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11885 SW James Court
CITYOF TIGARD PLUMBING PERNIIT
DEVELOPMENT SERVICES PERMIT#: Pl-M2002.00438
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSIIED: 11114/02
PARCEL: 2S103CA-02700
SITE ADDRESS: 11885 SW JAMES CT
SUBDIVISION: TRAVPORT PARK ZONING: R-4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCIIPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURED LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: 120 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect house to sewer lateral. Septic to be pumped, filled or removed and inspected 12-6-02: Add 40'line
work to permit for a total of 120' line w,)rk
FEES_
Owner:
-- F=—
Description Date Amount
LEWIS, EUGENE R
JANET L ll'LUMIiI I'crmit I cr 11114/02 $72.50
1 18'35 SW JAMES CT I I'AXI M/a Stwe Tax 11/14/02 $5.80
11885 7, OR ES I I'LUM13I Permit 1�cc 12/6/02 $46.40
TIGAI1 ANI S S(atc Tax 1216102 $3.71
Phone : ---� --
Total $126.41
Contractor:
REQUIRED INSPECTIONS
Phone - Sewer Inspection
Misc. Inspection
Reg 4: I I( 151481
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 dill expire if work is not. started within 180 days of issuance, or if work is suspended
for more than "i 80 1iys. ATTENTION Oregon law requires you to follow rules adopted by the Oregon
.............
Issued By:
Permittee Signature:
Call (503) 639-411 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Uatc received: f ermu
City of Tigard,
Sewer permit no.: Building permit no.:
Address: 1?125 SW Hall Blvd,Tigard,OR 97223 —
City ofTigard phone: (503) 09-4171Project/appl.no.: Expire date:
Fax: (503) 598-1960 tate issued: By: Receipt no.:
Land use approval: Uj 07-);;l • Z'r.3e, ease file,no.: Payment type:
U 1 &2 family dwellink or acccti,;ory U Commercial/industrial U Multi family U Tenant improvement
J New cons tntction U Addition/alteralion/replicement U Frrcxl service U 0111^r:
I!R SITE sspekin�11111orinfillon
Joh address: / kS C� �. �},P Ue%criplion _ (jty. Fee(ea.) 'Total
Bldg.no.: 1 Suite no.: — New 1-and 2-famiiV dwclliugs only:
(Includes 100 It.foreach utility connection)
Tax map/tax lot/account no.: SIR(1)bath
1
Lot: Block: Subdivision: - -- ---
S Z- � SFR(z)bath-_-- —
Pmject name: a v r % SFR(3)bath- -- --- -- - --
City/county: r QQ ZIP: 77Z j Each additional bath/kitchen -^
Descrf doan oculion of work on premises:.{�A/ !'�_�� Sheutllitles:
Catch b-tsin/arca drain
Est,date of completion/inspection: -- DrywellYlvach line/trench drain
OR Footing drain(no.lin.ft.)
PLUMBING CONTRACT
Manufactured home utilities
Business name: '> "fc Manholes
-Address: Isnu1/� _ Rain drain connector
Cily:42 Statc 7.1 P:F 740 76) Sanitary sewer(no.lin. ft.)
Phone: .1`/2 9 f' x.57p E-mail: Storni sewer(no, lin. ft.) _
CCB no.: Plumb.bus. re no: Water service(no. lin. It.
City/metro lic.no.:
/�-L— 8 -- Fixture or•item:
_
Contractor's representative signatunr:' �
-- Absorption valve
"Namle:
il -- - Back flow preventer
An Date: Y C2 Backwater valve
Basins/lavatory _
19--> -Clothes washer—
Address: -� Dishwasher
City��-- _---- _ - State: ZIP:
Drinking fountain(s)
--- F.jectors/sump
Phone:
Fax
/' J L-mail: Expansion tank
Fixture/sewer cap
_Name(print , ��, FI(x)r drains/floor sinks/hub
Mailing address:_ 8j - �--- -- -- -� Garbage disposal _
Hose bibb
City: 5tatc: ZIP: f 7 223 [cc maker -
Phone; _ Fax: 1 E-mail: Interce)itor/grease trap
Owner installation/residential maintenance only: The actual installation f'rinur(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _
employee on die property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature:_ _ Date: _ _ rSump _
1` Tubs/shower/shower pan —
Name: Urinal
- -- — Water closet
Address: Water heater — -
City: State: ZIP: Other:
Phone: Fax: I E-mail: Total
I iot all jurisdictions accept credit cards,please call jurisdiction for more infrnmation. Notice:'this permit application
Minimum fee................$
U Viaa U MasterCardPlan review(at _ %) $
expires if a permit is not obtained -
credrt card number:_ --�rnl�_ within 180 days after it has been State surcharge(8%)....$
--Name of cardholder as shown on credit c accepted as complete. TOTAL .......................$
Colder signature Amount 440-1616(MrOM)
PLUMBING PERMIT FEES: -
----- PRICE TOTALS New 1 and 2-family dwel��n8s only. 1 PRICE TOTAL
(in�tudes all plumbing fixtures in II 0.� (ea) A!;IOUNT
QTY ea AMOUNT FIXTURES Individual _. � thu �weliing and the firat100 ft,—
16.60 for each utility connection_ _ $249.20
Sink 16.60 one_ ------ $350.00
Lavatory — 18.110 Two 2 bath__._---•------ $399.00
Tub or Tub/Shower Comb Three 3 bath __----
18lill
Shower Only �'•— 18.61
----------TOTAL
SUB
water Closet _ - 18 80 8'.s/ TATE SUHARGE
_ R�
PLAN REVIEW
Urinal — 16.60 — 28•/.OF SUBTOOTAL
Dishwasher 16.60
Garbage Disposal... 18.80 _
Laundry Tray 16.60
Washing Machine 16.60 _ PLEASE COMPLETE:
Floor Drain/Floor Sink 2" 16.60 —
3" --
16.60 --------- Quantit b Work Performs
4" — New Moved Replaced Removed/
16.60 Fixture Type: _ Capped_
Water Heater u esoa separate mechanical —
Gas piping q — Sink — —
ermit. 46.40
MFG Home New Water Service —_ _ _ Lav8to46.40 Tub or Tub/Shower _
MFG Home New SanlStorm Sewer 16,60 Combination `
Hose Bibs --- 16.60 Shower Oni
Rost DrainsWater Closet —
16.60 Urinal
Drinking Fountain — 1u 60 Dishwasher
Other Fixtures(Specify)(—y) — Garba a Dis osal —_
= Laund Room Tra — —
_ Washin Machine
Floor Drain/Sink: 2"
55.UJ 3" —
41
48.40
Sewer-1 st 100'
Water Heeler
Sewer-each additional 100' 55.00 Other Fixtures
Water Service•1st 100' 46.40 S eci
Water Service-each additional 200' S—
Storm&Raln Drain.-1st 100' 46.40 _
Storm&Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 27,55 _
Resident al Backflow Prevention Device' 16.60 _------
Catch Basin 62.50 r,ARDING ABOVE:
t-xistin Plu bi g or Spec Ily erlhr COMMENTS R'
Inspectic❑r_ 9 — _`----- --- �--
Re uesled Ins ecu�r^ 65.25
Rain Drain,single family dwelling _ 18.80 --
Grease Traps --
QUANTITY TOTAL —
isometric or riser diagram Is rrrquired if —
Ouantit Total is 1'9
*SUBTOTAL r1 r L% --- - ----_---
%STATE SURCHARGE
••PLAN REVIEW 25%OF SUBTOTAL
R qui—_ed only�t fixture_cty-1oTO9TAL
�.
*Minimum Iyrrrrit fes Is$72 5d+8%slate surcharge.exropl Residential Backfluw
Preventinn Device,which is$36 25 if slate surcharge
"All New Commercial' Buildings require 2 seb of plans with Isometric or riser
diagram for p
is\dsts\forms\pirn-fees.doc 12/26/01
CITYOF TIGARD _ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00301
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 LATE ISSUED: 11/13/02
SITE ADDRESS; 11885 SW JAMES CT
PARCEL: 2S103CA-02700
SUBDIVISION: ZONING:
BLUCK: LOT: JURISDICTION:
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: Connect existing house to newly installed sewer lateral. Reimbursement District#22 fee of$9,000
paid on this date.
Owner: --- —
_____
LEWIS, EUGENE R FEES
lucscription Date Amount
JANET L _
11885 SW JAMES CT I S"".JSA I S\�r Connect 11/13/02 $2,300.00
TIGARD, OR 97223 1SWINSI11 Swr Inspect 11/13/02 $35.00
Phone: -- - -- —
'otal $2,335.00
Contractor:
Phon
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. It he permit expire, '0
days from the date issued The total aniount 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 thdough OAR 952-001-0100
You mny obtain c ogies of these rules or direct questions to OUNC by calling(503) 246-6699.
-7)
Issued by: Permittee Signature:
�
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
106455
CleanWater ervices
Sourco 2550 SW
ControlDivision
Highway
Durham Wastewater Treatment Facility
25505W HiilsboroHlghwoy
MIIlsboro,OR97123
(50318468931 LIQUID WASTE HAULER LOAD TICKET AND
(503)846.8937FAX HAULER INVENTORY SHEET
LIQUID WASTE HAILER LOAD TICKET
Company Name: 11Sln��/Q--- =, L- ----
USA Permit Number: j Truck License Number 01
Date Liquid Pumped: Time Pumped: '
Date Dumped at USA: t- 7 -_� — --- Time Dumped: _ —
Approx. Gallons Pumped: Sample Taken: Yes_x _ X-No. ^_�
No pH _L_
LIQUID WASTE HAULER INVENTORY SHEET
Yes[_]No❑ Receipts Attached (Please includo all information requested)
1(� �! tn) r 5 Telephone Number:
Customer Name: - _
Address: _ .__1-�-0-- -5 --moi�
Date Pumped: J "r' �. Gallons Pumped:
Vessel Pumped: Septic Tank: Chemical Toilet: ❑ Other (Please List)
Customer NamTelehone Numbere: _ p
Address. -
Date Pumped: __ Gallons Pumped
Vessel Pumped: ❑ Septic Tank �_) Chemical Toilet L ; Other (Please List)
Customer Name: _ _ Telephone Number
Address: -
Date Pumped: Gallons Pumped
Vessel Pumped. F-_i Septic Tank L:7j Chemical Toilet EJ Other (Please List) --.
Certification
I certify under penalty of law that the above information is true and correct to the best of my knowledge, and
further certify that the truck listed above contains only domestic septic tank or chemical toilet waste and does not
contain process waste fr m either a co ercial or industrial facility.
Print Name/Titl '� ..Q YsCr 4X I' IZ-.ty-- - —_- -------
Signature — - - - -- - - ----- DateaddlSiOl -
While-Ueen Water Sc rvices Yellow-industry Form 1201-02
;1
4
A-AFFORDABLE
SEPTIC SERVICE
P.O.BOX 1130
WILSONVIL.LE,OR 97070
lr(5C3).,2.,,. FAX 1503) 570-0779
CIISTOMER'S ORDEn NO PHgNF UA I E
I _ '
NAME
—. 12.�---.�\.-ifrf4.(1-J--... ----
ADDRCSS /
SOLD BY C 8H C.O.D. CHARGE ON ACCT. MDSE.RETD. PAID OUT
DESCRIPTION
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TAX I
! RF.CEIVFD BY TOTAL
All rlalms and returned goods MUST be acrompan*d by this hilt
To Reorder THANK Y O U
fS017 22S A380 m notm com
CERTIFICATION OF EXISTING SYSTEM
ABANDONMENT
4
PERMIT NO. a/►'7
T S, R E, Section , Tax Lot(s) _
I certify that the existing /(-septic t k/ drywell / cesspool (circle one or more)
was properly abandoned t6-9, tatersVindards. The sewage contents were
removed by
(Company Name)
a licensed sewage disposal pumping service. The unit was then backfilled with
rock or(tand, and the building sewer promptly capped or removed.
Signature Date
CITY OF TIGARD 24-Hour �
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Received _ ,ate Requested__ - AM _-
l 9 g- - PM - - RUP
Location _Suite MEC _
Contact Person r Ph( -) - 1 s PLM
Contractor Ph
_ - -- i _--- R
BUILDING Tenant/Owner -
---- ELC
Footing - - - - _
Foundation Access: ELC -
Ftg Drain -----
Crawl Drain ELR
Slab Inspection NoteS: _ - SIT
Post$ Beam --_ --._--.-
Shear Anchors - - - --
ExtSheath/Shear
Int Sheath/Shear
Framing --
Insulatio,r
Drywal'Nalling
FirewAll -- - - —
Firc Sprinkler
Fire Alarm —
Susp'd Ceiling -
Roof
Other:-
Final _
PASS PART FAIL
_PLUMBING -
Post&Be—am
Under Slab _
Rough-In
Water Service
Ram rains -,_ _
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
R
LNIPAL
1I _
ASSPART FAIL --- __
_ _ --
Post 8 Beam
Rough-In
Gas Line -
Smoke Dampers
Final _—.�-----
PASS PARTFAIL
CTRIC
ELEAL_
Service
Rough-In -
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd.
SITE _ 0 Please call for reinspection RE:_ _._ [] Unable to inspect-no access
Fire Supply Line - ---
ADA
Approach/Sidewalk Date �L _ _ Inspector .._
Other. Ext_ - ---
Final DO NOT REMOVE this Inspection record from the job site.
'ASS PART FAIL