11070 SW ERROL STREET f �
0
V
O
Cl)
m
O
r
4
X
m
r
r i
r
I
11070 SW ERROL STREET
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00028
Fps
13125 SW Hali Blvd., Tigard, OR 97223 (503) 635-4171 DATE ISSUED: 1/28/03
SITF_ ADDRESS: 11070 SW ERROL ST PARCEL: 2S103AD-00503
SJBDIVISION: ECHO HEI;HTS ZONING: R-4.5
__BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: "EW GARBAGE DISPOSALS: MOBILE I iviOE 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:
TI tp;SHOWERS: SEWER LINE: G0 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: I
Owner: FEES -
--`
BOS FLL, WILLIAI%" R + Description Date Amount
GLADYS F TRS I I'LUMB] Permit Fre 1/28/03 $72.50
11070 SW ERROL ST ITAX] 8%Stele I'm 1/28/03 $5.80
TIGARD, OR 97222 [PLUMB] Permit Fee 2!3/03 $62.50
ITAX] 8"i�Statr Tax 2/3/03 $5.00
Phone :
Contractor:
Tota $145.80
- --- —
MCROOTER DRAIN SEWER & P'.BG SVC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone : 503-255-4505 Sewer InspectionMisc. Inspection
Reg#: LIC 103682 Final inspection
PLM 26-724PB
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 dome in accordance with approved
plans. This permit will expire if work is not started within 180 days Of issuan"p, or ;f work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow 3 adopted by the Oregon
Issued By: _ Permittee Signature:
Call (503) 6394175 by 7:00 P.M. for 3n inspection needed the next business day
OFFICE USE ONLY
Plumbiap, Permit App lkii ion Received ' Plumbing
Date/By: _ Permit No.:/1,t1 - �D
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.: _
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact lutis.: sec Page 2 for
24-hour Inspection Request: ,03-639-4175 Nsme/Method Supplemental Information.
TYPE OF WORK FEE"SCHEDULE.(forspecial Information use checklist
New construction _Demolition
Description c2ty. Feetca.) Total
LJ Addition/alterationreplacemcr,t ❑ Other: New 1-&2-family dwellings
CATEGORY OF CONSTRUCTION Includes 100 ft.for each unlit rr
co
SFR I bath _ 249.20
1 &2-Family dwelling LJ Commercial/Industrial SFR 2 bath _ 350.00
Accessory Building Multi-FamilySFR 3 bath _ 399.00
Master Builder Other: Each additional bath/kitchen _ 45.00
JOB SITE INFORMATION and LOCATION Firesprinkler-sq,ft.: Pae 2
Job site address: _ Site Utilities
Suite#: Bld ./A t.#: Catch basin/area drain IG.GO
Dr well/leach line/trench drain 16.60
Project Name: Footing drain no.linear ft. Pae 2
Cross street/Directions to job site: Cr- Manufactured home utilities 110.00
Manholes 16.60
I`I Rain drain connector 16.00
Sanitary sewer no.linearft. Pae 2 ` • my
Subdivision: Lot#; Storni sewer no.linear fl. Pae 2
--- -- -:--- Water service no.linear fl. Pae 2
Te:; .nap/parcel#: _ Fixture or Item
DESCRIPTION F WORK Absot tion valve 16.60
U) 'r Backflow reventer Page 2 _
Backwater valve 16.60
Clothes washer 16.60
` - Dishwasher _ 16.60
Drinking fountain 16.60
PROPERTY OWNER TENANT Ejectors/sump 16.60
Nairne: _ z Expansion tank 16.60
Address: Fixture/sewer cap 16.60
Cit /state/Zit Floor drain/floor sink/hub _ 16.60
S Garbage disposal _ 16.60
Phone: Fax: _ Hose bib _ 16.60
APPLICANT CONTACT PERSON Ice maker 16.60
Name; _-_ J_ Interce tor/ reasc trap 16.60
Address: Medical gas-value: S Page 2
✓ Cit /State/Zi Primer 16.60
/ � I?: Roof drain commUciat 16.60
Phone: Fax: - Sink/basin/lavatory 16.60
E-mail: Tun/shower/shower pan 16.60
_ CONT CT Urinal 16.60
Business Name_._ * 'i Water closet 16.60
ater atcr 16.60
' Address: - C _ ther: t_ tr ,St
'r Cit /State/Zip: �.�_ Other:
Phone: - - Fax: Plambin Permit Fees*
Subtotal S
CCB L
C.
Plumb. LiC.#:�V_ Minimum Permit Fee$72.50 S r C
Authorized ` , C Residential Backflow Minimum Fee$36.25 _
Signature: `� Date: Plan Review(25%of Permit Fee $
r State Surcharge 8%of Permit Fee S ICNIKO
(Please print name) TOTAL PERMIT FEE i $ Arel, ,
Notice: This permit application expires If a permit is not obtained Within All ne%commercial buildings require 2 sets of plans w isometric
Igo days after It has been accepted all complete. riser diagram for plan review.
'Fee methodob,gv set by Tri-County Building Indu ry Service Board.
ODsts\Permit Forms\PlmPcrmitApp.dcx 01!0;
Numbing Permit Application - city of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: _
Footing drain-I"100' 1 55.00 0 to 2,000 $115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer-I st 100' 55.00 7,201 and greater $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' 55.00 Medical Gas S stCms:
Water Service-each additional 100' 46.40 Valuatie n: Permit Fee:
Sim in&Rain Drain- I sl 100' 55.00 $1.00 to�j,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,0000)and$1.52 for each
Fixture or Item Qly. Fee(ea) Total additional 3100.)or fraction thereof,to and
including$10,0).).
Cummercial Back Flow Prevention Devic,- 46.40 $10,)1.00 to$25,0).00 $148.50 for the first$10,)0.)and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25 27.55 and Including$25,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,)0.)and$1.45 for
each additional$1).00 or fraction'hereof,to
Inspection of exislir6 plumbing or and Including$50,0).).
specially requested ins ections-pet hour 72.50 - $50,001.00 and up $742.00 for the first$50,)0.)and$1.20 for
Subtotal: each additional V00.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
uantit b Fixture Work Performed I Comments regarding fixture work:
Fixture Type: Replace
New gloved Piliting d ---- -
Ba list /Font
Bath -Tub/Shower _
-Jecu?W/Whirl of -- -- -
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator - _ --
Dishwasher -Commercial _ - --
-Domestic
Drinking Fountain --�-
Eye Wash - ---- - -
Hoot Drain/sink -21.
3.,
4„
Car Wash Drain *Note: If the fixture work under this permit results in an
garbage -Domestic
Disposal -commercial _ _ increase of sewer EDUs,a sewer permit will be Issued and
-Industrial fees assessed for the sewer increase nwst be paid before the
Ice Mach./Refri .Drains plumbing permit can be issued.
Oil Separator Gas Station
Rec.Vehicle Dump Station
Shower -Gang -
-Stall _
Sink -Bar/Lavatory
-Bradley
-Commercial
-Service -
Swimmina Pool Filter
Washer-Clothes
Water Extractor
Water Closet-Toilet _
Unnal -
Other Fixtures:
i\Dsts\Permit Forms\PlmPcrmitAppPg2 doc 01/03
CITY O F TIGARD
IGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2001-00155
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/9/01
PARCEL: 2S 103AD-00503
SITE ADDRESS: 11070 SW ERROL ST
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LCT: 0 ( JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: :;r UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS/COMPRESSORS HOODS:
FUEL TYPES _ 0 - 3 HP: 1 D0IN1ES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HN:
REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP:
WOOD
STOVES:
PRESSURE: C ti HP:
FURN t 100! BTU: 1 AIR hANDL_ING UNITS CLO DRYERS:
OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: –
>
GAS OUTLETS:
10000 cfm:
Remarks: Replace existing gas furnace and a/c unit with like kind.
Owner: FEES
SANDRA CLUTE Type By nate Amount Receipt
11070 SW ERROL ST PRMT CTR 519/01 $72.50 272001000C
TIGARD, OR 97223 5PCf CTR 5/9/01 $5.80 272001000C
Total $78.30
Phone:503-963-2936 -- --
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS _ _—
Heating Unt Insp
Phone:620-5643 Final Inspection
Reg #:LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days ATTENTION Oregon law
requires_Wlo follow rules adopted in the nregon Utility Notification Center. Those rules are set forth in OAR
952-OD1-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246-9189.
I i
Issue By: , -� Permittee Signature: Y—�
Call (503)639-4175 by 7:00 P.M for inspections needed the next business day
Mechanical Permit Application
IDaterecelved: S y D/ Permit no.: /If C' -co 1!5 j
City of Tigare, Project/appl.no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permitno.:
f
I1 &2 family dwelling or accessory U Commercial/iodusti,it 0 Multi-family U Tenant improvement
U New construction � ddition/altemtio •ehlacement ❑Other: _
.10R SI UE INFORMATION job 1 : f
Job address: p CIL
Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lot: Block: Subdivision: *See checklist for important application information and
Project name: C.11tt t-r - jurisdiction's fee schedule for residential permit fee. •
City/county: ,21C .- S ZIP: 3 t
Ue ription and ocation of wok on premises: 7Airhancdling
t.date of completion/inspection: $ / 916( Descrl on Qty Rtes.only Ftes.onlyTenant improvement or change of use: unit CFM
Is existing space heated or conditioned?Byes U No tianrng(site p an require )
Is existing space insulated'? Ves ❑No onciexisting A system
ompressors
State boiler permit no.:
_Business name, sjoleoyep L '1 qCh ch h 1jeat
HP Tons__BTU/H
Address: 5 6 / ) U,7 s'/ e/smo a amper uct sma a etectors
City: I a!�4 State:Q,� ZIP:9 7oz 5t 3 pump(site p an re uire )Fax598,vJ/ E-mail: ta rep ace umacelburnerAnT./
rC::--:Icase
CB no.: , 7 Including ductwork/vent liner ,�'Yes D No
�� e _ nsta rep ac re locate eaters-suspen ec,
rolic.,to.: wall,or floor mounted
print): r t-f{ZI_G Vent ora lance other an urnuce --
f e gest on:
'"PURSON
Absorption units` BTU/H
Name: T-P L ze N �GI K r7(1 4 Chillers HP
Address: a- v / 5 rCom Compressors _ HP
701,
� nr ronmenta exhaust an vent atlon:
77
City: c./ Stae:C� ZIP: Appliance vent _
Phone 3 G,,;2o-� Fax:; �p-jl$' Email: Dryerex gust _
Hoods,Type / res.kitchenihazmat
hood fire suppression system
Namc: 4 o-i,,dief 'C&0,, Exhaust fan with single duct(bath fans)
Mailing address: p 7 ) ) 6 j j 01 $1 Exhaust systema an from heating or AC
City: /ya,J I Stat oe ZIP: rt I��_.� Fuelp p ng and disiribution(,up to 4 outlets)
Type —LPG NO Oil
Phone — 7 - fox: 1:-mail: uelt�2
n eac a itiona over4out ets
rocp p ng(sc ematicrequired)Name: Numof outlets
ter t app ace or equipment:
Address: Decorative fireplace
City: State: ZIP: nsert-type
Phone: Fax: E-mail: oo stove/pel et stove
OTC_r
Applicant's signature: nytvs Date: i0/ Ot er: _
Name(print): !ry 6 ,five—
Not atl junsrections accept credit canis,please call jurisdiction for more infnmutiort. Permit fee... .................$
U Visa U MasterCara Notice:This permit application Minimum fee................$ -_
Credit card number,_v _ / / expires ifa permit is not obtained me plan review(at %) $
Expires within 180 days after it has been State surcharge(896) ....$ • �
Naof cardholder a shown an credit care accepted es complete. TOTAL $ ?_12—C
_
Cardholder signature ^Amount 4404617(&MCOM)
Comm,arclal Schedule
1&2 Family Dwelling Schedulsi
ASSUMED VALUATIONS PER APPLIANCE
Description
Furnace to 100,000 BTU Table I A Mechanical Code Oly Price Total
includingducts&vents 955 1) Furnace la Cts& 0 BTU
inGudm duds 6 vents 1400
Furnace>400,000 BTU 2) Fumau 400,000 BTU+
Indudrn duds 8 vents 17.40
including ducts&vents 1,170 3) F Fn`gm l
Mdudm vent 14 00
floor furnace 4) Suspended heater,wall heater
-ncluding vent 955 of floor mounted heater 1400
suspended heater,wall heater 5) Ven l no(included in appliance permit 680
or floor mounted heater 955 6) Repair units 12 15
Check all that apply 'Boller Heat Alt
Vent not Included in appliance permit 445 For nems 7-10,see or Pump Cond O1y Price Total
Repair units 805 7)<ctnote%1.2 oin
3HP,abib unit to
s _
<3 hp;absorb.un)t t00K BTU 14.00
6)3.15 HP.absorb unit
to 100k BTU 955 look to Wit BTU 25.50
3-15 hp;absorb.unit units53i mil 13Tuoro 35.00
101k to 500k BTU 1700 TO)30.50 HP,t sore
unit 1-t.r5 mil BTU 5220
15-30 hp;absorb.unit 11)>50HP,absorb unit>1.75 mil BTU
87.20
501k to 1 mil.BTU 2310
12)Air handling Anil l0 10,0t•,CFM
30-50 hp;absorb.unit 10.00
13)Air handling unit 10,000 CFM-
1-1.75 mil.BTU 3400 17.20
14)Non•poAable evalJoralu cooler
>50 hp;absorb.unit i 10.00
> 1.75 rill.BTU 5725 15)Vent tan connected to a single duct
8.90
Air handling unit to 10,000 cfm 656 16)Ventilation system not Included In
appliance permit_ _ 10,00
Air handling unit>10,000 cfm 1170 17)Hood served by mechanical exhaust
Non-portable evaporate coffer 656 _ 10.00
P P ls)romesiw incinerators
vent fan connected to a single duct 446 17'40
19)commercial of industrial type Incinerator
Vent syst.not Included in appliance permit 658 69.95
Hood served by mechanical exhaust 656 20)Other units,Including wood stoves 1000
Domestic incinerator 1170 21)Gas piping one to lour outwit
5.40
Commercial or Industral Incinerator 4590 22) ore than 4-per outlet(each)
t.0o
Other unR,Including wood stoves,Inserts,etc. 656 Minimum Permit Fes(72.60 SUBTOTAL
Gas piping 14 outlets 360 _ ex SURCHARGE
Each additional outlet 63 PLAN REVIEW 25%OF SUBTOTAL
Required for ALL commercial permits only
TOTAL
011ier Inspections and Fees:
i InspeciWa outside of nomiai business hour(mown cm datse-bu Mur)
1172.30 pit four
7 Inspschora M which cad see h specifically md,cawd(1lwwrarh darge-hait Mur)
372 tid per hour
Total Valuation FeeJ AAddN plan revww resurd Uh
by anaec addlimi or revaona a pans(mnxrnn
-- ottaWv whaa haw)1172 50 per hout
_ __ _ •Suw Contractor 6040,Certification Ahmved
S 1.00 to S5,000.00 Minimum$72.50 "ResldenaM Air reouees site pl:.n srio.+ne pl-w n1 N limn
S5,001.00 to 510,000.00 572.50 for the first 55,000.00 and$1.52 for
each additional S 100.00 or fraction thereof,
to and including$10,000.0
$10,001.00 to S25,000.00 5148.50 for the first 510,000.00 and$1.54
for each additional$100.00 or fraction
thereof,to and including$25,000.00
525,001.00 to 550,000.00 $379.50 for the first$25,000.00 and 51.45
for each additional S 100.00 or fraction
thereof,to and including S50,000.00
$50,000.00 and up S742.00 for the first$50,000.00 and S 1.20
for each additional$100.00 or fraction
thereof
0
�� eW NaUSE
�M1
ti
�S
la
ST12.EET�
rno�Et_ � 7-
CITY OFTIG�►RD ELECTRICAL PERMIT —
PERMIT#: ELC2001-00249
DEVELOPMENT SERVICES DATE ISSUED: 5115/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL. 2S103AD-00503
SITE ADDRESS: 11070 S`/V ERROL ST
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT : 010 JURISDICTION: TIG
Proiect Description: Installation of one branch circuit for a/c unit and furnace dieonnect and reconnect.
J)b No. R 0179
RESIDENTIAL UN11 _ TEMPSRVC/FEEDERS MISCELLANE=OUS
1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 400 amp: SIGNIOUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FDR: 601+arnos - 1000 volts: MINOR LABEL (10):
_ SERV;CE/FEEDER BRANCH CIRCUITS _ _ADD'L INSPECTIONS _
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDPs: 1 PER HOUR:
401 - 600 amp: EA ADD'L. BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION
1000+ amp/volt: >-4 RES UNITS: > 600 VOLT NOMINi.L.
Reconnect only: SVCIFDR >= 225 AMPS: _ CLASS AREA/SPEC OCC__,—__`_
Owner: Contractor:
SANDRA CLUTE SHARPE ELECTRIC INC
11070 SVJ ERROI_ ST 22605 SW RIGGS
TIGARD, OR 97223 BEAVERTON, OR 97007
Phone: 503-9u8-29::6 Phone: 642-7937
Reg #: LIC 81518
SUP 33445
ELE 34-2170;
FEES^` � _� Required Inspections
Type By Date - Amount Receipt Flough-in
PRMT CTR 5/15/01 $46.8. 2720010000( Eisct9 Final
5PCT Cl R 5/15/01 $3.75 2720010000(
- -----�-
Total $50.60 -
This Permit is issued subject to the regulations contained in the Tigard Municipal Code State of OR Specialty Codes and all other applicahle laves.
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 it work is
suspended for more than 180 days. ATTENTION Oregon law requires ycu to follow rules adopted by the Oregon Utility Notification Center Those
rules are. set forth in OAR 952-001-0010 through R952--001-0080 You,„ay obtain copies of these rules or direct questions to OUNC at(503)
246-6699 or 1-800,832434+1,\ a
Permit Signat l o: Issued By: t
------ ==-t-� .
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intendeo for sale, lease, or rent.
OWNER'S SIGNATURE: _ _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICC-NSE NO: Jq � —. -- . ------- ------
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
—�
"Dateived:
City of Tigard Project/appl.no.: Expire date:
City ofTi and Address: 13125 SW Hall Blvd,Ticard, OR 97223
Date issued: By: Receiptna.:
Phone: (503) 639-4171 — --
Falx: (503) 598-19F11) Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
I &2 family dwelling or accessory J Contrncrcial/industrial ] Multi-family U Tenant improvement
U New construction 14Addition/al tern tion/re place ment ❑other: O Partial
JOB SITE INFORMATION
]ob address: Tax map/tax lot/,ccount no.:
Lot: Block: Subdivision: _
Project name: U T'L' Description and location of work on premises: /}- c
Estimated date of completion/inspection: / C>/
CONTRACTOR APPLI�ATION FEE SCIllEDVLL
Job no: vee Mas
Business name: /` [r
Description "v• (ea.) Total no.Insp
New residential-single or multi-family per
Addtcss:,-;,,Ai &C_rj SCJ-) dwelling unit.Includes machedgarage.
City: jf(tate:Q " ZIP: L7700-1 Serviceincluded:
Phone:_rc j it L61 IV31 I Fax: I E-mail: 1000 sq.ft.or less 4
CCB no.. Elec,bus.lic.no: - ,� Each additional 500 sq,ft.or portion thereof
Limited energy,residential _ 2
City/metro lic. o.: A5--3 _ Li mi led energy,non-residential 2
_ _ Each manufactured home or modular dwelling
Signdture of supervisi g electrician(required)_ Date Service and/or feeder 2
Supelect.name(print) L
ServiLes or feeden–Instal lotion,
alteration or relocation:
PROVElftY OWNER a 200 amps or less 2
Name(print):(3Q "'ti
ti 201 amps to 400 amps 2
401 amps to 600 amps _ 2
Mailing Address: /ox _ i 5� 601 amps to 100!t:;•y,. 2
City: (�, State: ZIP: 13 Over 1000ampsorvolts _ 2
Phone: WY7 � j t'aX: I E-mail: — Reconnect onl I
Owner installation:The installation is being made on property I own Temporary services or feeden-
which is not intended for sale,lease,rent,or exchange according to installation,alteration,or relocation:
URS 447,455,479,670.701. 200 amps or less _ 2 _
201 amps to 400 amps 2
Gwner's signature: Date: 401 to e00 amps 2
Marl lo Branch circuils-new,niteration,
ore.to sloff
per panel:
N tme: A. Fee for branch circuits with purchase of
Address sc.-vice or feeder fee,each branch circuit 2
Ci'.y: Stale: ZIP: B. Fee for branch circuits without purchase
— of service or feeder fee,first branch circuit. _ 2
I'll in(,: Fax: E-mail: Each additional branch circuit:
Misc.(Service or feeder not Included):
U Service over 225 amps-commercial U Health-care fucihty Each pump or imgnuun circle 2
J Service os or 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2
family dwellings J Building over I00M square feet four or Signal circuitlsa or a limited energy panel.
:.1 System ncerfi(M)volts rommal more residential units in one structure alteration.urextensim- – 2
J Building over three stones J Feeders,4M amps or more 'Description: —
()ccupant load over 99 persons J Manutactured structures or RV park Foch additional inspection ov!r the allowable in any of the above:
.1 b.cnsulightingplan J Other __ Per inspection
Submit i sets of plans with ANY of the above. Investigation fee _
LThe above are not applicable to temporary construction service. Other
Not Al nuisdirttuns arcept crrtit cartas,pleasr rasa jurisdiction for more Information Notice:This permit a;tplication
Permit fee... ............... .
UVisa J MasterCard expires if a permit is not obtained plan review(al _ %t $
C edit card number _ within 180 days alter at has been State sutchatge(8%) ....5
Name of eI .r u shown on credit stud Esp1fes accepted as complete.
TOTAL ....... ............... ii
_ S
Card older signature Amount 4404614(6MCOM)
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 --
B P _
Date Requested _✓�"' AM _,PM _-- LD
Location / l0 7 a S�' �r k e, / _�-/__ Suite
Contact Person __ Ph do Z_0 -56 Z4PLM ��a
Contractor Ph SWR
BUILDING Tenant/Owner ELC _
Retaining Walt Y ELI
Footing ,access: T�
Foundation FPS
Ftg DrainA T/'�'i w 3' 74> 4J,we .tea 7 L --e-"Orr ti, SGN
Crawl Drain Inspection Notes: - -----
Slab - l�i•�•✓r x S /�/� l s •- t.ycn C_ SIT
Post& Beam --� --- - -- ---
Ext Sheath/Shear
Int Sheath/Shear
Framing -- - - -- --
Insulation
Drywall Nailing
Firewall - -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ___-_-
Roof
Misc: —
Final
PASS PART FAIL --
�PLIIJIWNG
Post& Beam —
Under Slab
Top Out — --
Water Service lq�e,d re eL_
Sanitary Sewer
J3aiu Drains
F"
PA PART FAIL
e
Post& Beam - '&, r*et +L Jq r a- �y w O 7"i N •'�'- y ��-
Rough In
Gas Line --- ----
Smake Dampers
&ttECTRICAL
ART FAIL
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:— _—_- ( J Unable to inspect-no access
ADA 2 i S
Approach/Sidewalk Date Intl ecto� r��
Other P -- ----- Ext -
Final
PASS PART FAIL DO NOT REMOVE this; inspection record from the job site.
z
CITY OF TIGARD BUILDING INSPECTION DIVISI N
MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested / �� AM� FIM BLD
Location 1,1070 S4✓ C -s`( S Suite MEC
Contact Person Ph ( .3 PLM
Controctor Ph SWR _
BUILDING TenanUOwner ELC wr✓/-GG
Retaining Wall i ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl '),ain I nspection Notes: ---- -- -- -
Slab --- — --- SIT
Post&Beam _
Ext Sheath/Shear
Int Sheath/S&aar _
Framing -
Insulation
,Drywall Nailing _
Firewall
y
Fire Sprinkler G/
Fire Alarm
Susi'd Ceiling
PASS PART FAIL ------- — -
PLUMBING
Post&Beam —
Under Slab
Top Out
Water Service
Sanitar,•Sewer -
Rain Drains
Final
PASS PART FAIL _
MECHANICAL y
Post&Beam -- - - --
Rough In
Gas Line - -
Smoke Dampers
Fina!
PASS PART FAIL
Service
Rough In
UG/Slab — ------ -- _-
Low Voltage
Fire Alarm
ASS ' PART FAIL
Backfill/Grading -
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ J Please call for reinspection RE: [ ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date Q Inspector Ext
Other —
Final
PASS PIAT FAIL DO NOT REMOVE this inspection record from the job site.
CITYOF TIGARD __ PLUMBING PERMIT
DEVELOPMENT SERVICES
PERMIT#: PLM2001-00196
ML 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/15/01
SITE ADDRESS: 11010 SW ERROL ST
PARCEL: 2S103AD-00503
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER 4EATERS: 1 CATCH BASINS:
_
FIXTURES LAUNG;<Y TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSET'S: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water heater with like kind and raise piping.
FEES
Owner. -- — —
O Type By Date Amount Receipt
SANDRA CLUTE —
1 1070 SW ERROL ST �PRMT CTR 5/15/01 $72.50 27200100000
TIGARD, OR 97223 _5PCT CTR _5115/01 $5.80 27200100000
Total $78.30
Phone 1: 503-968-2936
Contractor:
FULLMAN SERVICE CO LLC
52.21 SW CORNETT
PORTLAND, OR 97201-3716 REQUIRED INSPECTIONS
Phone 1: 224-5221 Final Inspection
Reg#: LIC 122310
PLM 26-443PB
This permit is issued subject to the regulations contained in use 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 startE d 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.
+7'::�'
Issued By: Permittee Signature• `
y.
Call (503)1639 4175 by 7:00 P.M. for an inspection needed the next bu`ilness day
Plumbing Permit Application
Date received: 7 /s Q/ Permit no.: C}/
City rif Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 — -
Ciryoj7igard Phone: (503) 639-4171 ProjecUappl.no.: Expire date: _-
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
;Johaddress: /
1 &2 family dwelling or accessory J Coounercialf ndustrial U Multi-family U Te,iant improvement
New construction U Addition/alteration/replacement U Food service U Other:
�(126 64 __L__" - s5T 1)(wcri tion Qt . f�(ett.) 'lbtal
Bldg.no: Suite no.: New l-and?-family dwellings only:
g• . _ --- — (Includes 100 f.for each utilityconneclion)
Tax map/tax lot/account no`: t:;�X_ [_5 C SFR(1)bath
Lot: _ Subdivision: SFR(2)bath
Pro. SFR(3)bath
City/county: ZIP: ' — Each additional bath/kitchen
Description and location of work on nremises: ( •— Siteutlllfle•:
l �r_`= �-��pa-s Catch basiivarea drain
Est.dote of completiorJinspcetion: `5—' - D/ Drywells/leach line/trench drain
Footing drain(no.lin.ft.) _
Manufactured home utilities
Business name: FULLMAN/KINETICS SERVICE Manholes _
Address: 5221 SW Corbett Rain drain connector _
City: Portland — Stnte:OR ?Ip: 97201 Sanaarysewer(no.lin.ft.)
Phone: 224-:221 Fax:417-0328 Email: Storm sewer(no.lin. ft.) _
CCB no.: 122310 Plumb.bus.reg.no: 26-443I B Water service(no.lin.ft.)
City/metro lic.no.: 1619 - Fixture or Item:
Absorption valve
Contractor's representative signature: Back flow reventer
Print name: d onp Date:S- -D Backwater valve —
Basins/lavatory —,--_
7Na : Clothes washerDishwasheress. Drinking fountain(s)
City: _ State: _ZIP: E'ectors/sump
Phone: Fax: E-mail Expansion tank
Fixture/sewer cap `
Floor drains/fl(xir sinks/huh
Name(print): •—_-- Garbage dis tsal — --- --
Mailing address:_ Hose bibb —_
City: — _ State: _ ZIP: Ice maker
Phone: Fax: E-mail: lntcrceptor/ reale trap _ _ __
Owner instal lat i orYtesidential maintenance only: The actual installation Primer(s) —
will be made by me or the maintenance and repair made by my regular R(x)f drain(comm,!wial)
1 employee on the property I own as ner ORS Qiapter 447. Sink(s),basin(s),lays(s)
Owner's signature: Date: _ Sunil
EWater
ower/shower pan
_
Name: _ _ loset
1 Address: _ heater
I T City; _ State: ZIP: Other:
_ �� ---
t'hone: _ Fat_ E-mail: Total
Minimum fee................$ 7d•Sd
Not all juriWlictions accept credit cants,pleue call jurisdiction for more information. Notice:This permit application
Plan review(at � 96) $
U Vies U MasterCard expires if a permit is not obtained _— —
credit card number. _ --_ __L—L— within 180 days eller it has been State surcharge(8r16) ....$
_ Fsp+ger TOTAL, $
Name of c older to shown on credit card
accepted as complete. """"""""""'
_ S
Canthalcler si`rtattnt Amount I 400-4616(& ICOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES IndivtdupJIQTY ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 18,60 -- for each utility connection) _
—_ One(1)bath _ $249.20
Tub or Tub/Shower 1,omb 16.60 .-Two_ 2 bath - —�_ _ $350.00
Shower Only 1 ,0 _Three 3) ath
Water Closet — _ 16.60 — SUBTOTALfi
Urinal 16.60 B%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF F SUBTOTAL
Garbage Disposal 16.60 __ _ — _TOTAL —
Laundry Tray 16.60 —
Washing Machine 16,60
r`loor Drain/Floor Sink 2" 16.60
3" - 16.60 PLEASE COMPLETE:
4"
Water Heater O conversion O like kind 16.60 — Quantlt b Work Performed _
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
Ca ed
MFG Home New Water Service — 46.40 Sink
MFG Home New San/Storm Sewer 46,40 — Lavatory
Nose Bibs 16 60 Tub or Tub/Shower
_ Combination
Roof Drains 16.60 Shower Only _
Drinking Fountain — 16.60 — Water Closet
Other x s Fiure (Specify) Urinal
_ Dishwasher
_ Garba a Dis nsal _ _
-- --- Laundry Room Tray -
- — —
Washing Machine
_., Floor Drain/Sink: 2"
Sewer-1st 100' 55,004 3" —
Sewer-each additional 100' 46.40 4"
Water Sirvice-1st-100' 55.00 Water Heater _
Water Service-each additional 200' t46.40Other Fixtures
S ecl Storm&Rain Drain-1st 100' .00Storm 8 Rain Drain-each additional 100' .40Commemial BBack Flow Prevention Device .40Residential Backflow Prevention Device' .55Catch 135,in —
Inspection o`Existing Plumbing or Specially 72.50
Reuq ested Inspections _ er/hr _ COMMENTS REGARDING ABOVE:
Rain Crain, single family dwelling 65.25 —
Grease Trafs — 16.60 ----- --- -------
QUANTITY TOTAL — ---- '—
Isometric or riser diagram is rego1red if -
- Ouant�total Is >9 _ ---- -- --
"SUBTOTAL - --
8%STATE SURCHARGE ----- — — --
•'PLAN REVIEW 25-/a OF SUBTOTAL
_ __nr!quired oni-if fixiure t tatal is>A
TOTAL E
"Minimum permit fee is$72 So 4 8%state surcharge,except Residential backflow
Prevention Device,which Is$36 25-8%state surcharge
**All New Commercial Buildings require plans with isometric nr oser diaprarn and
plan review
IAdsts\forms\plm-fees.doc 10/10100
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2003-00043
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 1/28/03
SITE ADDRESS; 11070 SW ERROL ST
PARCEL: 2S 103AD-00503
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 010 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection. Reimbursement District#21 fees paid.
Owner: ----
FEES
BOSWELL, WILLIAM R +
GLADYS F T�?S Description Date Amount
11070 SW ERROL_ ST ISWI_iSAI Swr Connect 1/28/03 $2,300.00
TIGARG, OR 97223 (SWUSAISwr Connect 1/28/03 $0.06
Phone: (SWINSI'l Swr Inspect 1/28/03 $35.00
[SWINSPJ Swr Inspect 1/28/03 $0.00
Contractor:
--- — Total $2,335.00
Phone:
Reg#:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit rxpires 180
days from the date issued The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
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
� � Permittee Signature: /L 1 /
Issued by: I ,�,Z, g o.Gc ^
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: P -UUO?_8
DATE ISSUED: 1/td/0326/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2 S 103RD-00503
SITE ADDRESS: 11C70 SW ERROL ST
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: NEW 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: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIU DRAIN: ft
Remarks: Install approximately 50 If of line work to connect to sewer lateral. Reimbursement District#21 fee paid.
Septic to be pumped or filled.
FEES _
Owner: Description Date Amount
BOSWELL, WILLIAM R + I111,UMI3] Permit Fee 1/28/03 $72.50
GLADYS F TRS [TAX]8%,State Tax 1/28/03 $5.80
11070 SW ERROL ST = -- -- —
TIGARD, OR 97223 Total $78.30
Phone :
Contractor:
TFD MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Sewer Inspection
Phors : 939-5246 Fig : Inspection
Reg#: I.IC 110314
This permit is issued subject to the regulations contained in the Tigard MunicipF.l Code, State of OR.
Specialty Codes and all other applicable laws. All wcik 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 suspe ided
for more than 180 days. ATTENTION: Oregon law requires yoga to follow rules adopted by the Or_3gon
{ Permittee Signature:f y" l -�
Issued Byes. _ �� ��
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures 00
Plumbing Permit Application, Received J Plumbing ,
-- Date/Iiy_!—tea-O Permit No..
Planning Approval Sewer
City of Tigard Datc/13 : _ Permit No.: —
13125 SW Ilall Blvd. Plan Review Other
Tigard,Oregon 97223Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Date/F3y: Case No: _
Internet: www.ci.tigard.or.us Contact Juris.: Scc Page 2 for
24-hour Insp;,,tion Request: 503-639-4175 Name/Method: _ Su�Icmental Information.
TYPE OF WORK FEE*SCHEDULE forspecial Informatirn use checklist
New construction_ — ❑ Demolition Description _— I Qt� Fec(ca—) lblal
Addition alteration/re lacr_ment ❑Other: New 1-&2-family dwellings
Includes 100 ft.for each utility connection
CATEGORY OF CONSTRUCTION
1 &2-Family dwelling commercial/Industrial SFR 1)bath 249.20
�— � SFR 2 bath 350.00
Accessory Building Multi-Family — SFR 3 bath _ 399.00
Master Builder Other: Each additional bath/kitchen 45.00 _
JOB SITE INFORMATION and LOCATION _ Fire sprinkler-sq.ft.: _ Pae 2
Job site address: IAD_7142_5L�) , Site Utilities
Suite#: _ 131dg./Apt.#: Catch basin/arca drain 1G.Go
Protect Name: Dr ell/leach line/trench drain 16.60
Footing drain(no.linear ft.) Page 2 _
Cross street/Dii --+ions to job site; n - W � Manufactured home utilities _110.00
Manholes 16.60 --
Rain drain connector 16.60
Sanitary sewer no.linear ft. Page 2
Subdivision: Lot#; Storm sewer no.linear ft. a�_ P 2
- - Water service no. linear f1J Pae 2
Tax map/parcel #: Fixture or Item_ _
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer _ Pae 2
Backwater valve 16.60
Clothes washer 16.60
-- — -- - ---- Dish A asher 16.60
Drinking fountain 16.60
PROPERTY OWNER TENANT,i Ejectors/sum _ _ 16.60
Name: L _ _ Expansion tank _ _ 16.60
Address: jtCno dr,,W I�Q Fixture/sewer ca 16.60 _
Cit /State/Zi 67 x-12 1) Floor drain/floor sink/hub 1 .60
Garbagr disposal 16.60
Phone• I Fax: Hosc bib 16.60
FJ APPLICANT CONTACT PERSON Ice maker 16.60
Name: Interce tor/ rease trap 16.60 _
Address: _ Medical gas-value: $ Page 2 —
CitCity/State/Zip: Primcr 16.60
Y p—__ -- Roof drain(commercial) _ 16.610
Phone: Fax: _ Sink/basin/lavatory _ 16.60 _
E-mail: f Tub/shower/shower pan 16.60
CONTRACTOR Urinal _ 16.60
Business Name: `JJe 8 EC Water closet_ Water heater _ _166(1
Address: Other: _
City/State/Zip: � Ocher.
- - -
Phone: _ _F_ax: Subtotal
Plumbing permu' Fees*
CCB Lic. #: Plumb. Lic.#: btotal a
Minimum Permit Fee 572.50 5
Authorize / Residential Backflow Minimum Fee$36.25 ` -0 _
Signature: �'� Date:< '�3 Plan Review 25%of Permit Fee 5
State Surcharge 81b of Permit Fee $
-� (Please print name) TOTAL PERMIT FEE 5 17
Notice: This permit application expires ire permit Is not obtained Nilltin All n:w commercial buildings require 2 sets of plans with isometric or
180 days after It has been accepted as complete. riser diagram for pian review.
*Fee methodolol y set by Tri-(aunty Building Industry Service Board.
is\I)sts\Permit Forms\PlmPermitApp doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: _ Residential fire Suppression Systems:
Site Utilities Qry. Fee(ca) Total
Square Foots Permit Fee:
Footing drum- I" 100' s5 00 0lo 2,000 $115.00
Footing drain-each additional 100' 40.40 2,001 to 3,000 — $160.00 _3,601 to 7,200 $220.00
Sewer-1st 100' 55,00 - -
_ 7,201 end greater $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' 55.00 Medical Gas System_s_:
Water Service-each additional I()0' 46.40 Valuation: Permit Fee: _
atorm&Rain Drain- Ist 100' 55.00 SHit)to$5,000.00 Minimum fee$72.50
Shim R Rain Drain each addimmul 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000 00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item — Qty. Fac(ea) Total including$10,000.00.
Commercial Back Plonk Prevention Ikvicc 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum pernut fee$36.25 27.55 _ and including$25,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 51.45 for
--
Inspection of existing plumbing or each additional$100.00 or fraction thereof,to
_
s ciall re ucsted inspections-per hour 72.50 and inch,din.$50000,00.$50.001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping, nwsing or replacing exisling fixtures? it
111'es",please tndicale work performed by fixture. Failure W
accurately' reLrrf fixtures could result in increased sewer recti*.
t uantil•by Flxturc Work 1'erfornted ('omments regarding fixttir-e iiork:
�Flxture Typa: Replace
New 11t_mved Exbtin _ Capped ----------- — _--
Baptist !Font —
Bath -Tub/Shower
-Jacuzzi/Whirlpool _ _--- ___ ---- ------._.._.------------ ___.
Car Wash -Each Stall
-Drive 1'hnrCuspidor/WaterAspirator -----
Dishwasher -Commercial _
-Domestic _Drinking Fountain — — - ----------- --
Eye Wash -- ----- -_-_--_.
Floor Drain/sink -2..
-3.. -- ____ - --------- -
4.. -- - -
Car Wash Drain
tiarbage _ -Domestic *Nott: If lila fixture is'ork under this permit results in an
Disposal -Commercial increase of'!eiier F11111s.a seiier permit %lilt he issued and
-Industrial _ fees assessO for the sewer increase must be paid before file
Ice Mach./Refri .Drains plumbing permil caul lie issued.
Oil Separator Gas Station
Rec.Vehicle Dump Station _
Shower -Gang -
-Stall
tinrk -Bar/lavatory,
-Bradley
-Commercial
-Service _
Swimming Po I Filter
Washer-Clothes
Water Extracto, -
--
WaterCloset- Ioilet - - --
Urinal _
Other Fixtures
ODsts\I'emiit 1,orms\I1ImPcmmAppPg2.doc 01'03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Busi-tessline: (503)639-4171 _ _
fopom
BLIPReceived —___ __ -__ Date Re nested—_ AM- � -_ BLIP
Location -- 1 _� -� �____ _�^_Suite MEC
Contact Person Ph( ) �✓`7 -Sd PLM CO-0-6-a 0a0
Contractor_ ------ Ph(--) _- SWR
BUILDINGS Tenant/Owner - ___ ELC
Footing ELC
FoundationACCes
Ftg Drain � ,A/ �.- U �� 7L O n�,vE2 ELR -- --_ --
Crawl Drain L
Slab Inspectiootes: SIT
Post&Beam
Shear Anchors ..
Ext Sheath/Shear _
Int Sheattuahear
Framing -_.._------ -- _--
Insulation
Drywall Nailing ------ -,—.-- _�-- -- --- ----
Firewall
Fire Sprinkler — --------- —
Fire Alarm -
Susp`d Ceiling -- ---- --
Roof
Other:
Final -
PASd PART FAIL —�
PLUMBING --
Post&Beam
Under Sieb..
RoughSe
Water Service_TT ----
aln-Drains - --—
Catch Basin/Manholes/
Storm Drain -�---
Shower Pan �h _ Ls�,
Other: -_ - --
Final
ASSPART _FAIL_
MECHANICAL
Post&Beam
Rough-In -- ---- - —
Gas Line ----- - -- --- ^—
Smoke Dampers -- - -- --
Final
PASS PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab �—
Low Voltage - --
Fire Alarm
Final Heins pection foo,„ required before next ins
PASS PART FAIL [ 1 I -- 4 pectlon. Pay at City Hall, 13125 SW Mall Bloc!
.SITE -- Please call fnt „—n'aI,Ir II'm 111 _ Unable t0 inspect
Fire Supply Line
Approach/Sidewalk
ADA Date l� C ' Inspector
Other:
Final _ DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
04/24/1997 02:55 5032515429 STEVE Mc:REE
F[>t-1S4—FOrdR Ca Ea :lOip Ari r aPrE .r�P 1 FF' i TN1 7 v?
James Griffiths Excavating, Inc. Invoice
d.b.a. Griffs Septic Service _
PO Box 1136 DATE INVOICE•
Canby, OR 97013 1/4/2003
303-263.8038 503-263-1743 Fax I tooSILL TO
JOB NAME/ADDRESS
Sii-Vi MCiEE.EXCAVA-iw6 ! 11070 SW FIUtOL ST-
11428 NP SCHUYLEA i TIGARD, OR
PORTLAND, OR 97z2o
I �
I
M O NUMBER- � -- - TERMS DUE OATE TELRtDMONE A �T CC9/ DE06
- -� DUB UPON RECEIPT 104320 :)-1'464
06SCRIPTION AMOUNT
P"ELD 1,000 GALLON STP.E;L SEPTIC TANK I 23000
'TWO I'G7 DIRT OFF TOP OF LM TO TANK ! )5.00
I
I
I
I
I
THAM[ YOU—F0 R-YOIJR 8US1NI~SS
rTotal $283,00
•A service cheek of 1 5%will be levied on All part doe invoices
-Ramuryow check fere is 1120 00
' In cavus auh, astlan or 4rStrrtion is instituted by rither patty fat hrwch ar to eidbrce any proviuons herein,
ourt
the oshall avrerd reasonable attormev fess and actual eons to the rwailmo party at trial or arhitration. or
tenon env appeal taken there Rvm