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12605 SW 121ST AVENUE 12605 SW 1214 Avenue CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-OC 136 DATE ISSUED: ►/2./2002 Ak 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 251036C-00600 SITE ADDRESS; 12605 SW 121ST AVE Sl"13DWISION: ZONING: R-4.5 BLOCK: LOT: JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWEL-ING UNITS: 1 TYPE OF USF.: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFW-E: Remarks: Connect existing residence to newly installed sewer lateral. Septic tank must be pur,iped, filled and inspected. Oviner: — FEES _ STEVENS, JAMES HAND LYNN N Type By Date Amount Receipt 12605 SW 121 ST TIGARD, OR 9722.3 PRMT CTR 4/2/2002 $2,300.00 .'_7200200000 INSP CTR 4/2/2002 $35 00 27200200000 Phone: Total $2,33500 Contractor: Phone: Reg # Required Inspections Sewer Inspection Septic Tank Filled This Applicant agrees to comply with all the rules and regulations of the Unified S%wage Agency. The p armlt 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 s:-ver is not located at the measurement given, the installer snel! r rospect 3feet in ail directions from the distance given. If not so located, the installer shall purchase a "Tap and S;de Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adop�ed by the Oisgon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued by: Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day CITYOF TIGARD SE WE R CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-00136 =� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/2/02 SITE ADDRESS; 12605 SW 121ST AVE PARCEL: 2S103BC-00600 !USDIVISION: ZONING: R-4.5 BLOCK: LOT: JURISDICTION: TIG 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: Conroct existing residence to newly installed sewer lateral. Septic tank mush be pumped, filled and inspected. Owner: STEVENS, JAMES H AND LYNN N FEES 12.605 SW 121 ST Type By Date Amount Receipt TIGARD, OR 97223 I—�-�� -- PRMT CTR 4/2/02 $2,300.00 27200200000 INSP CTR 4/2/02 $35.00 27200200000 Phone: — Total $2,335.00 J Contractor: 3 _ Phon:: Reg #: Required Inspections Sewer Inspection Septic Tank Filled This Applicant agmes to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 da fs from the d.te 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' Perm Issud by: Pr,nnittoe Signature: Call (503)630-4175 by 7:00 P.M. for an Inspection needed the next business day CITYOF TIGARD _ PLUMBING PERMIT _ DEVELOPMENT SERVICES PERMIT P: I:1I.M2002-00111 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/4/02 SITE ADDRESS: 12605 SW 121 ST AVE PARCEL: 2S103BC-00600 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: -RAPS: STORIES: WATER HEATERS: CNTCH BASINS: FIXTURES LAUNL,P'(TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 0 TUB/SHC'A'ERS: SEWER LINE: 40 ft WATER CLOSETS: WATER LINE- ft DISHWASHERS: RAIN DRAIN: ft Remarks: Approximately 20'of line to connect existing house to sewer lateral and 20'of line work to re verse plumbing. Reimbursement fee has been paid. Owner: __—_ _ FEES – STEVENS, JAMES H AND LYNN N Type By Date 'vat';int Receipt 12605 SW 121 ST PRMT CTR 4/4/02 $105.00 27200200000 TIGARD, OR 97223 5PCT CTR 4/4/02 $8.40 27200200000 Total $113.40 Phone 1: ---- Contractor: ANCTIL PLUMBING INC 16900 SW MERLO RD BEAVERTON, OR 97008 REQUIRED INSPECTIONS Phone 1: 503-642-7323 Sewer Inspection Reg #: LIC 24184 Final Inspection PLM 26-162PB This permit is issued subject to the regulations contained in thq Tigard Municipal Code, State of OR. Specialty Codes Lnd all other applicable laws. All work will be. done in accordance with approved plans. This permit will expire if wol k 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 obtain copies of these rules or direct questions to OUNC by calling (503)246-1987. Issued By: i I,(- It ), Permittee Signature: ifs Call (503)639.4175 by 7:00 P M. for an inspection needed the next business day Piunt,bing Permit Application Datereceived: D� Permit no.: L/�6>ti} City of Tigard Sewer permit no/: _ Building permit no.: Address: 13125 SW Hall Blvd,Tigard,�)R 977.21 ProjecUappl.no.: Expire date: Cir,,of l'igal.d Phon (503) 639-4171 Fax: (503) 598-1960 Date issued: _ By: Receipt no.: Case file no.: P; lent type: Land use approval: __--� �---- t I &2 family dwelling or accessory LICoCommercial/industrialCI Multi-family ❑'tenant itnprovcutcnt U New construction li7d Arfditiun/alteration/replacement U Fond.ucrvice U i)ther: Dcscrljrtlon (p tice(ea.) Total Job address: Z.(,d UJ Z f _ New 1-and 2 fantlly Jwcllings only: Bldg.no.: Suite no.: (Includes 1000.for each utilitycnnnection) Tax map/tax lot/account no.: SFR(1)bath_ Lot; Block. Subdivision: SFR(2)batf� Project name: ,v� SFR(3)bath City/county: �� ZIP: ZL Each additional baltdkitchcn Description and I ti= Catch bassinn// ^-%work on premises: siti Cabarea drain Drywells/leach line/trench drain Est.date of completion inspection: Footing drain(no.lin. ft.) Manufactured home utilities BusineWP vr. tee. Manholes AddreRain drain connectorSanity sewer(no.lin.ft.) /City: State:D/� ZIP: �( rY Pttone7'5 E-mail: Storm sewer(no.lin.ft.Water service(no.lin.CCB nmb.bus,reg.no: 2G-t�Z Fixture or item: City/mAbsorption valve Contractor's representative signature: Back flow reventer Print name: c<<-/ �r✓� a` Date: -O'L_ Backwater valve _ Basins/lavatory Clothes washer Name: _--__- Dishwasher Addti ss: ___ -- -— Drinking fountain(s) _ City: _State: — Zip: E'ectors/sum�r Phone: Fax: E-marl: Expansion tank Fixturrlsewer cap Floor drain7floor sinks/hub Name(print): �, ✓`1��t:t. Garbage dis sal Mailing address: L.Ld w /2. '�-- Hose bibb City: Stateto?I I ZIP: q 7 2 - Ice m er _ Phone: fiw+ E-mail: Inteme tor/ reale trap _ Owner ins lation/residential maintenance only: The actual imtallation Primer(s) will he made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Charter 447. Sink(s),basin(s),lays(s) _ Owner's signature: __ _ _ Date: -_ Sum Tubs/shower/shower an Jf—rival Add ress: Water c oset_ Water he er State: ZIP: Other: .�Fax: Email: Total Minimum fee Na all Juriedica,xu accept credit cards,pteaae cdl)urisdlctinn fa n art inf"'matian. Notice:This permit application Plan review(at — %) $ -� U Visa U MasterCard expires if a permit is not obtained State surcharge(8%) ....$ Corfu cord numtx�t: _.__ within 180 days atter it hes been ap rca TOTAL .......................$ /1 25 t accepted as complete• Name of e n der u rh�wn on—credit cid s 11J (� ��, 7 L bt t}� M ►6(6MCOM) c r otdee'at(tnrure Atn"t! Y)-, /o PLUMBING PERMIT FEES: — T PRICE TOTAL I Now 1 and 24amlly dwellings only: FIXTURE§j�idividuv� - �TM ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16 60 the dwelling and the first100 ft. QTY (ea) AMOUIJT __ -- -- for oath utility connaction) . Lavatory - 16.60 One bath $24_9.20 Tub or Tub/Shower Comb 16.60 Two 2 bath $350.00 _ Shower Only 16.60 Threes b) ath _ __-----$399.00 _ Water Closet 16.60 - _ SUBTOTAL -_ Urinal - 16.60 8%STATE SURCHARGE _ Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL -_ TOTAL Garbage Disposal 16.60 -- ---- Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" �- 1660 PLEASE COMPLETE: 16.60 q" -- 16.60 _ Quantic b Work Perforated _ Water Heater O conversion O like kind 1660 GFixture Type: New Moved Replaced Removed/ Gas piping requires a separate mechanical Ca ed permit. -- - — - -� - MFG Home New Water Service 46,40 Sink_ MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Onl __— Drinking Fountain 16.60 Water Closet 16 60 Urinal_ Other Fixtures(Specify) _ Dishwasher Garbage Disposal _ Laundry Room Tra• Washing Machine -_ Floor Drain/Sink: 2" Sewer-1st 100' 55.00 - 3„ Sewer-each addit;jnal 100' 46.40 4„ Water Service-1st 100' 55.00 Water Heater Other Fixtures Water Service-each additional 200' 4640 (Specify) Storm&Rain Drain-191100' 55.00 Stonn&Rain Drain-each additional 100' 46.40 -- Commercial Back Flow Prevention Device 46A0 - - —` Residential Backflow Prevention Dearce' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or S^Ially _72.50 Requested Inspectionsper/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 --- Grease Traps 16.60 ---- -- — - QUANTITY TOTAL Isometric or riser diagram is required If Quantity Total " >9 'SUBTOTAL — — 8%STATE SURCHARGE -- — "PLAN REVIEW 25%OF SU.�TOTAL Required only If fix ure qty total le 9 _ TOTAL $ "Mlnlmuin permit fee is$72 50-e%stale surcharge,excepi Residential Bnckflow Prevention Device,which is$36 25+B%stale surcharge "All New Commercial Buildings require plans with Isometric or riser diagram and plan review lldsts\fonns\plm-fees.doc 10/10/00 A-AFFORDABILE SEPTIC SERVICE P.O.B()X 1130 WILSONVILLE, OR 97070 k j!.)03) "249291 FAX(503) 57Q-®7?9 I CUSTOMER'S ORDER NOPHONE DATE �- - - NAME r AODRES T SOLE sV` CASH C.O.D. I CHAROF ON ACCT. MDSE.RET'D. PAID OUT I i i _ Llt— I I I I -- I I I I 1 IMI _ I I I TAX I I RECEIVED 3 r — TOTAL All claims and ' I Num, THANK by this hIITH A N K YOU CITY OF TIGA,RD 24-Hour BUILDING Inspection tine: (503) 639-4175 INSPECTION DIVISION Business Line: (503) 639-4171 MST --- -- _ BUP _. Received - _ _Date Requester _ " 5 _ AM— PM BLIP Location _ G `� _ �- =�_ _ _Suiite� ' MEC Contact Person Ph PLM ��� Oct Contractor _ -- _- - -_ - Ph( ) _ SWIG Z CC,2 -CL.1 S(� BUILDING _ Tenant/Owner _ ELC Footing Foundation ELC _ Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes — SIT _— Post&Beam Shaer Anchors ---- — Ext Sheath/Shear Int Sheath/Shear Framing --- Insulation Drywall Nailing — Firewall Fire Sprinkler -- -- - -_ -- - - - -__ Fire Alarm Susp'd Ceiling Roof Other: - Final 0`� PASS PART FAIL - PLUMB_INGi _ -- -- -------_..------ Post&Beam Under Slab Rough-in Water Service -- -- Sanitary Se it Rain rains _ -- - - -------.__-- Catch Basin/Manhole Storm Drain Shower Pan Fin - ------ ' _PART FAIL. CHANI_CA L Post& Beam Rough-In — Gas,Line Smoke Dampers ---- --- -_- ---- - - -- Final PASS PART FAIL -- - - -- -- ELECTRICAL _ Service Rough-In UG/Slab - ----- Low Voltage Fire Alarm ----- ------ -�----'- Final n Reinspection fee of$ ____required before next inspection. Pay at City Hall. 13125 SW Hall Blvd. PASS PAF ' FAIL S E _ ❑ Please call for reinspection RE:__. _ —__ Unable to inspect- no access Fire Supply Line f i / ADAroach/Sldewalk Date 5 -02 Ins olrf�' ��1 pp Poet -- --.__:- � - -- Ext _------ Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL