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12440 SW 106TH DRIVE �a N .P O �A 1 O D C m 12440 SW 10f,'" AVE. CITYO F T I G AR __PLUMBING PERMIT DEVELOPMENT SERV'IrE , t� � PERMITM PLN11999-00445 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6h .1DATE ISSUED: 12/28/99111,4 i SITE ADDRESS: 12440 SW 106TH AVE i PARCEL: 2S103AA-0191'i a SUBDIVISION: COTTONWOOD PLACE ZONING: R-4.5 BLOCK: LOT: 003 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: Ft3 FLCOR DRAINS: TRAPS: STORIES: WATER HEATERS CA FC,H BASINS: FIXTURES �_AUNDRY TRAYS: SF FAIN DRAINS: SINKS: _ URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER UNE: :t DISHWASHERS: RAIN DRAIN: ft Remarks: Connection of existing residence to newly installed sewer line. Connection will made more than 5'from the hou,,e. The existing septic tank is to be pumped, filled and inspected or removed and inspected. Reimbursement fee of$5,597.82 was paid on this date, 12i28/99. Owner: FEES - -- _ — Type By Date Amount Receipt SHELL.EDY, RODNEY F PRMT DEB 12/28/99 $50.00 99-320696 JEANNINE B 12440 SW 106TH AVE 5r'CT DEB 12/28/99 $4.00 99-320696 TIGARD, OR 9722.3 Total $54.00 Phone 1: Contractor: GEOTECH CONSTRUCTION INC 1833 PIONEER PARKWAY ST#145 SPRINGFIELD, OR 97477 REQUIRED INSPECTIONS Phone 1: 541-302-6857 Sewer Inspection Reg #: LIC 131597 Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicabl,? 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 mora 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-OOC,1-0010 through OAK 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by callin, (503) 246-1987. Issued f�y; Cli Permittee Signature: . ` call (503) 639-417F by 7:00 P.M. for an Inspection needed the next buslnes<s day CITY OF I"iGARD Plumbing Permit Application Plan Ch Recd By', /--r 13125 SW HALL. BLVD. Commercial and Residential Date Redd - TIGARD, OR 97223 Date to P.E. (503) 639-4171 Date to DST Print or Type Pen nit#��//i4�- �-� Incomplete or illegible applications will not be accepted Related SWR# Called QTY PRICE AMT Name of Develop I UProJed FIXTURES (individual) - 11.50 �� / Sink _ Job 11.50 Sults Lavatory _ Street Address �/ - 11.50 Address ��/j,' Tub nr'�Ib/Shower Comb. yy0 54 D CHy11.50 Bldg# lState ZIP Shower Only 11.50 � G' r1? j Water Closet _ 11.50 -_- Name Urinal 1150 Owner Mailing Address Suite Dishwasher 11.50 Garbage Disposal 11.50 city/State Zip Phone Laundry Tray 11.50 WE] ashing Machine/Laundry Tray 11.50 FNae Floor Drain/Floor Sink 2„ l„ 11.50 ling Address Suite ,1.50 Occupant 4"Phone 11.50 ylState Zip Water Heater O conver,ion O like kind -- Gas I In re uires a se'orale mechanical ermit. 32.00 NameMFG Home Now Ovdler Service 32.00 yr- r 4 1 MFG Home New Sen/Storm Sewer 11,50 Ad as Suite ailing Contractor �'- Hose Bibs 11.50 Phone Roof D 11 rains 11.50 Prior to permit City/State ZIP:-�fI �•� J • �- Drinking Fountain issuance,a ropy / 15.00 of all license t are Oregon Const.Coal.Board LIc.# E;<p•�l / Other Fixtures(Specify)required it � '� � — Exp.Date expired In COT Plumbing Llc. /J database P , Name i 38.00 Sewer-1 51100' 32.00 a Architect Suite Sewer-each additional 100' Or Melling Address 38.00 Water Service-1st 100' 32.00 [EngWeer cit /State Zip Phone yystar Service-each additional 200' 38.00 _ _ Storm&Rain 131.1.1-1st — 32.00 Deecribo we is to be done. New O Repair U Replace with like kind' "es O Nu O Storm&Raln Dr11 ain •each additional 100, 32,00 Residential O Commercial U_ Commercial Beck Flow Prevention Device 19,00 T Residential Backflow Prevention Device' Additional description of work 11.50 Catch Basin 50.00 Are you capping,moving or replacing any fixtures? ins actions 45.0 01 Exlaling Plumbing or Specially Requested er/hr Yes O No O ) If yes,see back of form to indicate work performed by single family dwelling Rein Drain. 1,50 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps QUANTITY TOTAL WORK COULD RESULT IN INCREASED SEWER FEES. Isometric or neer die rem Uuunitly roa)is I Is required d t h-_ ac a that I have read this application,tnat the information 6 SUBTOTAL s given is correct,that I am the owner or authorized agent o f the owner,end that Ions submitted are in r:om Iplance with Ore r,n State Laws — ,;Jt;;Rf3E Si aturs'of Owno•'Agon)y,,_ Contact P, on Name Phone ••pt,AN REVIEW 26%OF SUBTOTAL kequiied only ff fixture qty=9 —_ TOTAL �' L 1 BATH HOUSE:178.110 2 BATH HotISV$250.00 BATH HOUSE$285.06 (This foo Includes all plun•hin9 tlxturns In th r dwelling and the first D vn��pr�ari nf25!l0%5>°u�diaf0e rchaipe.except Residential Beckllow Prevention 100 feet of sanitary sewer st,ln,'xnwcr and water nervine) -All Now Commerelsl Buildings require plans with isometric or riser diagram and plan review S 11Aele\IormHDIumapp doe 11118199 PLEASE COMPLETE: ( Fixture Type — Quantity by Work Performed _ f— New Moved Replaced Removed/Capped Sink -..__ ----- ---- — — - ----- ----------- Lavatory — Tub or Tub/Shower Combination -- S'it.wer Only —J----- - ---- Water Closet -- Urinal - Dishwasher —-- --- Garbage Disposal _--__.-_ — Laundry Room Tray __ --- _------ -- Washing Machine _ -- -Flour Sink 2" Water Heater— - Other Fixtures (Specify) — COMMENTS REGARDING ABOVE: I A§ttNorme\plumppp doe 11f19/9 CITY ®� �'� n I �' A 'd __SEWER CC•,qNECTION PERMIT_ DEV'EL'OPMENT SERVICES `(\YI' 9 PERMIT#: b /28/99 00276 13125 SW Hall Blvd.. Tigard, OR 57223 (503) 639-4171 DATE ISSUED: 12/28/99 SITE ADDRESS; 12440 SW 106TH AVE PARCEL: 2S103AA-01917 SUBDIVISION: COTTONWOOD PLACE ZONING: R-4.5 BLOCK: LOT: 003 JURISDICTION: TIG TENANT NAME: SHELLEDY USA NO: FIXTURE UNITS: CLASS OF WORK: NEW -)WELLING UNITS: 1 TYPE OF USE: SF N(;. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Connection of existing residence to newly installed sewer lateral. Existing septic tank is to be pumped, filled and inspected or removed and inspected. Reimbursement fee of$5,597.82 was paid on this date, 12/28/99. r Owner: FEES SHELLEDY, RODNEY F JEANNINE B Type By Date Amount Receipt 12440 SW 106TH AVE PRMT DE9 12/28/99 $2,300.00 99-320696 TIGARD, OR 97223 INSP DEb 12/28/99 $35.00 99-320696 Phone: Total $2,335.00 Contractor: Phone: Reg #: Required Inspections Sewer Inspection Septic Tai Filled This Applicant agrees to comply with all the riles and regulatior,s of the Unified Sewage Agency. The permit expires 180 days from the date issued The total amount paid will be forfeited if the permit expires. The ^^ency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the meazuremen, even,the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adopted by the Oregi n Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. Yo may obtain copies of these ruled or direct questions to OUNC by calling (503) 246-1987. Isst,tod by: �� ,�. Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD BUILDING INSPECT:ON DIVISION MST 24•-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP —�---- __ Date Requested (J _AM__-�_PM --_ BLD Location_ L L4 L- V ()Ln Y Suite _ MEC Contact Person S�r_a ,� Ph 1 �y�s ��2-- PLM Contractor _— Ph _ SWR BUILDING Tenant/Owner _, — ELC Retaining Wall ELR -______ !— — Footing Access FPS Foundution --- Ftg Drain SGN Crawl Drain Inspection Notes: 31T Slab --- -- Post&Beam Ext Sheath/Shear - -— Int Sheath/Shear Framing — Insulation _ Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -- Roof Misc: Final PASS PART FAIL — Post F, Beam ' Und%r Slab - Top Out Water Service — @>a Rain rams - —'—'-- Fin I PART FAIL _ — -�— MECHANICAL — Post&Beam — Rough In _- Gas Line Smoke Dampers Final -� — PASS PART .IL ELECTRICAL i u — Service Rough In UG/Slab — --- - Low Voltage Fire Alarm -.-- Final PASS PART FAIL —. ---- --SITE - --- — ---- Backfill/Grading -- Sanitary:'ewer Storm Drain ( ]Reinspection fee of$ regwred before next inspection Pay at City Hell 134,25 SW Hall Blvd Catch Basin i ]Please call for reinspection RF' _- —__ I J Unable to inspoct no ar,LesS Fire Supply Line ADA Approach/Sidewalk Date ( _Inspector Other Final PASS PART FAIL DO NdT REMOVE this inspection record from the job site. ..,�.r... ��r,......�..i'.;..d�„r.� _.T'A�� 1 ALOHA �° IRY SERVICE F .O. Bax 309, BANKS, OREGON 971 Q6 644-2797 6 6254 639-5166 NAME: 'ODRESS: iCITY: --i: STA z1k: HOME: (4,,�0S�(nl P �IIQRCELL: 7 tJOB SITE: IPAID SY CHANGE 0 ai HECK O CA r _ CREDIT CARD : _ DATE 1� DRIVER "?�a r� Z./ PUMP SEPTIC TANK 71 LINE OPENING 0 INSPECTION FEE ` ❑ SERVICE CALL_r _ U LABOR, LOCATING, DIGGING 8c BACKFILL — --t — —� I— J MATERIAL ---THIS IS NOT A SEPTIC SYSTEM JA/SPECTIpN REPOR-- TOTAL $ —j II;-�, TYPE OF TANK: STEEL L7 CONCRETE PLASTIC 71 HOMEMA,.)E I HORIZONTAL "1 VERTICAL 71 Fl ,KTANGLE 7a OTHER_. SIZE OF TANK: 350 0 500 O 750 O 1000 1"'1250 -1 1500 71 20001 3000 r-I LID LOCATION: INLET L-3 OUTLET , MIDDLE 1 ENTIRE TOP -1 TANI; CONDITION: Gi00G 0 " FAIR Pcptq FITTINGS: BAFFLES L`77( CONCRETE -J-' CAST IRON L-1 PLASTIC 0 NEEDS NEW LIQ? -1 YES / SIkE GROUND COVER OVER TANK __!�•�'"� /7�(',� COMMENT ON CONOITION OF DRAINFIEI.D ETZ. VEU BY i