10530 SW JOHNSON STREET CD
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10530 SW JOHNSON ST.
Invoice
G"RIFF'S SEPTIC' SEARVIC13, INC 0
Name Date
Addrp,is ZQ 513',e) 5 4) M-3/46-i!;-6 AJ Phone--� -<?
City
- / / I --- ---- Initial On Acct.
001-
State, Zip Code
Price Amount
-� '- - -7 3 / -- ----- ---- --
NOT RESPONSIBLE FOR LANDSCAPING
A service charge of 1.5%per mowh will he charged on all past due accounts. Total:
Not responsible for attorney's fees.
A fee of$25.00 will be charged on all returned checks,
t
.......... Appro al
C
By:
Customer Signature
qhank You PO PDX 1244. - Canby, OR 97n13
'503) 263-2087 or (503) 632-6138 CCB# 70548
nfi co Invoice # J, 13
SlINITnTION SUVICES, INC. Date:
P.O. it
P.O. Box 327 - Oregon City, OR 97045
11
Portland (503) 657-0219 * Vancouver (360) 695-1021
Fax (503) 656-6945
Name: kw_ J
Address: 41J21z /1 AD
City: ---- State: Zip Code:
._-
City: State: Zip Code!
Telephone: Area Code Mirnher Fax Number
Ordered By:
Frequency: 2 Wk 6 Wk I Mo 2 Mo 3 Mo 4 Mo 6 Mo Year Other
Quantity Amount Unit Price Total
SW WA Tip
Sales Tax
Total Due
Must be notified 30 da7 in advancz- to cancel regular services.
Serviced by: Rece i ved by
�12
Please pay from this invoice.
Finance Charge of 1'/P%rdr month, or annual rate of 18%is applied lo past due balance.
"Thank you for your business."
MY OF TIGARD BUILDING INSPECTION DIVISION
21. . our Inspection Line: 639-4175 Business Line: 639-4111 MST _
BUP
_Date Requested ( 1 ZZQ2 _—AM_— —PM I,BLO
Location- 1 7 ion sr- Suite ME_C
Contact PersonPh <
Contractor_ _ Ph (SWR
BUILDING Tenant/Owner ELC 3
Retaining Wall ELR
Footing Access:
Foundation FPS
Fig Drain
Crawl Drain Inspection Notes: - SGN
Slab --�
Post t Beam _-_----___ -- _ SIT --------
Ext Sheath/Shear
Int Sheath/Shear -- -
Framing
Insulation _-- - - ---
Drywall Nailing
Firewall - - -- ----%_
Fire Sprinkler
Fire Alarm -- __ - --
Susp'd Ceiling
Roof
Final L��% -�L�L- t.
PASS PART FAIL � �/r'�'ge
UMBIRIS
Past& Bearn -
Under Slab
P
To Out
Water Service
Ril Drains
q8 PART FAIL
RMHANICAL
Post&Beam -- ---- __ -
Rough In
Gas Line - --- _
Smoke Dampers $-
Itrial
PASS PART FAIL - - -
ELECTRICAL - -- - -_ -_
Service
Rough In - -- --- -- - -
Low Voltage - ---
Fire Alarm
Final
PASS PARI- FAIL-
SITE
Backfill/Grading -- --
Sanitary Sewer
Storni Drain [ ) Reinspection fee of$_ - required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RF- _ [ J Unable to Inspect-no access
ADA f n
Approach/Sidewalk Date `
Other Ilrspector Ext
Final
PASS PPRT -FAIL` Do OT REMOVE this Inspection record from the job site.
CITYOF TIGA,,RD _PLUMBiNGPERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2000-00009
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED:
SITE ADDRESS: 10530 SW JOHNSON ST PARCEL: 2S 103AA-01915
SUBDIVISION: COTTONWOOD PLACE ZONING: R-4.5
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTF S:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRANS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB/SHOWERS: SEWER LINE: ft
WA I-E2 OLOSETS: WATER LINE: it
DISHWASHERS: 01"N r)RAIN: ft
RemarKS: Plumbing reversal from septic tank to sanitary sever.
Owner: - -- FEES --- �_ ---_-�
Type By Date Amount Receipt
LAMBERT, ROBERT A
10530 SW JOHNSON ST PRMT BON 01/10/200C $50 00 00-321035
TIGARD, OR 9'223 5PCT BON 01/10/200[ $4.00 00-321035
Total — $54.00
Phone 1: --_--- ------ -----
Contractor:
LARRti CAMERON PLUMBING
1812 SE 159TH AVE
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone 1: 503-256-2705 Cc�,er Inspection
Reg #: LIC 4979E PLM/Underfloor
PLM26-366PB Final Inspection
0 R, I Gi IN A L
This permit is Is,!ted subject to the regulations contained in the Tigard Municipal Code, State of OR
Specialty Cedes 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 adopter] 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: �'� ( � ' Permittee Signature:) Z_ !�f�
Call (503) 639-4175 icy 7:00 P.M. for an inspection needed the next b,A4144s day
CITY OF T:CARD Plumbing Permit Application Kron Check
13175 SW }BALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Recd I -tit a'G
(503) 639-4171 Date to P.E.
Print or Type Date to DST -
Incomplete or illegible applications will not be accepted Permit#Fl-A1Z6XV) Cx>UV�
Related SWR#
Called
Name of Developm?nt/Project FIXTURES (individual) QTY PRICE AMT
Joh 1< i„, LA'-( Lc Sic:' 11.50
Address Street Address �L� Suite Lavatory 11.50
Tub or Tub/Shower Comb. 11.50
Bldg# City/State Zip Shower Only 11.50
Nam Water Closet 11.50
.i �1 yen2. Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.60
--J0! Garbage Disposal 11.50
City/State Zip Phone Laundry Tray 11.60
Name - Washing Machlne/Laundry Tray 11.50
2A/1/I Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite _ 3" 11.50
4" - 11.50
City/State Zip Phone _
Water Heater O conversion O like kind 11.60
----- Gas piping requires a separate mechanical permit.
L9me MFG Home New Water Service - 32.00
"rc tz.Y, COW 12 r c r�"� MFG Home New San'Slorm Sewer 32.00
Contractor Mailing Address suite -
z -ci- cam- Hose Bibs 11.60
Prior to permit Col/State Phone Roof Drains 11.50
Issuance,a copy agahtLALVZ F
Drinking Fountain 11.50
of all licenses are Oregon Const.Cont.Board L ic.# Exp.Date
required if Z Other Fixtures(Specify) 15.00
expired In COT Plumbing LIc.# Exp.Date
database
Name
Architect Sewer-1st 100' 38.00
or Mailing Address Suite Sewer-each additional 100' 32.00
��teEn ineer Zip Phone Water Service-1st 100' _ 38.00
Engineer Water Service-each additional 200' 32.00
Describe work to be done Storm&Rain Drain-1st 100' 38.00
New O Repair O Replace with like kind: Yes No O Storm&Rein Drain-each additional 100' 32.00
Residential O Commercial O -
Additional description of work: Commercial Beck Flow Prevention D(vla� - 32.00
r� Residential Backflow Prevention Devit e• 19.00
G 9c �G /c Lt UcS /4 Catch Basin 11.50
Are you capping,moving or replacing any fixtures? Insp,of Existing Plumbing or Speciall,r Requested 50.00
Yes O No O Inspectionsper/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.
I hereby acknowledge that I have read this application,that the Information QUANTITY TOTAL
Isometric or reser diagram Is requtred H ouantny Total Is >s
given Is correct,that I am the owner or authorized agent of the owner,and
that Ian submitted are in compliance with Oregon State Laws. "SUBTOTAL
SI rtf Owner/ Date
/C' _ Oc•f 8%SURCHARGE
_ � l
ontact Pers ame Phone
�✓� /e �Z a ,J�� 5-� - ��� y. **PLAN REVIEW 26%OF SUBTOTAL
1 BATH HOUSE:1 18.00 Required only if fixture qty total is>9
TOTAL
2 BATH HOUSE$26u-00
BATH HOUSE$285.00 - --�`Ilrhlls fee Includes all t Ium5ing fixtures In the dwelling and the first *Minimum pelmll fee is$50♦B%surcharge,except Residential Backflow Prever,flon
100 test of sanitary ae ser storm sewer and water service) Device,which Is$25.9%surcharge
**All New Commercial Buildings require plans with Isometric or riser diagram ano
plan review
I\dsts\formMplumapp doc 11/1 N99
4
PLEASE COMPLETE:
-- Fixture Type — Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink ------- - - — — — —
Lavatorj
Tub or Tub/Shower Combination
Shower Only -------- - --Y-- - -- -- —
Water Closet
Urinal ---- ----- ---- --- --- -- -
-Dishwasher
Garbage Disposal
Laundry Room Tray _—
Washing Machine
Floor Drain/Floor Sink 2"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I AMOomtilplum BDP lm:11158199 -
CITYOF T'IGARD PLUMBING PERMIT
\ DEVEI.OPMENT SERVICES PERMIT#: PLM2000-00C
13125 SW Hali Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 01/06/2000
SITE ADDRESS: 10530 SW JOHNSON ST PARCEL: 2S103AA-01915
SUBDIVISION: COTTONWOOD PLACE ZONING: R-4.5
BLOCK: LOT: 014 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:
'rug/SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks ..st 1 00'of sewer line
Y�
Owner: = - -- —
FEES
-- —�– Type By Date Amount Receipt
LAMBERT, ROBERT A --- —
AMBSCJ JOHNSON AT PRMT BON 01/06/200C $50.00 00-320951
10530 TIGARD, OR 97223 5PCT BON 01/06/200C $4.00 00-320951
Total $54.00
Phone 1:
Contractor:
TED MCBEE 'EXCAVATING INC
1 1428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone 1: 939-5246 Sewer Inspection
Reg #: LIC 110314
I`1nIf� I ��,Il1 �
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 obtaiii copies oftheserules or direct questions to OUNC by calling (503) 246-1987.
� 1
Issued By: Li��L Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CIT( OF T IGARD Plumbing Permit Application 'Ian Chock,#
13'i 25 SNIT HALL BLVD. Commercial and Residential Iiec't B (-%-��--
TIGARD, OR 97223 Dole Re'-.'—d - (l - 2-JU_2_
(503) 639-4171 Date to P E. _
Print or Type Date to DST
Inromplete or illegible applications will not be accepted Permit# 0_^?/7V
Related SWR# -_
Called
Nam(.of De�elopment/Project FIXTURES (Individual) QTYI PAkICE- AMT
Job Sin' 11.50
A(ldress Street Add ress ` Suite Lavatory - 11.50 - -
�7(�_`' i Tub or Tub/Shower Comb, 11.50
Bldg# City/Slate ,^ Zip Shower Only - 11.50
_ y
Nam. Water Closet 11.50
- ` Lalt2 Y Urinal -^- -- 11.51
Mailing Address Suite LLLIII
Owner 9 Dishwasher 11,50
u
Garbage Disposal 11.50
City/State Zip Phone -Laundry,IYaY 11.50
T Na -`- Washing Machine 11.50
_ Floor Drain/Floor Sink 2" •,1.50
Occupant Mailing Address Suite 3" 11.50
City/State - Zip Phone __ 4 11.50 —
Water Heater O conve;ion O like kind 11.50
—�- Name - -- Ga, i ink r�uires a cepa ate mechanical permit _
-F _M t , ) �^t( 'V C• MFG H)me New Water Service - 32.00 `
Contractor Mailing Address Suite MFG Horne New San/Storm Sewer 3200
Hose Bibs ---v 11.50
Prior to permit City/State Zip Phone Root Drains— 11.50
issuance,a copy •'C' _ -
- -
of all licenses are Oregon Drinking Fountain 11.50
onst.Cent Board Lic# Exp.Date _
required if ` ` ^ %4 Other Fixtures(Specify) 15.00
expired in COT Plumhing Llc.# Exp.Dale
database -----
- - Name -— ----— --- ---
Architect Sewer-1st 100' 38.00
Or Mailing Address Suite Sewer-each additional 100' 32.00
Engineer Cdy/State Zip Phone Water Service-1st 100' -- 38.00
Water Service-each additional 200' 32.00
Describe work to be done V Storm&Rain Drain- list 100' 38.00
NewRepair O Replace with like kind Yes O No O Storm R Rain t main-each additional 100' 32.00
Resid ntial Commercial O -
Additional description of work. Co,.rnerc:ial Hack Flow Prevention Device 32.00
11
0 Residential Backflow Prevention Device' 1900
L_Q i _- Catch Basin 11 50
Are you capping, moving or rep Ging any fixtures? Insp of Existing Plumbing or Specially Requested 50.00 —
Yes O No O -inspections er!hr
If 2s, see back of form to indicate work performed by vain Drain,single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps — 11.60
WORK COULD RESULT IN INCREASED SEWER FEES. —
I hereby acknowledge that I have read this application,that the information QUANTITY TOTAL
given is correct,that I am the owner or authorized agent of the owner,and Isometric or riser dlogram Is rec uired it Quantity Total is >9 -
Ihatbans submitted are in corroll3_nce with_Ore$oil State I.+ws `SUBTOTAL
SliggIpture of OwneNAg nt Dale
� -t t 8% SURCHARGE — I
:_�_—�_— _ �t�r
Conte arson Name Phone
r'�f c ?-1 �1��' �'C -- c l'„ — — **PLAN REVIEW 25%OF SUBTOTAL
` '- -- Rr�red only H fixture q�lal is>9
1 BATH HOUSE$178.00 TOTAL
` 2 BATH HOUSE$250.00 r`L
F BATH HOUSE$285.00 -------- �_-- -
(This fee Includes all plumbing fixtures In the dwelling and the first *Minimum permit fee Is$50+a%surcharge,except Residential Backflow Prevention
100 feet of sanitary sewer ntoiTr1 sewer and water service) Device,which Is$25+a%surcharge
"All Now Commercial Buildings require plans with Isometric or riser diagram and
plan revlrw
I ldslslformslplumapp doc 12/17199
1
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"
Vb'ater Heater___
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR1999-00263
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/15/1999
SITE ADDRESS; 10530 SW JOHNSON ST PARCEL: 2S103AA-01915
SUBDIVISION: COTTONWOOD PLACE ZONING: R-4.b
BLOCK: LOT: 014 JURISDICTION: TIG _
TENANT NAME: LAMBERT, ROBERT& GEORGIA
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: NEW DV,;FLLING UNITS: 1
TYPE OF USE: SF NO. (.F BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFPCE:
Remarks: Connection to sewer lateral as part of Reimbursement Uist,ict#12. Reimbursement fee of
$5,597.82 paid on 12/15/99. Septic tank to pumped, filled :)r removed and inspected.
Owner: -_----- FEER _
LAMBERT, ROBERT A
10530 SW JOHNSON ST Type Bl Date Amount Receipt
_�-- -- --
TIGARD, OR 97223 PRMT GEO 12/15/199 $2,300.00 99-320425
INSP GEO 12/15/199 $35.00 99.320425
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections —
Sewer Inspection
Septic Tank Filled
ORIGINAL
this Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
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' 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 OAR 952.001-0010 through O X952-001-0080
You may obtain copies of these rues or direct questions to OUNC by calling (503) ?AA 987 1
,1
Issued by: .` �I� ��^c -- —� Permittee Signature:;+
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day