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CITY OF T[GARD B111l,DIIVG INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639-4171
Date Requested: --1p %Z _ A.M. P.10. MST: _
Location: _ A� 25 C1& /y;( �L �__ _.�. —�_ 13UP:� ---
Tenant: Suitte:_n Bldg: — MEC:
Contractor:-^ --- Phone: / t /•�`��`--- PLM:
Owner. _Pltone: C C:
BUILDING BI, (/ MECHANICAL MitTRICAL� SITE
Site Post/Beam Post/Beam Post/Beam Cover/ServiceeZobstorm
Footing Roof UndFl/Slab Rough-In Ceiling Watcx Line
Slab Framing lit Gas Line Rough-In UG Sprinkler
Foundation Insulation Sma .) Ilood/Duct Reconnect Vault
Bsmt Damp I)ywa!l Storni Furnace 'temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump Low Volt
,Approved q._.� Approved Approved Npproved
APer/Sdwlk Not Approved Not W oved Not Approval Not Approved Not Approved
FINAL FINAL FINAL FINAL
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r- �Ca I for reinspection O Reinspection fee of$ teyuimd bef a rex 'tspec:tion O I Inable to inspect
In.�pector. Date: _ Page— / of
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CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : F'LM98-0010
0 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 01 /21 .198
PARCEL: 2S111BD--00605
511-E ADDRESS. . . . 1 Oc'-05 SW 96TH AVE.
SUBDIVISION. . . . . DARMEL N0.2 ZONING: R--3. 5
BLOCK. . . . . . . . . . . L0T. . . . . . . . . . . . . :032 JURISDICTION: TIG
CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPAC1--S. : 0
TYPE OF USE. .. . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . ,. „ . 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES--------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE. TRAPS. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 100
WATER CLOSET'S. : 0 WATT R LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft) . . . : 0
Remarks : Lairson
Owner: ---- --- --------__._.________.____________.____ _..-----__—_-- FEES --_---____--_--
ERIC LAIRSON & VICTORIA LAIRSON type amos-int by date recpt
15025 SW 96TH AVE F'RMT 30. 00 JSD 01/21/98 98--302640
TIGARD OR 97=24 SPCT $ 1. 50 JSD 01/21 /98 98--302640
Phone #:
Conti,act
PENGUIN TRACTOR
PENGUIN TRACTOR AND EXCAVATING SER
11.84 NE SUNRISE LN
HIL.L.SBORO OR 97124 ----------------------------------------
Phone
----------.--_._—_-------.--------------
Fhone #: 681-0319 f :31. 50 TOTAL
Reg #. . : 104782
------- REQUIRED INSPECTIONS --- ----
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other F i r,a 1 Inspection
applicable laws. All work will be done in accordance with _
approved plaits. Tl.is permit will expire if work is not started
within 180 days of issuance. or if work is suspended for more
�- than 180 days. ATTFNTION: Oregon law requires you to follow rules
in adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-0001-0010 through OAR 952-9001-0080. You say
�— obtain copies of these rules or direct questions to OUNC by calling
—' 1503)246-1987.
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1 � G,_1ed Ry : _ Permittee Signati-:re :
++++++++++++++++++++ ++++++++++++.1•h+++++++++++++++++++++++++++++++-F i-++.++++++++
Call 639-4175 by 7:00 p. m. for an inspection needed the next bi.tsiness day
4-++++++++++++++++++ h++4tttt 4 f E++-}+++t t4 t-1 ....+-......+t+....i-+-++...f......+ttt++.
CITY OF TIGARD Plumbing Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Redd
TIGARD, OR 97223 Ddre to P.E.Date to DST
(50 ) 639-4171 Permit# 2 -N n -
Print or ?ype Related SWR# ;,._4
Incomplete or illegible applications will not be accepted Called r _
Name of DevelopmenUPro!ect On back indicate Work Performed by fixture.
Job FIXTURES (Individual) QTY PRICE AMT
X Address Street Addressq Suite Sink 9,00
So ZS fui . tG�� Lavatory 9.00
Bldg# Ci ISwe Zip/�i�>2D Tub or Tub/Shower Comb. _ 9.00
N=e Shower Only 9.00
Water Closet 9.00
4 Owner Mailing Address Suite Dishwasher 9.00
JrZ' 9G , Garbage Disposal 9.00
Cit /State Z7' Phonep Washm Machine
_ /�C/?/!L0 r�j/Q Y�o2o7C �j=,7- l/O!Y 9 9.00
Name Floor Drain 2' 9,00
3' 9.00
Occupant Mailing Address Suite
a" 900
City/State Zip Phone Water Heater O conversion O like kind 9.00
Laundry Room Tray 9,00
Name Urinal 9.00
` y 1 Other Fixtures(Specify) 9.00
Contractor Mailing Address Suite
9.00
Prior to permit Cijy/ s e ZIQ Phone 9.00
issuance,a copy 1,/ �� LL Pon"
r_' > C 9.00
of all licenses are Oregon Const.Cont.Board Lic.# Exp.Usla 9.00 _
required if (' — t /fLi Sewer-1st 100" _
expired in COT Plumbing Lia.# Exit.D to x — 75 30.00
database C Sewer-each additional 100' 25.09
Name Water Service-1st 100' 30.00
Architect Wa,jr Service-each additional 200' 15.00
or Mailing Address Suite Storm R Rain Drain-1st 100' 30.00
Storm&Rain Drain-each additional 100' 2500
Engineer City/State Zip Phone Mobile Home Space 250,)
`-- Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New O Addition O Alteration O Repair O Pollution Device _
to be done: Residentlar1f, Non-resldential O Residential Backflow Prevention Device' 1500
Additional description of work: Any Trap or Waste N t Connected to a Fixture 9.00
Catch Bain 9.00
~� Insp.of Existing Plumbing 40.00
per/hr
Existing use of Specially Requested Inspections 40 00
building or property— _ per/hr
+— Rain Drain,single family dwelling 30.00
N Proposed use of —
Grease Traps 9.00
ilding or property
H QUANTITY TOTAL
I hereby acknowledge that I have read this application,that the Information Isometric or riser diagram is required d Quandy Total Is >9
given Is cored,that I am the owner or authorized agent of the owner,and *SUBTOTAL
that plans submitted-are in coatpliance with Oregon State Laws.
Signatyce•or nerfAgeht Dat , 7 i
—j 6 h SURCHARGE
Conbct Person Name Phone PLAN REVIEW 25%OF SUBTOTAL
-R"L1ved o re cft.total is,9
/-�iG �r9//tdv.✓ ��`? ` TOTAL / j)
✓'�. um permit fes Is$25+5%surcharge.except Residential Back G
G r vention Dekrice,which is$15+5%surcharge
I ldslslplmapp dioc 5/97 v / 7 /l�j�li!.1 I
/
PLEASE COMPLETE.
Fixture Type _ Quantity by Work Performed _
New Moved Replaced Removed/Capped
Sink
Lavatory
Tub or Tub/Shower Combination _
Shower Only -
Water Closet -
Dishwa ,ner
Garbage Disposal -
Washing Machine
Floor Grain 2"
Water Heater -
Laundry Room Tray
Urinal _ ---
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
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CITE( OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
PERMIT
13125 SW Hall Blvd., Tigard,OR 9720 (503)639.4171 PERMIT #. . . . . . . : SW R98-0008
DATE ISSUED: 01/21/98
PARCEL: 2S 1 1 1 BT)-00605
SITE ADDRESS. . . : 15025 SW 96TH AVE
SUBDIVISION. . . . :DARMEL NO. 2 ZONING- R-3. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :03,2 JURISDICTION: TIG
---------------------------
TENANT NAME. . . . . :LAIRSON
USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0
CLASS OF WORK. . . :ALT DWELLING UNITS. . : 1
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . :LTPSWR IMPERV —)URFACE: 0 sf
Hemet-ks : Lairson RE: PLM98-0010 hll_+st pmmp, fill, and cap septic system.
Owner-: ._-_-------------------------------------------------- FEES --.------------
EP.IC LAIRSON R VICTORIA LAIRSON type amol.tnt by date recpt
15025 SW 96TH AVE PRMT $ 2200. 00 JSD 01/21/98 98--302640
TIGARD OR 97224 INSP $ 35. 00 JSD 01/21/98 98-302640
Phone #:
Contractor: __—.------___------.----------____--
GWNU-R
Phone #: $ 3. 00 TOTAL
Reg #. . :
-------- REQUIRED INSPECTIONS --------
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 190 days from Septic Tank Fill
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 wi:l 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 _
92-01-001@ through OAR 952-9081 ,may obtain copies of
�'- these rules or direct questions to R.Rk (503)246-1987.
L
lssi_ted by:__ Permittee Signatl-tre:_
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W
+.++++++++++++++++++++++++++1-+++++++++-L++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 p. m. for an inspection deeded the next bi_tsiness day
4++++++++++++++++++++++++++-++4.++++++++t+f-++++++++4-++l.......f-I...................4-+4
Jun-11 -98 09 : 42A P _01
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FROM PENGUIN TPACTCF SEP:1ICE PHONE NO. : 503 681 M19 .Jun. 11 1998 10:28AM P01
Penguin Trac:,-Fr and Excavating Services, Inc.
1184 NL' Sunrise Lane
Hillsboro OR 97124
YNfox: 503-681-0319
June 11, 1998
To Whom it May Concern:
Thig is to inform you that the septic system at the residence Owned by Eric Lairson
at 15025 SW 96th Avenue in Tigard, Oregon, has been pumped .,nd filled.
Sincerely,
Barbara Summer, Ownrr
Penguin Tractor Service
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