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11385 SW FONNER STREET-2 11385 SW Fanner Street ru'rZ-JETTE Invoice 1,1089 S W ROY ROGERS RIS pale Invoiced Sherwood,OR 97140 T17;!u(I; I'�t Bill To Ship To FONNER STREET — )9395 KIM ERVIN I I(;ARD.OR' P.O.BOX 23215 PORTLAND,OR IMI N 503-590-5373 503-750-0909 P!J No. Terms Rep Ship Via F.O B. Project 7/1700111 t,tuantlry Item t;oae t)escrrptrun Price Each AMOU"t I(N)00 100.00 I I Xcata►um DILL SEPTI('TANK WITH SAND 111111111 I1N)(N) I Supplies INA NI) I i i L01 i I � l i I S21)0.(N1 ALOHA SANITARY SERVICE P.O. Box 309, BANKS, OREGON 97106 644-2797 648-6254 639-5188 ADDRESS: � CO-Ty. 4� STATE._, zip: I)ZI 11L- -ELL: J.408 SITE: r3-P-J- P.0.#: PAID By CHARGE -1 CHECK (37 ASH 0 CREDIT_CARD 2 DATE 1 ) 7.r.,1 l I DRIVE,-1 *N404 Am LINT PUMP SEPTIC TANK LINE OPENING INSPECTION FEE SERVICE CALL -1 LA!�qR,Locxr[NG, DIGGING & BACKFILL MATERIAL- --v f THis Is NOT A SEPTI ' YSTEM INSPECTION REPOR11- TOTAL I , L A) / f) RKS - - TYPE OF TANK': STEEL 1 CONCRETE 1 PLASTIC 1 HOMEMADE HORIZONTAL 1 VERTICAL 1 Pf.-.CTMCLE 1 OTHER SIZE OF TANK: 35071 500 -1 750 7 10001 1250 -1 1 SnO 7771 2000 1 3000 q Lil) LOCATION: INLET -1 OUTLET MIDDLE 1 EMME Top Ll TANK CONDITION: GOOD 1 FAIR -1 POOR 1 FITTINGS: BAFFLES 1 CONCIIETE 1 CAST IRON 11 PLASTIC 11 NEEDS NEW LID? 1 YES Size GROUND COVER OVER TANK Commr--NT' ON CONDITION OF DRAINFIELD ETC. ISIGNM Ry ---nA-T F CIT ' OF TIGARD BUILDING INSPECTION DIVISION MST 639-4171,ir : SUP 24-Hour Inspection Line: 639-4175 Business L Date Requested �''� 3 M--PM ----- RLI - cry 5� rr n Location 4,_ 5 7 Ph Suite — � MEC L..�11 � �GPLM Contact Person --- PLM Ph WR Contractor ELC BUILDING Tenant/Owner ELIR �Retairnng Wall FPS Footing Access: Foundation SGN Ftg'hair Crawl Drain Inspection Notes: _ _ SIT Slab — post&Beam I --— -`— Ext 5heathlShear Int S:?path1She9r — Framing — Insulation Drywall Nailing ---- Firewall — Fire Sprinkler Fire Alarm Susp'd Ceiling --- _ Roof Final PASS PART FAIL f INEeamlabtice ,,/��S 1 Cains� PART FAILANICAL Beam Inne Dampersn — PASS PART FAIL - kSupply TRICAL _- e - In lab —---- -- oltage Fire Alarm larm -- S PART FAILSITE ary Sewer Reinspection fee of$ required before next inspection. Pay et City Nall, 13125 SW Hall Blvd Drain [ ]Unahle to inspect-no access t�Basin Please call for reinspection RE: Supply Line ADA r '�-;�. -Q sE ✓ �- Ext Approach/Sidewalk Date�� p / _Inspector � Other ___-__.__- Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITYOF TIGARD __ PLUMBING PERMIT ' DEVELOPMENT SERVICES PERMIT#: PLM1/01 00293 13125 SW Hall Blvd.,Tigard, OR 97223 (5fi3) 639-4171 DATE ISSUED: 7/111/01 PARCEL: 2S103AC-01200 SITE ADDRESS: 11385 SW FONNER ST SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE D'SPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCL4,'«19VC( GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS. SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: 100 it WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of 100 ft. or less of new sewer Service to_conne_ct existing house to sewer lateral FEES Owner_ — -� Type By Date Amount Receipt KIM E SVW FUNNER ST IN PRMT CTR 7/11/01 $72.50 27200100000 TIGARD, OR 972235PCT CTR _7/11/01 $5 80 27200100000 Total $78.30 Phone 1: Contractor: LUTZ JET1 E, INC 16928 SW REEF BEND RD. SHERWOOD, OR 97140 REQUIRED INSPECTIONS Phone 1: 503-590-7521 Sewer Inspection Final Inspection Reg#: LIC 89585 This permit is issued subject to the regulaticns contained in the Tigard Municipal Code, State of OR. Specialtv Codes and all otf , applicabl,9 laws. All work will be done in accordance with approved plans This permit will expire if worn 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 adapted f;y the Oregon Utility Notification Center. Those rules are set fortis 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 L Fest _U ATL I�(a�lL.! Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the n xt business day Plumbing Permit Application 7 I C� Date received:"// /i f Ul Permit no.:City of Tigard ( / —. Address: 13125 SW Hall Blvd,Tigard,OR 9722 Sewer permit no.: Building permit no.: ii c /i iguni Phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) 598-1960 �( Date issued: By: Receipt no,: Land use approval: Case lite no.: Payment type: 'I VPE OF 1 &2 family dwelling or accessory ommQ ContmeroaYhulu�trial U Multi-family U Tenant improvement U New constniction IJ AdditiotValteration/tttpi.icement U Food service U Other: 1 � Joh address: //1d'�� JHJ �, Description Qty. Fcc(ea.) 'Total Bldg.no.: Wn I Suite no.: Nen I-and 2-family dwellings only: `— Tax map/taxlot/account no.: (includes 100 It.for each utllityconnection) Lot: Block:n t SSFR(1)bathubdivision: SFR(2)bath Project name: SFR(3)bath - City/county: I lei I ZIP: e?"UAEach additiocal hath/kitchen Description and Itkation of wore on premises: Site utilities: _ Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drain PLUMjjING CONTRACTOR Feting drain(no.lin.ft.) Manufactured home utilities Business name:=,, i ,:', —C I� ` rf . Manholes Address: Rain drain connector City: _ State: ZIP: Sanitary sewer(no.fin.ft.) / _ Phone: Fax; E-mail: Storn sewer(no.lin. ft.) CCB no.: PluP15.bus.reg.n Water service(no. lin.ft.) City/metro lie.no.: �— Fixture or Item: Contractor's representative signature: Absorption valve Back flow reventer Print name: � tate: Backwater valve 4''// Basins/lavatory Name: rn rV t�1' Clothes v•as er Address: Q v Dishwas er Drinking fountain(s) City: t r =, State: ZIP: c('l - Ejcctors/sum Phone: r �' r ,. le: . .T E-mail: Expansion tank Fixture/sewer cap Name(print): �.`'VL I l _ Flag drains/floor sinks/hub Mailing address:—�l'��' �� r - /i Ilose ge bis Al t Flosc hibb -- 2i, y: —one: ��t ,�� r. Fax: __-- — Ice maker Interceptor/grease trap O1,ner installation/residential maintenance only: The actual installation Primer(s) will In Glade,by me or the maintenance and repair made by my regular Roof drain(commercial) enillluyee on be property 1 own as per ORS Chapter 447. --S-5t71 (-S), asin(s), ays(s) O«ner's signature: Date: Sum Tubs/shower/shower an Name: Urinal —_____ __. Watcrc oset Address: _—� — - Water heater City: State:- ZIP: Other: Phone: Fax: E-mail: Total $ Not all Judedlcnaccept rept ri,Nue de,pletcell Jurisdiction for mare informat:a. Notice:This permit application Minimum fee................ - ' U Visa U Masier(•ard ex ires if a Plan review(at _- 19) $ p permit is not obtained Credit card nnndw._ Fxp1rc within 180 days nller it has been State surcharge(8%,)....$ — accepted as complete. TOTAL .......................$ 7 Z �< Nutx of cardholder m shown on credit culete.d p P $ }}} ^�_ -- Cardholder olpature _ Amount r�C� ' 6C' 4404616(60WOM) �)J PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES individuate QTY oa AMOUNT (includes all plumbing fixtures Irl PRICE TOTAL Sink 1660 the dwelling and the first100 ft. OTY (ea) AMOUNT _—�— — 16.60 for connection Lavatory __.r each u-�-- __ )------ _j Tub Tub or Tub/shower Comb ---- __-_____� One(1)bath _ $2449.20 — 16 60 Two 2 bath $350.00 Shower Only 16.60 Three(3)bath $399.00 Water Closet ,- 16.60 SUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray -- -- 16.60 - Washing Machine 16.60 Floor Drain/Floor Sink 2" -- - 1680 _3" 16.60 PLEASE COMPLETE: 4" 18.60 Water I leater O conversion O like kind 16.60 Quantit b Work Performed Gas piping requires a separate mechanical Fixture Type. New Moved Replaced Removed/ ermil. _ _ Capped 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 Only -_ Drinking Fountain 16.60 Water Closet Other Fixtures(Specify) 16.60 - Urinal _ _ Dishwasher Garbage Disposal -- Laundry Room Tray _ I— - -- Washing Machine Floor Drain/Sink: 2" Sewer-1st 100' 55.00 3" - - Sewer-each additional 100' 46.40 4" _ Water Service-1st 100' 5500 Water Heater -- Water Service-each additional 200' 46.40 Other Fixtures _ (specify) Storm 8 Rein Drain-1st 100' 55.00 Storm 8 Rain Drain-each additional 100' 46.40 _— Commercial Back Flow Prevention Device 46.40 — - - - Residential Backflow Prevention Device' 2755 '- Catch Basin I 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections perthr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 _ _ — Grease Traps 16,60 ----- QUANTITY TOTAL Isometric or riser diagram Is required If — Quanlftv Total Is >a "SUBTOTAL 8%STATE SURCHARGE -� "PLAN REVIEW 25%OF SUBTOTAL _ Required only If fixture qty.total Is,I) TOTAL E "Minimum permit fel Is$72.50•8%state surcharge,except Residential Backflow Prevention Device,which is$38 25*8%state surcharge "All New Commerclsl Buildings require plans with Isometric or riser diagram and plan review 1:\dsts\forms\plm-fees.doc 10/10/00 CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICrS PERMIT#: SWR2001-00209 13125 SW Hall Blvd., Tigard, .,,R 97223 (503) 639-4171 DATE ISSUED: 7/11/01 SITE ADDRESS; 11385 SW FONNER ST PARCEL: 2S103AC-01200 SUBDIVISION: 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: Sewer connection permit to connect existing house to sewer 13teral. Septic must be properly abandoned by either pump fill and inspection or removal Owner: KIM ERVIN FEES 11385 SW FONNER ST Type By Date Amount Receipt TIGARD, OR 97223 PRMT CTR 7/11/01 $2,300.00 27200100000 INSP CTR 7/11/01 $35.00 27200100000 Phone: Total $2,335.00 Contractor: Phone: Reg #: Required Inspections Sewer inspection Septic Tank Filled This Applicant agrees to comply with all the rules and regulations 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 Agency does not guarantee the accurary 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 through OAR 952-001-0080. You may obtalh copies of these rules or direct questions to OUNC by calling(503) 246-1987. Issued by: �� LAILL�( �.s2(�K Permittee Signature: 6nLL11 `J — Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next usiness day