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10730 SIN NORTH DAKOTA ST
114
CITY CSF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
PERMIT
13125 SW Hall Blvd.,flgand,OR97223(503)639-4111 PERMIT #. . . . . . . : SWR98-0047
DATE ISSUED: 03/22/98
PARCEL: 19134DA-02600
SITE ADDRESS. . . : 107?Vr SW NOPIH DAKOTA ST
SUBDIVISION. . . . : ZONING: R-3. 5
BLOCK. . . . . . . . . . t_OT. . . . ., . . . . . . . . . JURISDICTION: TIG
-----------------------------------------------------------------------------------
TENANT NAME. . . . . :LARSON, WAYNE
USO NO. . . . . . . . . . : FIXTURE UNITS. . . : 0
CLASS OF WORN,. . . :ALT DWELL I NG Uhl I TS. . : 1
TYPE OF USE. . . . . :SF NO. OF BUILDINGS% 0
INSTALL TYPE. . . . :LTPSWR I MOE Rl+ SURFACE: 0 s f"
Remarks: Sewer line and connection.
Septic must be pumped, filled, and inspected.
Owner. ---------------------------------------------------- FEES
WAYNE A L_ARSON type amo+.rnt by date recpt
10730 SW NORTH DAKOTA PRMT $ 2300. 00 R 09/22/98 98-309343
TIGARD OR 97223 INSP $ ?` _ 00 n 09/22/98 9 8-309,3 'a?
Phrrne #:
Contractor: ------------------------------
OWNER
__—_—___-_-------------------OWNER
---------------------------------
Phone #: E 2335. 00 TOTAL.
Reg it. . .
F EQU T RFD INSPECTIONS
This Applicant agrees to comply with all the rales aid regulations Sewer Inspection
_
of the Unified Sewage Agency. The permit expires 188 days from Septic Tallk Fill
the date issued. The total amount paid will be forfeited if the WJAI
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 _
O. Oregon Utility Notification Center. These rules are set forth in OAR
952-1181-0811 through OAR 952-8N1-M. You may obtain copies of
these rules or direct questions to RNC by calling (503)246-1987.
An*m T s s r.r e d b y: . _ ...... Permittee Sig n a(+_r re. -
(9
W
+++++++++fi•}+++++++++++++++++++++++++++++.++.++++++- 4+++++++++++++++++++..++y
Call 639-4175 by 7:00 p. m. for an inspection needed the next business day
++++++++++++++++++++++++.I.+++++++++++++++++++++++++++++++++++++•t+++++++.++++++++++
CITY OF TIGARD BUILDING INSPECTION DIV BION T al-n1/I -7
24-Kour Inspection Line: 639-4175 to_f7 (Business Line. 639-41711/
BUP
pate Requested_ /u —'� BLD —_
LocationSuite MEC _
Contact Person Ph pLM ,�—
Contractor— _ Ph _ _ SWR ?y 7
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Ftg Orain
Crawl Drain Inspection Notes: TSGNSlab
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear t
Framing
Insulation
Drywall Nailing 6r==1ex
Firewa!t
Fire Spiinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: --- V
Final
P T FAIL -
UMBI
Post&Beam -- -
Under Slab
Top Out _
_ Sanilar j Sew —
Rain rains,-` —
Final — I
PASS PART FAIL _—
MECHA
Post&Beam — -- — - - --—
Rough In
Gas Line - — --
Smoke Dampers
Final -----
OASS PART FAIL
ELECTRICAL -� ----- —�
IL Service.
re Rough In
N UG/Slab
Low Voltage --
Fire Alarm
.1 Final
G1 PASS PART FAIL
5 SITE
Backfll!/Grading --- ----------— -
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ]Please call for reinspection RE:. —_----__ [ ]Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record f otle the fob site.
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SWHaHBlvd., 119aid,OR97223(503)639x171 PERMIT M. . . . . . . : PLM98-033=
DATE ISSUED: 09/22/98
PARCEL.: 1.S 134DA--02600
SITE ADDRESS. . . 10734 S14 NORTH DAKOTA ST
SUBDIVISION. . . . : ZONJNG: R- 3. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . .. . . . : JURISDICTION: TIG
------------------------------
CLASS OF WORT!. . :AL.T GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. :. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . :R? FLOOR DR.AINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . .. 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
�'YTLIRES ---------- -- LAUNDRY TRAYS. . . . . s 0 SF RAIN DRAINS. . . . . : 0
S +KS. . . . . . . . . . 0 URINALS. . . . . . . . . . . s 0 GREASE TRAPS. . . . . . . : 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 300
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Sewer- line
owner-: --------------------------------------------------- ------ FEES _-----
WAYNC A L_ARSON type amount by date recpt
107.3Qi SW NORTH DAKOTA PRMT $ 80. 00 B 09/22/98 98-309343
TIGARD OR 97223 5P("-T $ 4. 00 B 09/22/98 98--309343
Phone f: 639-7828
C o n t r act n r,----------------------------------
WAYNE" LARSON
10730 SW NORTH DnVIOTA
'TIGARD OR 97223 -------.--------------------__--.___ ..
Phone #: $ 84. 00 TOTAL
Reg #. . :
REQUIRED INSPE'CTIONS - - -_.__—
This permit is issued subject to the regulations contained in the Sewer- Inspection
Tigard Municipal Code, State of Ore. Specialty Codes :md all other Final Inspection
applicahle laws. All North will he done in accordanrr with
approved plans. This permit will expire if work is not started
n within 188 days of issuance, or if work is suspended for morethan 188 days. ATTENTION: Oregon law requires you to follow rules —
N adopted by the Oregon lttility Notification Center. Those rules are
set forth in OAR 952-0001-0010 through DAR 952-AA81-W..0. You may
cbtain copies of these rules or direct questions to OW by calling
m (503)246-1987. -
W
Issi.ied
V . "- �_ Permittee Signature :
++++++++++.+++++++++++++++++++ ►44++++++++++++++++++4•+4-++++ + ++++++4++++++++ F++
Call 639--4175 by 7:00 p.. m. foi- an insper_tion needed the next business day
++++...++++++++++++++....++++a.++++++++++++++...F++-F+++++++++++++++++++++++4++++++i-+
CITY OF TIGARD Plumbing Permit Application Plan Check _
13125 SW HALL BLVD. Commercial and Residential Rer'd By
TIGARD, OR 97223 Date Recd
(503) 639-4171 Date to P.E. _
Print or Type Ds-le to DST
Incomplete or illegible applications will not be accepted "efmit0
Related SWR!_
Called
Name of Development/Project
Job sink 9.00
Address Street Addre.N suns Lavatory _ 9.00
AA kAA— Tub or Tub/Shower Comb. 9.00
Bldg# V11t1VyAf?D
/State Zip Shower Only g p0
hornel Water Closet 9.00
42
— — Dishwasher --- g 00
Ownerall�ng.4 v s Una Garbage Disposal 9.00
Washing Machine g 00
C /State -ip Phone _
ah! / el Floor Drain/Floor Sink 2" 9.00
Note 3" F
00
S 4" -- E
00Occupant Mailing Address Suite WaterNeaterOconversion O like kind 00
Gas pipl�e ulres a separate mechanical permit.
CitylStato Zlp Phone Laundry Room Tray Q
-- Naam Urinal — 9.00
Jepli 0j
J Other Fixtures(Specify) 9.00
Contractorf ailir-7 // suite 9.00
(�s 9.00
Prior to permit CIWIate Zip Phone Sewer-1 st 100' 30.00 6�
issuance.a copy / ,4 } PZ (p2
of all licenses are O on Co ort soon)Lic. Exp.Date Sewer-each additional 100' 2 25,00
required If Water Service-1 a 100' 30.00
expired in COI' 131 r blFtg LIC.0 Dale Water Service-each additional 200' 25,00
database � Storm il,Rain Drain-1st 100' 30.00
Nems Storm&Rain Drain-each additional 100' 25,00
Architect — Mobile Home Space — — 25,00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City/state Zip Phone Residential Bach.'ow Prevention Device" 15.00
(Irrigation timing de rices require a separate
Describe work to be done: restricted one L)en,4.
New O Repair n Replace with like kind: Yes O No O Any Trap or Waste Not t nnected to a Fixture 9.00
Residential O Commercial O Catch Basin 9,00
Additional description 4work:
Insp.of Existing Plumbing 40.00
C' tNiUPC fi � S� �L/ea 4 p 9 9_ perthr
Specially Requested Inspections 40.00
X Rain Drain,single family dwelling X00
N Are you cappl g,moving or replacing any fixtures? _
Va Yes O No 13-- Grease Traps 9.00
>" If yes,see back of form to Indicate work Performed by -- — - „,t
H QUANTITY TOTAL
J fixture,. FAILURE TO ACCURATELY REPORT FIXTURE Isometric a riser dlapram Is required K Ouartlity Total is >9
m WORK COULD RESULT IN INCREASED SEWER FEES. Isometric
"'
I hereby acknowledge that 1 have read this application,that the information `i
W given Is correct,that I am the owner or authorized agent of the owner,and 616 SURCHARGE
J that plans submitted are in compliance with Oregon State Laws. _ op
Signature of Owner/A ent Date ""PLAN REVIEW 26%OF SUBTOTAL
/1 r /� R ked only If axturs qty.total Is>9
`/ VV TOTAL
Cortfa Person Name Ph ne
—�I —'Minimum permit fee Is$25+5-A surcharge,except Residential Baddlow
1 _ Prevention Device,which Is$15+5%surcharge
"All New Commercial Buildings require plans with IsomeMr,or riser diagram
and plan review
i%dvteiplumapp doc MM
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed -
New Moved Replaced Removed/Capped
Sink _
Lavatory _—
Tub or Tub/Shower Combination _
Shower Only -
Water Closet
Dishwasher
Garbage Disposal
Washing Machine__ �-
Fioor Drain/Floor Sink 2"
3„ -- — --7Z - ---
Water Heater
Laundry Roum Tray _
Urinal --
Other Fixtures (Specify)
COMMENT G REGARDING ABOVE:
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I k SWphimam noc 7flMp
Oct-07-98 08:48A John E I-rank Contractor, 503 628 0155 P.02
ALOHA SANITARY SERVICE
P.O. BOX 309, BANKS, OREGON 97106
644-2797 * 648-6254 * 639-5186 , 3 ,
NAME: — I4. L--
ADDRESS: —
CITY: STATE: ZIP: ---
HOME: — WORK- too ~ 77 6 n C) CELL:
-oT SITE: 10 73 0 5,w, P O.#:
PAID BY CHARGE i1 HEC CASH ❑ CREDIT CARD CO
HATE /0- to-C, DRIVER 0116 ' -~' AMOUNT
PUMP SEPTIC TANK_
O LINE OPENING
If' TIQN FEE --------- � -- --
SERVICE CALL
LABOR. LOCATING. DIGGING & BACKFILL
0 MATERIAL
P�e1C 46OL- U
---THrs Is Nor A SEPTIC SYSTEM INSPECTION REPORT— LOTAL 11 240.1
- - REMARKS - -
TYPE OF TANK: S*L Cl CONCRETE n PLASTIC r l HOMEMADE
HORIZ AL i'l VERTIJ2AL I RECTANGLE Cl OTHER_
SIZE OF TANK: 350 r I 1 750 PI 1000 n 1250 71 1500 [l 2000 0 -3000 C1
LID LOCATION: INLET q IO MIDDLE O EN'v IRE TOP n
TANK CONDITION: GOOD n FA POORCI
IL FITTINGS: BAFFLES n CONC E rl CAST IRON ❑ PLASTIC O
NEEDS NEw LID? I YES SIZE
GROUND COVER OVER TANK
COMMENT ON CONDITION OF DRAINFIV 0 ETC. \\�
m
iSIGNED BY -'---- ------- DATE^--