11015 SW ERROL STREET-1 11015 SW Errol Stmet
CITYOF TIGAR® SEWER CONNECTION PERMIT
\` DEVELOPMENT SERVICES PERMIT#: SWR2002-00321
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/3/02
SITE ADDRESS: 11015 SW ERROL ST PARCEL: 2S103AA-00802
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS-
INSTi LL TYPE: I.TPSWR IMPERV SURFACE:
Remarks: Spwet connection to newly installed sewer lateral. Reimbursement district t# 21
Fees Haid $6,000.00.
Owner: FEES_
OLSON, RANDY S + NANCY
11015 SW ERROL ST Description Date Amount
TIGARD, OR 97223 [SWUSA}Swr Connect 12/3/02 $2,300.00
[S W USA]Swr Connect 12/3/02 $0.00
Phone: [SWINSP]Swr Inspect 12/3/02 $35.00
1SWINSI11 Swr Inspect 12/3/02 $0.00
Contractor: -�
Total $2,335.00 ---t 7-J
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The-t,ttal.arnGwnt-Said-wilt be forf4 ited4-"perfrrit-expire3r'The Agency does not guaranter-
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" Perm
Issued b Permittee Signature:
Cell (503) 639-4175 by 7:00 P.M f�,! in inspection nee(ijd tho next business day
Building.-Fixtures�I
7- 41(11 USE. ONLY
Plumbing P r*rtnit Application III
--- i)ate received Permit no.
City of Tigard Sewer permit no.: Building pem it no.: —
Address: 13125 SW Nall Blvd,Tigard,OR 97223 projrct/appl.no.: Expire date:
C11yOfNard Phone: (503) 639-4171
Date issued: By: Feceipt no.:
Fax: (503) 598-1960 -
Case file no.: Payment type:
Land use approval:
LJ1 &2 family dwelling or accessory U Commercial/industrial ❑Multi-family U Tenant improvement _
U New construction U Addition/alteration/replacement U Fred serviceLlystil ❑Other:
t t
KO
L 5-rec-- Descripliun Qt . Fee(ea.; Total
Job address: D �� (al ��RD ew 1-and 2-family dwellings only:
Bldg. no,. Sidle no.: (includes 100 ft.for each utility connection)
Tax map/tax lot/account no.: SFR(1)bath ---
Lot: Block: Subdivision: — _ SFR(2)bath
Project name: SFR(3)bath --
Z[P: Each additional bath/kitchen
City/county: ---- Siteufilities:
Description and location of work on premises: _�._ _ d Catch basin/area drain
p1 -
_ Drywells/each ins/trench drain
Est.date of completion/inspection: Footing drain(nc,,lin.ft.)
' Manufactured home utilities
Business name: _ Manholes
Addr ss: ! Rain drain connector
Stale: P: Sanitary Sewer-(no. lin--fl.)r�rryl�Cc'
City: Storni sewer(no.tin. ft.)
Phone: Fax: tl Water service no.lin.ft.
CCH no.: — Plumb.bus. g.tr : __
Fixture or Item:
City/metro I c.no.: Ab so tion valve
Contractor's representative signature: Back flow preventer
Print name: Date: Backwater valve
Basins/lavatory
Clothes washer
Name: Dishwasher
Address Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E-mail: Expansion tank _
Fixture/sewer can —
Floor drains/floor sinks/hub
Name(print): _Cl.i lC�b l i l bade is osal _
Mailing address: J kk 01, J1 Klose bibb
City: rl '? 1) State:t)f� ZIP:<17 ZZ 3 Ice maker
Phone:`,) (c' 0 `>1N0 Fax: 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 commercia
employee or,the property I own as per ORS Chapter 447. Si k(s),�asin(s),lays(s)
ump
owner's signature: _ Date: _--
Tul�s/mower/shower pan
Urinal — -
Name: _ Water closet
Address: _ -_ _.. Water eater
�— Sta►e: iIP: Oter:
City: -
Phone: Fax F-mail ota
Minimum fee................ SNot all Jurisdictions accent credit cards,please cd:Jurisdiction for more Infurmaltott. Notice: This permit application Plan review(at — %) S _---
U vise o MasterCard expires if a permit is not obtained State surcharge(8%).... $ ---
Credit cud number. — within IRO days after it has been TOTAL...... .......... . S
np+res accepted as complete. .
Name of car older a shown—on credit card $
410-4616 IWOQII:OMI
A°O1°t
Car der signature 1 •—
PLUMBING PERMIT FEES:
PRICE TOTAL. New 1 and 2"farilly dwellings o ply:
FIXTURES (Individual) _ QTY ea AMOUNT (includes all plumbing fixtures h1 PRICE TOTAL
Sink 16.60 the dwelling and the firstl0o ft. QTY (ea) AMOUNT
Lavatory 16 80 for ear!:udlity connection
One(1)bath _ $249.20
Tub or Tub/Shower Comb. 16.60 wo(2)bath J $350.00
Shower Only 16.60 three 3 bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal i� 16.60 -` 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 250/6 OF SUBTOTAL _
GarbageDispusar - 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
Water Heater ()conversion O like kind 16.60 Quantic b Work PeH rrmed
Gas piping requl:ea a separate mechanical Fixture Type: New Moved Replaced Removed/
ermit. Capped
MFG Home New Water Service 46.40 Sink _
MFG Home Ndw SanlSlorm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 1 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16,60 Water Closet
Urinal
Other Fixtures(Specify) 16.60 Dishwasher
Garbage Disposal
Laund Room fray _
Washing Machine
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3"
Sewer-each additional 100' 46.40 4"
Water Service-let 100' 55.00 Water Heater _
Other Fixtures
Water Service-each additional 200' 46.40
(Specify)
Storm 8 Rain Drain-1st 100' 55.00
Storm 8 Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 -
Residential Backnow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 62.50 �~
Re uested Ins actionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60 _..------- - --- ...-- -
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total Ism 99 _v
"SUBTOTAL
8%STATESUR6HAi2GE - -- - ----
'"PLNN REVIEW 25%OF SUBTOTAL
Required only if fixture gly total Is>9
TOTAL
Minimum permit fee is$72 50«a%state surcharge,except Residential Backflow
Prevention Device,which Is$39,25+Lr%state surcharge
'All New Commercial Buildings require 2 sets of plans with Isometric or/leer
diagram for plan review.
1:ldstslformslplrn-fees.dor, 12x26/01
To:Rick Bol-n For: +1(503)024-3081 Piige 2 of 4 Friday,Uecwmber 27,2002 11 19 AM
From 'AeYa McBee Few:+1(503)251-3920
CCa N 118314 24hr (603)261.0606
Tod MC1390 11426 NE Schuyler St. Mobile (603)039.6246
Pertlend,OR 97220 Fox (603)261-3920
Boring & Excawfing' Ince
UrT-bqRJ.:TJ RX icx:�e�r `JV (p.l Uiy GrTii
December 27, 200:,'
City of Tigard
Attn, Inspector Rick Bolen
Tigard,OR
Rig SEPTIC ARANDOWIENT-11016 SK ERROL
-..o whom tt may concem,
at the above
dress has
en
This letterk filled with%tminus grathe nule In coimpliance wic tank th State and City codes for the abandonment menof
than
on site sewage disposal systems
If you have any questions or concerns, contact me direct at (503) 515-4452 or Steve McBee at (503)
939-5246.
Sinoerely,
Chris Rugloskl
Estimates/Scheduling
Ted McBee Boring&Excavating, Inc
CLR/olr
CITY OF TIGARD 24-Hour
BUILDING Inspectiun Line: (. 03) 639-4175 MST
INSPECTION DIVISION Business Line: (503) 639-4171 � BUP -- —
Received —__ __ Date Requested �a AM PM /✓ SUP --- ---
Location - Suite— -- MEC —
Contact Person Ph(— ) �,+� 'i( PLM _ :2
Contractor --- --- ._ Ph(._-) --— ----- SWI". -
BUILDING Tenant/Owner __.__ --_— —_`— _ ELC
Footing ELC -
Foundation HCC@SS:
Ftg Drain ELR
Crawl Drain SIT
Slab Inspection Notes:
Post&Beam
Shear Anchors
Ext Sheath/Shear - --
Int Sheath/Shear —
Framing -- --- - ----
Insulation
Drywall Nailing - —
Firewall ---
Fire Sprinkler -
Pira Alarm
Susp'd Ceiling — i
Roof ---- - _ —_
Other: - -- -
Final
_LUMBPASS PART FAIL --
_PING
Post& BeamIOVZ _
Under Slab - --- —
Rough-In
Water Service ------- ---- -
wer
Rain rains
Catch Basin/Manhole
Storm Drain -- -----"--
Shower Pan
Other:--- - ---- -_ _ - —
Fin _— -
AA PART FAIL
Mk:CHANICAL ---- - ----- ----- - -- --
Post&Beam v-
Rough-In - -- — - - --—-- -—
Gas Line —
Smoke Dampers __ _.-_ ---_-_-- ---------------
Final
PASS PART FAIL - -- ---
ELECTRICAL — ___-- ,_----__-- ------- - ----
Service ---_.-- -
Rough-In _- ---- - - — —
UG/Slab
Low Voltage —
Fire Alarm
Final L� Reinspection tee of$_-__-_ required before next inspection. Pey at City Hell, 13125 SW Hall Blvd.
PASS PART FAIL ! �
BITE Please call for reinspection RE: --- u Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date � � �" ir►aPector __�-_ -Ext -
Other:
Final DO NOT REMOVE this Inspection record from the)cis site.
PASS PART FAIL
W,
I t►�13Erqi, 26= 174; F'. 01 �
;;C:
Janees GrWiths Excavating, Inc. Invoice
d.b.a. Griffs So p is Service DATj INVOICED
Ptd Box 1136 —
Canby, OR 97013 12/18/2002 1607
503-263.8038 503-263-1743 Fax
BILL 10 JOB NAME/
STEVE MCBP.B EXCAVATING 11011 SW ERROL ST
11928 NE SCHUYLEiR 11GARD,OR
PORTLAND, OR 97120
—TERMS - DUE DATE 'TELEPHONE M' TCCBS DEC#
P 0 NUMBER - —
____.
DUE UPON RECEIPT 12/1812002 939.8246 l 104320 31464
AMOUNT
DESCRIPTION --
- 10.00
PUMPED SEPTIC TANK FrOR ABANI)ONMF NT
PAID IN F1JLL BY CHECK.#8421
i
THANK YOU FOR YOUR BUSINESS. —~ Total S150 nn
•A gem ice nherWC-f 1,1%will be IrAed on 0 pwt due Inv*05 --
•Returned check feo Id $20 OU for j%iT191011ted bY
• In is elhc it, A lem 07 Athittal aeneonable Minrney feeghAnd W1101 wNtl t,3 the trevaili B pert at trial or
herr _