10880 SW ERROL STREET t
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10880 SW ERROL ST
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLI 12003-00604
13125 SW Hall Blvd., Tigard, OR 97223 (501) 639.4171 DATE ISSUED: 4/23/04
SITE ADDRESS: 10880 SW F_RRUL ST
PARCEL: 23103AD-00401
SUBDIVISION: ECHO HEIGHTS ZONING: R-4 5
BLOCK: LOT; 013 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: 130 ft
"NATER CLOSITS: WATER LINE: ft
L,;S HWASHERS: RAIN DRAIN: ft
Remarks: Connect to sewer, approximately 130' of sewer line & reversed plumbing under(1) house.
FEES
Owner; — --
Description Date Amount
SEVCIK, FRANK E JOAN L --�`--
10880 SW ERROL ST I I'LUNIBI 1'ermit Fee 4/26/04 $163.96
TIGARD, OR 9722s I I'AX) R",'n State Surchart 4/26/04 $13.11
Total $177.01
Phone :
C intr3ctor:
THEODORE D. MCEEE
13691 SE WILLINGHAM CT
CLACKAMAS, OR 97015-7253 REQUIRED INSPECTIONS
Phone : 503-239-2909 Sewer Inspection
Misc. Inspection
Reg#: LIC 75513 Insp existing/capped fixtures
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all 0her applicable laws. All work will be done in accordance with approved
plans. This permit will ;e 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
Is�ed By: — LL`��LG1 ,� Permittee Signature:
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business rhy
BuildinV Fixtures
Plumbing Permit Applicatimi F0k,0FV10E UgE.IRN1,1V
City of Tigard Received 1 Pcinut,4o il
Tigard,OR 97213 /! Date/B : //
13123 SW Hall Blvd.,Ti 0
g Alan Revie
Phone: 503.639.4171 Fax. 503.598.1960 Dates: Y /f t t Other Permit No.:
24-Hour Inspection Line: 503.639.4175 Dace ReadytBy f ® Seepage 2 for
Internet: www.ci.tigard.or.us Notifed/Method Sup,' mental Information
" TYPE OF WORK FEE" 'SCHEDTil
n
[�New consna etion For s ectal in ormarion use rkeckilsL
❑Demolitio -Q --
- - ---"---- Description I Qty, I Es. I Total
❑Addition/alterauotvi_placement ❑Othet _ New 1-2-family dwellings(includes 100 It.for each utility connection)
ql` F CONSTRUCTION SFR(1)bath 24920
�] 1-and 2-family dwelling a _U Commercial/industrial SFR(2)bath 350.00
[�Accessory building ❑Multi-family SFR(3)bath 399.00
- — - Each additional bath/kitchen 45.00
-^� V JOB SITE INFORMATION AND Fire sprinkler(_sq.R.) Page 2
M Master builder ler:
LOCATION
_ Site utilities
Job site address: g�J C f f Gij F r r a 1 Catch ba3in or area drain 16.60
City/State/ZIP: , ' Drywell,leach line,or trench drain 16.60
Suitc�bldg./apt.no.: Project name: Footing drain(no.linear ft.:_J Page 1
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear ft.:`JY Page 2
Storm sewer(no.linear A ) Page 2
--
Subdivision: Lot no.: Water service(no.linear R
- - Fixture or Item
Tax map/parcel no
Absorption valve 16 60
DESCRII'T1QN O ,tp Q la Backflow reventer Pag
e 2
- P
Backwater valve 1660
Clothes washer 16.60
-- _ Dishwasher 16.60
Drinking fountain 16.60
Ejectors/sump 16.60 _
Name: -;- _ Expansion tank 16.60
Address: Ig?�C� E r ro 1 Fixture/sewer cap 16.60
City/State/ZIP: oFloor drain/floor sink/hub_ 16.60 —�
Phone:(93) �7 r 2 Fnx:( ) Garbage disposal_^ 16.60
A�'13)r ICANT t Hose bib 16 60
[I.CONTACT PEi SON
----= -- -- - -- Ice maker 16.6r,
Business name:
_ Ca Vfl 1114 _ interceptor/grease nap 16.60
Contact name: 1 t 15 CSL i ^ _ - Medical gas(value:$,) Page 2
Address: I /q 5 / f� Primer 16.60
of drain(commercial) 16..60
City/state/ZIP: SinWbesivlavatony 1660
Phone:( ) ' ILFax:
-�
y
Tub/shower/shower pan 1660
E-mail Urinal 1660
Water closet 16.60
Business name: —4 Water heater 1660
Address: — Other: �S
Subtotal
City/State/ZIP: -- --
Minimum permit fee $72.50 ,/_��
Phone:( ) Fax:( ) i Residential backflow minimum permit fee $36,25
CCB Lic.: , 3 471 1.0 V I Plumbing Lic.no.: -- Pian review (25°x,of permit fee)
State s.rcharge(8%of permit fee) ,
Authorized signature: j TOTAL PERMIT FEE172O
Print name: ►C}C10 Syk_— Date: y This permit application expires if a permit Is not obtained within
180 days after it has been accepted as complete.
,,Fee methodology set by Tri-County Building Industry Service Board
i\Buildrna\rcrmru\PLMF-PeinikApp doc I Vii 440-4616-r(I0U11C0MfwE8)
11himbinm Permit Application - City of Tigard
Page 2 - Supplemental Information
F'ec_Schetlule:_ _ _Residential Fire Suppression Systems:
Site Utilities, Qty. Feeea) Total I Square Footage: PeJ mit Fee:
Footing drain-l"100' 5500 0 to 2,000 $115,00
Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00
,r 3,601 to 7,200 $220.00
Sewer-I st 100' 55.00
�`> 7,201 and lZeater $309.00
Sewer-each additiowil 100' / 46.40 C
water Service-1st lfo' 55.00 Medical Gas Systems:
Wa:er Service,-each additional 100' 46.40 -
Sturm&Rain Drain-1 t 100' 55.00 Valuation: Permit Fee:$1,00 to$5,000.00 Minimum fee$72.50
F:, n&Rain Drain each additional !00' 46,40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1,52 for each
I+ixture.4r item Qty. Fee(ea) Total
additional$100.00 or fraction thereof,to and
including$10,000.00.
Cenunercial Bac::i' %k Prevention Dc%is 440 $10,001.00 to$25,000.00 $148.50 for the first$10.000.00 and$1 54 for
Residential Backilow Prevention Device each additional$100.00 or fraction thereof',to
mininturn permit fee$36.25 27.55 and includin $.5,000.00
Rain Drain,single family dwelling _ 65.25 $25,001,00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Inspection of existing plumbing of
each additional$100.00 or fraction thereof,to specialty requested inspections- S hour 72.50 and including$50,000.00.
$50,001,00 and up $742.00 for the first$50,000.00 and$1.20 for M
Subtotal: each additional$100.00 or fraction thereof.
t j
Fixture Work:
Are you capping, moving or- replacing existing,fixtures? If
"yes",please indicate l%ork performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
uan(ltt b LiFixture)Work Performed
Fixture Type: Replace
Moved 611511"6 Capped Comments regardllig fixiiire viiork:
fia nstr Font -bath -Tub/Shower
-Jecuui/Whirl ool
Car Wash -Each Stall
-Drive Thru -- -_--_- -- --
Cu idor/Water Aspirator
Dishwasher -Commercial
-Domestic _ —
Drinking FountainEye Wash _
Floor Drain/sink .2" - -
3"
4„
_ CarWash Drain -_
Garbage-Uontestiestic
Disposal -Commercial *Note: if the fixture work under this permit results in an
Industrial
Ice Mach.iRefri .Drains increase of sewer EDUs
a sewer permit will be issued and
�
Oil Separator Gas Station) fees assessed for the sewer increase must be paid before the
Rec.vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stail - -
Sink -Bar/Lavatory
-Bradley — Quantity Total
-Commercial Isometric or riser diagram is required if fixture quantity
-Service total is>9.
Swunmin Pool Filter _
Washer-Clothes
Water Extractor _ Plan Review
Water Closet-Toilet Plan review is required if fixture quantity total is?9.
Unnal -
Other Fixtures:
i�Bui!dtngla nt;ILM PermitApp doe 3•103
CITYO F T I G A R L SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PFRMIT#: SWR2003-00392
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 11/25/2003
SITE ADDRESS; 10880 SW ERROI_ ST PARCEL: 2S103AD-00401
SUBDIVISION: I (*l IU I I I:I(;I f l S ZONING: It-4.5
BLOCK: LOT: U 13 JURISDICTION: TIG
TENANT NAME:
USA NO: FIX'rURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect to sewer reimbursement District#21
$5947 paid, receipt 2720035160
Owner: — FEES
SEVCIK, FRANK E JOAN L -- — �`---
10880 SW ERROL ST
Descriptio-, Date Amount
TIGARD, OR 97223 1SWUSA, Swr Connect 11/25/200 $2,400.00
1tiWIISA ISwr Connect 11/25/200: $0.90
Phone: ISWINSP) Swr Inspect 11/25/200: $35.00
1tiWINSP] Swr Inspect 11/25/200 $0.00
Contractor: - — --
-- -----------
Total $2,435.00
Phone:
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The perm!t expires 180
days from the date issued The total amount paid will he forfeited if the pur mit expires. The Aoency does not guarantee
the accuracy of the side sewer laterals If the sewer is not located at the measurement given, the nstallei 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 OAP, 952-001-0010 through OAR 952-001-0100 You may obtain copies
of thase rules or 6irect questions to OUNC by calling (503) 246-6699
Issued by: Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
i
INVOICE
4647
I:
P.O. Box 2349
Oregon City, OR '
97015
E"OC Complete
New Installations Industrial
r■w■r■■
WasteRe air Existing Systems ■a ■ ■■r■w ■■
Sewer Connectionsrr r' ■ ■r ■ 0:0 .0 r ■■ ■ ■
r ■ r r ■ . ■ Removal
Drainflelds w" ■■r@■ w w w r w ■r r w n a w Septic Tank Cleaning
Cesspools Sum
Excavating Line Cleaning
'irhmond Construction Ent., Inc.
(503) 253-7537
APut 9-10:00 a.cn. La:rIiar c.i ,.ALL
i�
Customer P.O.# Date 4/30/04
Billing Name
Address 13691 Svr, 4iltingiiam Ct.
Job Site#_ j
Cit Clackamas OR 97015 �
Y State Zip Code i
Ordered By red Phone# 502-3.511 Date 4/29/04
Job Location x-st. -Vlalnut Ave. ( 10380 SCJ Errol/Tigarrl)
��rrlolao3-oo�o�f
Service Call
Labor _ $
Sep 500 180. 00 n 7�
Pumping gallons � _ $ ,,,
Misc
70
Conditions of tank/Distribution Boomou
i r4/►7/,j%e:� ,.fh �I ' elf,45 rIr wr f.J T •'• (� "r
TOTAL CHARGES
" Fnviroclear Is in no way respr nsibie for damage to the septic tank or lids on the system.
TERMS:Net 10 days.1-1/2%per month will be charged on Fast due accounts.(18%per annum).
Customer's Signature:
Service Driver's Signature Time t /S- Date sed- Oy
TERMS AND CONDITIONS ON REVERSE SIDE REDEEMABLE IN ALL COUNTIES
Siler:D•wvl+-r �p,(A!"1p•�1F1'"*'•"�...� .I'R�'`."ry' 1 '.
TERMS AND ('ONDITIONS
rHE CUSTOMER AGREES TO NAY All INVOICES ARISING OUT OF PUMP-
ING SERVICES, AND ANY OTHER SPECIAL SERVICES HEREIN WITHIN 10
DAYS FROM THE DATE OF INVOICE.
THE CUSTOMER A GEES TO PAY SUCH EXTRA AND OVERTI%i_
CHARGES AS MAY r3E INVOICED FROM TIME TO TIME: FOPSERViC'ES'
RENDERED.OVER AND ABOVE THE NOPMAL SERVIC►NG SCHEDULE, ON
BEHALF OF THE CUSTOMER.
THE CUSTOMER AGREES TO ASSUME RESPONSIBILITY FOR ANY DAM-
AGE TO CUSTOMERS OWN REAL OR PERSONAL PROPERTY AFkSING
FROM PUMPING SERVICES WHICH TAKE PLACE ON CUSTOMERS PREM-
ISES, WHERE THE DRIVERS AND VEHICLES OF ENVIROCLEAR HAVE
BEEN INSTRUCTED TO ENTER.THIS INCLUDES, BUT IS NOT LIMITED TO
DRIVEWAYS, TREES, POWER LINES OR POLES, AND BUILDING, STRUC-
TURES.
IF ENVIROCLEAR FINDS IT NECESSARY TO ADD LIQUID TO THE TANK ON
,.JOBSI'rE. CUSTOMER WILL BE CHARGED FOR THE. ADDITIONAL GAL-
LONAGE RESULTING FROM THESE CONDITIONS
CUSTOMER AGREES TO REIMBURSE ENVIROCLEAR SERVICE FOR ALL
REASONABLE ATTORNEY'S FEES, COURT COSTS AND OTHER EXPENSE
INCURRED BY SAID COMPANY TO ENFORCE COLLECTION OR TO SERVE
THEIR RIGHTS UNDER THIS AGREEMENT.
CUSTOMER AGREES TO THE ABO%!, CONDITIONS
REDEEMABLE IN ALL COUNTIES.
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171
J
UP
_
Received Date Requested -3U _ AM _CM_ � BUP --
Location � G K�U ��� Suite __ MEC
Contact Person _ �— Ph( ) 5Z)2,-35) 11 P L cin
Contractor _ Ph( ) SWR
BUILDING TenanVOwner ELC
Footing - ELC
Foundation Access:
Ftg Drair. ELR
Crawl Drain
Slab Inspection Notes: SIT -- -
Post&Beam -_-
Shear Anchors T'
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -- - -- -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ------ �T
Root
Other: ---�--
Final
PASS _PART FAIL
PLUMBING _ _ —__—
Post& Beam ^
Under Slab -- --
Rough-In
Water Service - -
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain -� -
Shower an
CFi
FPAS PART_FAIL_ V-
MECHANICAL
— -
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 Please call for reinspection RE:_ F-1 Unable to inspect-no access
Fire Supply Line / / �i��•,
ADA y ',� �/ , /
Approach/Sidewalk b� --.._�--__ Inspector �e,L Ext--
Fina Other: -_ DO NOT REMOVE this Inspection r�cord from the job site.
PASS FART FAIL