Ceiling � /ice _ Roof , � � F AP- Misc: Final PASS T FAIL MBI Post & Beam Under Slab Top Out Water Service e—Tailitary Sewer) R ain R Fi fg,. PART FAIL HANICAL 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 1 `7 Inspector Oa Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. "•` -- .b -i3.iV 1 -0h C" ° :j 41 -,-% '0nfrru4+L1^dl`: 0, %. il4...f Y�,■=�;i - '. wr• 4. 'it= r '4.4`.a -v 'Jr'c �Y, +L^'•' 4�,, , ,9 _ • 4 - ` • ,^ ALOHA SANITARY SERVIC .. P.O. Box 309, BANKS, OREGON 97106 644 -2797 * 648 -6254 • 639 -5188 04199 _ ',, NAME: k C Co l_C\ Q� P • - ` ADDRESS: CITY: STATE: ZIP: ( 1 HOME: WORK: • CELL: ' A 1 r' - — JOB SITE: — I /SZ. gill, / J Atli P.O.#: PAID By CHARGE kr CHECK ❑ , CASH ❑ CREDIT CARD ❑ DATE , ( P- -2600 I DRIVER 061.0. 'jar, Ilea/ AMO UNT Fi PUMP SEPTIC TANK ._ i\a, 366 09- . ❑ LINE OPENING � : s ` , ❑ INSPECTION /FEE ❑ SERVICE CALL ❑" LABOR, LOCATING, DIGGING & BA KFILL - ❑ MATERIAL • „ _ - .£ . 2 iralei2 46 `'' i N -- - THIS IS NO A EPTIC SYSTEM INSPECTION REPORT y TOTAL $ - 300 - - - REMARKS - TYPE OF AN : STEEL ❑ CONCRETE ❑ __ PLASTIC ❑ HOMEMADE - - HORIZ I NTAL ❑ VERTICAL % RECTANGLE O OTHER 1 SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ ' " 000 ❑ 1250 ❑ 1500 ❑ 2000 Cl 3000 ❑ • LID LOCATION: INLET ❑ OUTLET % MIDDLE ❑ ENTIRE TOP ❑ - TANK CONDITION: GOOD ❑ F • R ❑ POOR ❑ FITTINGS: BAFFLES ❑ ONCRETE ❑ CAST IRON ❑ • PLASTIC O - NEEDS NEW LID? ❑ YES' SIZE GROUND COVER OVER TANK COMMENT ON CONDITION OF DRAINFIELD ETC. SIGNED ( 7 f/ Y DATE I ----°."----__--- •