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8935 SW MCDONALD STREET 133HIS aIVNOaow MS S£68 F- w w ce co a � J a z O - o a 3 LO M 0) 00 8935 SW MCDONALD ST CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)631D-4175 • MST INSPECTION DIVISION Business Line: (503)6394171 BUP Received _ -Date Requested AM_ PM SUP _ Location` JJ _ Suite —_ MEC _ Contact Person — Ph(—,--)� 2-,4? -.3 PLM _DQ 1 ' Contractor _ P'h.(_ ) _ SWR BUILDING Tenant/Owner R-4 h = �d►�1�� ELC _ Footing — ELC Foundation Access: Ftg Drain ELR — Crawl Drain _ Slab Inspection Notes: SIT _ Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing -- - — Insulation Drywall Nailing --- — - - - ------— Firewall Fire Sprinkler —— ---- — Fire Alarm Susp'd Ceiling - — Roof _ Other: Final PASS PART FAIL PLUMBING Post&Beam Under Slab -- -- -- Rough-In Water Service -- — — Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain — -' Shower Pan 0th ^`- A PART FAIL - — 4MtHANICAL _ Post& Beam Rough-In — -- Gas Line a Smoke Dampers -- Final N PASS PART FAIL — — ELECTRICAL I^ Service J Rough-In m UG/Slab 0 lt V Low Voltage 11J — J Fire Alarm Final Reinspection fee of$ _—required before next inspection. Pay at City Hall, 13125 SW Hell Blvd. PASS PART FAIL SITE Plea3e,wt ror reinspection RE:-------- Unable to inspect -no access Fire Supply Line // L ADA Approach/Sidewalk Inspector_ Ext Other: Final _ DO NOT REMOVE thls Inspoctlon record from the job sits+. PASS PART FAIL 1 CITY OF TIGARD PLUMBING PERMIT _ DEVELOPMENT SERVICES PERMIT#: PLM2004-00122 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 3/24/04 SITE ADDRESS: 08935 SW MCDONALD ST PARCEL: 2S 102DC-01301 SUBDIVISION: EDGEWOOD ZONING: R-4.5 BLOCK: LOT: 010 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXT%;' ES: TUB/SHOWERS: 1 SEWER L-.;4E: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace shower stall and water closet _ Owner: _ FEES LEHR, RONALD n + DONA K Description Date Amount 8935 SW MCDONALD IPLUMB] Perm• Fee 3/24/04 $72.50 TIGARD, OR 97224 ITAX] 8%St-.te 3/24/04 $5.80 Total $78.30 Phone : 503-624-2152 Contractor: PORTLAND PLUMBING & HEATING INC 0614 SW VERMONT PORTLAND, OR 97219 REQUIRED INSPECTIONS Phone : 503-293-3266 Top-out InspFinal Inspection Reg#: LIC 158611 PLM 26-752.PB a a i his permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. m Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. LU This permit will expire if work 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 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699. Issued By: /Yy Permittee Signature: , 'ev�I ,2.'��? Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day Mar 23 C;4 02: 50p Mika 503-293-3261 p. 2 ""•voo iv.oe rAA Du;l3981080 CITY OF TIGARD • � 4004/006 J Plumping Per dation ,,,„,r,d pnwtlrif i Dsts%y! 1No ,t -OZ� Ci of�'i 8 sI J Ir.ta,,neA s.wer hr 1��4 D.tW trn>K Na 13125 5W Hsu Bhv rim Review - Otber Tigard,the fon 91223 NiIA�' DasrJNr: /srnNt No.: ( f'on-eta'0kw Land Use tv Phone: 503.639-4171 ra, 513.r* Daum No. --- Internet. WW .ei.tigard.orus', C)� -- G 14-)►rtl►r{nsP nl tttivlt R areal: -4115 contw iters. R9 Ste pale 3 tar I ' XFJEp?NORICi.', j_ ld8' !GD '6t�f!r,�' sltat>smafJbae"cYatltlltt New construction ' Demolition DOCflaw �t�r_o) Toth ddition/alte7ation/re lacenw.nt M Other: ,�►°' SMI= `el6litr i ;,.,• a npreeebatdl' Law: • cAp'EcoRY', Olvrntuc><'1r r, :-:� .. -•' «�:<' 8.2 Family dwell m ConttnercieJ/Inttustrial SFIR l bA 249?0 ACCesso $nildin� SFR 2 bath 330.00 Multi-Farm SFR 3 bath 199.00 Master Builder Other: Each additional bmMift 45,00 loll 1571K. O arii_L ATd r Fire sprinkler• A.:. p Job site addrrss:-J %s1� n q� r: Suite q: $1d¢,/Aqt 14<: titch bucn�a aha dnlew 16.60 Project Nme: Drrve.114awh line/ d trench n_in _ 16.60 Foo ina drain(no.Unew R. 2 Cntse street/1 vexhtml:to job site Mmsuhwured home utilities 110.00 Manholes 16.60 Rain drain cw mcctor_ 16.60 -- Sanitary sorter(no.linear It.) _ rate 2 Subdivision:^ -_ - - LOt Storm scwerSno.linear t).) page 2 Tax arcel Water service "a tG P 2 .."• .<aiy,i,-�pT1p1��Wt�RK ..� ''• . is "' j s" �°�_ ''"' 1•,e. .t�r:., .; Abeor tion velre _ 16.60 _e��. .�1_t--r ,S�tLu r'� - BeckAow prerentt� �Poge 2 __ _V Backwret valve Clothes wal6er 16.60 ^� DisbWashet 16.60 1Y19lts r: T T prinks fountain 16.60 6.60 Ex ension tt+nk 16.60 __... Finlure/servo cep _ 16.60 - CI /StawZi -~ - Floordraintfloorsink/bub 1b.80 ;L 4.2,15d, Fax: Garber adtspocel 16.60 dP� roh hr. ii Hoceb,b _ 16.60 -- } Ise melba Name: _ 16.60 n•t �-�`- lnrc - !"�- 16.60 Addmss: C�Q J U �� -'- Maftgl as-r lura £ Parc 2 CI /$IdtelZicorr 16.60 -� Ropfd -� Roofdrarn tmerelal) 16.60 Phan � V 29� - 2 6 1 SWUbasinnayswry 16.60 E-mai I: Tubhhow er/shower M 16.60 U in 16.60 Business Now., F� W tx 0sel 16.60 Address;ZtL,I q S cG V �i 1 ettx heater la6o � t>tna: a C�/State/Zip: a 1, GC Phone- Fax. 0 3- _�.c r. CCB Lie.#: 4tlmb LiC.Af: titin;,,>w,m►etrtdr Fee $71.50 f Autttonzed e` Signature __ pne`�(� flestd nal Nackllow btiniirlunt Fee 136.f3 (� Plan Review 2311 of Ir�rrtit Pa f ' J {°�r r Gn �� _-.. _ State ftttc_ h8me of:alall Fee s (l<l (Plow Print name) TOTAL it RNOT kE f Metiet. TMs pertmnt aPplitatfen r Ares Ira perwit it net obtalard witbin Ar ncr'r tiawttcNI ernt6lm=s i•et{etit'1 sets wr 09ews .itlt ktwaarte err tea dM atter it bss berm aecepa.A ss cempletc rifer dla r- hr plain re•iaw. J *rw wwbadelso rat by Trl-Cerwly ttrpdIM Inamsrry Sorvire ward. e:\Dm\PermitFom%NMrnPcr"*A"doc DIMI CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Vale: 639-4171 i p� BUP lb 1 Z Date Requested 11_- O _—AM _PM _ BLD _ Location "� Suite MEC Contact Person n Ph �_L ~L /u _�_ PLM Contractor —� Ph BUILDING Tenan caner ELS' _ Retaining Wall _ ELR _ Fooling ACCL'$S: , ' FPS Foundation Ftg Drain rit SGN Crawl Drain Inspection Notes: Slab — __-- _ — SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -- Roof Misr. - ------ - Final _ ART FAIL -- - -.-_- —__.--- --.---_---- Post&Beam -- _---- - --- - Under Slab Top Out Water Service ,.arntarySewer',a ---------- — -- Pa-in-17—rains AS F, - - PART FAIL. LAICAL Post&Beam - -- Rough In Gas Line -- — Smoke Dampers Final -- PASS PART FAIL ELECTRICAL ---- --- -- - a. Service _ ir Rough In ~ UG/Slab } Low Voltage Fire Alarm _ - -- - - --- — Final OD PASS PART FAIL W — Lu SITE -j Backfill/Grading —� Sanitary Sewer Storm Drain ]Reinspection fee of$—_ —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Su PP y I Line [ ]Please call for reinspection RE:--- [ ]Unable to inspect-no access ..._ ADA Approach/Sidewalk Date V Inspector Ext Other -- Final PASS PART FAIL DO NOT REMOVE this Inspection record from the jab site. CITY CSF TIGARD DEVELOPML.,-M i ZRVICES SEWER CONNECTION 13125 SW Hall Blvd., Tigard,OR 972231, '3)6394171 PERMIT PERMIT #. . . . . . . : SWR98-0282 DATE ISSUED: 10/19/98 PARCEL: 2EIO2DC-01301 SITE ADDRF�3S. . . :08935 SW r4CDONALD r SUBDIVISION. . . . :EDGEWOOD ZONING: R-4. 5 BLOCK,. . . . . . . . . . LOT. . . . . . . . . . . . . ..010 JURISDICTION: TIG TENANT NAME. . . . . :LEHR, RON & DONA USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0 CLASS OF WORK. . . :ALT DWELLING UNITS. . : 1 TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 0 INSTALL TYPE. . . . :!TPSWR IMPERV SURFACE: 0 sf Remarks : Sewer line & connect. Septic must be pumped, filled, and inspected. Owner: --- ___-- -------- ---------- -- ------- --____ _ --- -- FEES --------------- I_EHR, RON & DONA type amoun% by date recpt 8935 SW MCDONALD PRMT f 2300. 00 T)LH 10/19/98 98-310111 T'IGARD OR 97224 INSP f 35. 00 DLH 10/19/98 98-31Qt111 Phone #: Contractor: _.------------- OWNER --------------------------------------------------- Phone #: f 2335. 00 TOTAL Reg #. . . ------- REQUIRED INSPECTIONS ------- This Applicant agrees to comply with all the rules and regulations Sewer Inspection of the Unified Sewage Agenry. The permit expires 188 days from Sppt is Tank Fill the date issued. Tne 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?wpr is not located at the measurement given, the installer shall prospert 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 instali a lateral. ATTENTION: Oregon law requires you to follow rules ad.pted by the a Oregon Utility Notification Center. Those rules are set forth in OAR 952-881-MIS thrcagh OAR 952-8881-8888. You may obtain copies of these rules or direct questions to OUNC by calling (5@3)246-1987. J Issued b : _ Permittee Signa"--ore: ED a W J +++++++++++++++++++++++++++++++++++++++++++++++++++++++f•++++++++++++++++'. t++t+++ Call 639-4175 by 7:00 p. m. for an inspection needed the next business day ++++++ -++++++++++++++++++++++F++++++++++++++++++++++++++++++++++++++++++++++++++ CITY OF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT 13125 SW Haii Blvd.,Tigard,OR 97223(503)6394171 PERMIT #. . . . . . . s PLM98-0381 DATE ISSUED: 10/19/98 PARCEL: 2S102DC-01301 SITE ADDRESS. . . : 08935 SW MCDONALD ST SUBDIVISION. . . . : EDGEWOOD ZONINGS R-4. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :010 JURISDICTION: TIG ------------------- --------------------------------------------------------------- CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :9F WASHING MACK. . . . . . : 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 TRAFS. . . . . . . s 0 LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0 TUR/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 5 WATER CLOSETS. r 0 WATER LINE (ft ) . . . : 0 DISHWASHE:RS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks : Sewer line to connect last five feet to the 'ioo_ise Owner: -------------------------------------------------------•— FEES -------------- LEHR, RON & DONA type amoi_int by date recpt 8935 SW MCDONALD PRMT f 30. 00 DLH 10/19/98 98-310110 TIGARD OR 97224 5PCT f 1. 50 DLH 10/19/98 98-310110 Phone #: Cont rar_t or.------------------------------------ RON LF_HR R DONA LEHR 8935 SW MCDONALD TIGARD OR 97224 ----___.__________.___---_._-------------- Phone #: $ 31. 50 TOTAL Reg #. . : 000000 -------- 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 Final Inspection _ applicable laws. All work will be done in accordance with L approved plans. This permit will expire if work is not started K within 184 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-*N. You may 3 obtain copies of these rules or direct questions to ui1MC by calling (503)246-1987. 7 U ---- Tsso-led By: i Permittee Si gnat +44-+++4........4F....}+++++•4•+++++++++++++++.+.+++++++++++++++++++++++++++•h+++++++ Call 639-4175 by 7:00 p. m. for an inspection needed the next business day +++++++++f+i•++++++•+++++++... •1-++++++++++++++++++++++++++++f+++++++++++++++++++++ INSIC'iT ID :5032422968 OCT 16 '98 9 :43 No .007 P .02 4 -CITY t)F TIGARD Plumbing Permit Application 13125 SW HALL OLV0, Commercial and Residential Plan Shea a_ y TIGARD, OR 97223 ', i! ;'" o.f.rt.ra�zt— (61D3)639.4171 �, Dela ro I�.E, Print or Type uate b DST I �`nuimplgty or Illegible applkatlon•will not bo accepted ftmh fi1LT2f=I . �; Rrhled stivR� Name of Job PU-b: Address $a S ` 1v er C;in 1 �+ -- mar ONl 1.00 _ 1. Owner WHYM Addreale au a oerG./e py,e.:1 - tr Phone weal q ozo;re aim '' I -a 1�,7- FWW omshnoa ink Z I.OD 3 � �• 1.00 Occupltnt McI64Aaftav ' walerHoal•t oaomrarelon p,00 ase I ekes••• rah megNenleM e�t+tll, Irl! Phone l•wHry ray No --- twillI.OD i r'bd —mt pully?-��,.... —,..., 'M.U0 Contractor MlflkV 04 res Sue _ 9.00 --- 1.00 Pyla to yerrnli zVY71M. tine er•IN 100 Issuance.■nupy of all loonses era nreverl L 1, 1 xp,Orle ��r'7-X oral 100' -- requlrw If ,' ,I !IM 6afVlea-1M 109—�"~' on:Ired In COT Plmt 1 r,,,I;,l Ersp. Mhtar service- e ural 26.00 Mobil" ,!• E=lortn Df Din•1 It IOU k.00 Nrf111 {{ Architect ! " I4 �, ^' j4' nafeehDtaln.er a d6416hill 40Wr : t 1 Mo M HMrw •e• - - GO Or Mall n0 A4 , r +"U—mrw m• 18.01 Flaw Prawn on or 23.00 Clomm n OIMae Englneelr �. hoRrNtNnuN OaelA+m,r a• 1e.t>o (lalpeow dmlro dovkata l'eq t a wplcvu E cnbe woAc fo D. on•� �l►:. 1r FRepalr 0 Ro0u*:yJll}ri�ll-:iW!'w4W4' No O AmyTnPorwaele a cenroot wroe Wure Loo ldonllsl O Gotten• , mortal ties on cd 0.00 nap,of WXXV PbinelRl aSQA►.1Zi.Y C �I►- �t} 4.00 �r��S�� I'i; � � t�,'t 6pedafy tr Inc'�""aP•rllone�"`� s --- Ara you capping,moving or a alp yly kture/ e n ! p e y dwel --- Ye 1 0 No a 9 oieiii Ttoo Loo If yea, aim bank of ford;to 110 I)�t6',Wella 06Norttletd by — GU TITY TDTAI. j fixture. FAII.URE TO AGGUR�1 It IPQRT FIXTURE I.amrrlo«rl,er m1s neatro tarty.a WORK COULD RESULT IN 1Nd�9p iewtR_rVIS. •! BTDTA emby eoknowtedpe even l appllor ,ftl hs loon j elven is uoneo.that I Wn the ownrr dr a Iktl of fits owner,end - _.__-._ thel tan.oubmllled m an0eret�Ulen f�AfAb d q Laws. ,�(l el� ra of OwnerfA art "PLAN RE O!1 elldlbTAtf a 0 o t •son MemoPhone I T 2 •Mlnlr>wm�errrllt he 1i a sive,eecapl la1 drflow - Provell4w MNta.which k$16-PA%auh1hat" i t ;,r 1 w_�—y ^AM Near GorlRnerold aW1A111�N tipuMM piety rrllh hemairin or deer dlrmrem and plan wWw CITY OF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT 13125 3W Hall Blvd., Tigard,OR 97223(503)639-0171 PERMIT #. . . . . . . : PLM98-0377 DATE ISSUED: 10/19/98 PARCEL: 2S102DC-01301. SITE ADDRESS. . . : 08935 SW MCDONALD ST SUBDIVISION. . . . : EDGEWOOD ZONING: R-4. 5 BLOCK. . . . . . . . . . . L0T. . . . . . . . . . . . . :010 JURISDICTION: TIG ------------------------------------------------------------------------------------ CLASS OF WORN,. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUr,ANC_Y 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 L_AVAT0RIES. . . . : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 200 WATER CLOSETS. - 0 WATER LINE (ft) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft) . . . : 0 Remarks : Sewer line Owner: ----------------------------------------------------- FEES --------------- LEHR, RON & DONA type amount by date recpt 8935 SW MCDONALD PRMT f 55. 00 DLH 10/19/98 98-310112 TIGARD OR 97224 SPCT $ 2. 75 DLH 10/19/98 98-310112 Phone #: Contractor-------------- ------------------- HOLLENBACH & HURD INC 3000 SW 174TH AVE ALOHA OR 97006 ------------------.------------ -------- Phone --___----_- _------- Phone #: 591-5987 f 57. 75 TOTAL. Reg #. . : 012180 ------- REOUIP.ED INSPECTIONS ------- This oersit is issued subject to the regulations contained in the Sewer Inspection _ Tigard Municipal Code, State of Ore. Specialty Codes and all other Final. Inspection applicable laws. All work will be done in accordance with approved plans. This pertit will expire if work is not started within 188 days of issuance, or if work is suspended for tore than 180 days. ATTENTION- Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are rt set forth in OAR 952-0001-8010 through OAR 9R-MI-M. You say 4 obtain copies of these rules or direct questions to UK by calling (503)246-1987. Tsstied By:_ a �-- Permittee Signature: -1 +++++4.4++++++++++++++•++++++++++++++++++4-+++++++++++++++++++++++++++++++++++.... Call 639-4175 by 7:00 p. m. for an inspection needed the next bt_tsiness day +++++++++++++++++++++++++++++++++++++++++++++++++.fi++++++++++++++++++++++++++++ CITY OF TIGARD Plumbing Permit Application Plan Che 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGAIRD, OR 97223 Date Rec'd' (503) 639-4171 Date to P E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permits Related SWR Called /0 Name of Development/Project \ ;F!XMRES (Individual) , l;Q1Y>. PRICE to Job `- rl`F �`Q--Z'. d e L Sink 9.00 Address 31reel Add r ss sone Lavatory ---- 9.00 Tub or Tub/Shower Comb. 9.00 Bldg• City/Stale Zip Shower Only - 900 Name Water Closet 9.00 Dishwasher 9.00 Owner Mailing Address S.lite Garbage Disposal 9.00 Washing Machine 9.00 City/State Zip Phone -- . Floor Drain/Floor Sink 2' _ 9.00 Na 3' 9.00 4" 9.00 Occupant Mailing Address Suite Water Heater O conversion O like kind 9.00 Gas piping requires a separate mechanical permit, City/State Zip Phone Laundry Room Tray 9.00 Urinal 9.00 Name � o��a h�r7o �� 1 1 vY Other Fixtures(Specify) 9.00 Contractor Mailing AddressA� Suite _ 9.00 C.> 0 O S V,/ \ l`' "' 9.00 Prior to permit Cit /Stale Zip Phone Sewer-1st 100' 1 30.00 1 �) issuance,a copy \Q�q0, Q\'70 0(o S i -S9X 1 - Sewer-each additional 100' � 25.00 � of all licenses are Oregon Const.Cont.Board Lic.l" Exp.Date required if % t7 I( (1(� Water Service-1 sl 100' 30.00 expired in COT Plumbing Lic.0 Exp.Date Water Service-each additional 200' 25.00 database Storm 6 Rain Drain-1st 100' 30.00 Name Storm A Rain Drain-each additional 100' 25.00 Architect Mobile Home Space - 25.00 Or Mailing Address Suite Commercial Back Flow Prevention Devine or Anti- 25.00 Pollution Device Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00 (irrigation timing devices require a separate Describe work to be done restricted energy permit.) _ New Lf Repair O Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00 Residential O Commercial O _ Catch Basin 9.00 Additional description.f work per/hr Insp,of Existing Plumbing 40.00 Specially Requested Inspections 40.00 erRtt Are you capping, moving or replacing any fixtures? Rain Drain,single family dwelling 30.00 Yes O No Ily" Grease Traps 9.00 If yes,seri back of form to indicate work performed by QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram Is required NQuanttty Total Is '9 WORK COULD RESULT IN INCREASED SEWER FEES. 'SUBTOTAL I hereby acknowledge that I have read this application,that the information given is correct,that I am the owner or authorized agent of the owner,and 6%SURCHARGE that plans submitted are in compliance with Oregon State Laws. Signature of Owner/Agent_ Date **PLAN REVIEW 26%OF SUBTOTAL Reyuked only N nxture qly.total is>9 TOTAL .• y 7 Contact Person Name Phone 'Minimum permit fee is$25+5%surcharge,except Residential BaWow Prevention Device,which is$15+5%surcharge **All New Commercial Buildings require plans with Isometric or riser diagram and plan review I WOMplumapp doe 72/98 PLEASE COMPLETE: Fixture Type Quantity by Work Performed _ New Moved Replaced Removed/Capped Sink � - Lavatory Tub or Tub/Shower Combination Shower Only —� Water Closet Dishwash::r _ Garbage Disposal Washing Machine Floor Drain/Floor Sink 2" 3" — --- �- — _ Water Heater — _Laundry Room Tray _ Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: \ CD � . w I%dslsYdi imapp doc 7/7198 11/18/1998 14:07 503-848-6837. HOLLENHAC•H & HURD PAGE 02 ALOHA SANITARY' SERVICE P.O. Box 309, BANKS, OREGON 971 05 644-2797 548-8 54 539-5188 19 2 4 NAME: AoQReas: CITY: STATE: IJP: HOME: - W CELL: sloe SmE� S FOA Ar PAID BY CHARGE JW CHICK ❑ CAA f_7 CREDIT D O DATt -18-q? I DrmR _ AMOUNT PUMP 119PTIC TANK Cl LINE OPENING O INSPECTION FEE O SERVICE MALL 0 LABOR, LOCATING. DIGGING�t RACVFILL OMATERIAL —Tm Is N07 A SEPTK: S13Tsm NsFwcnm REPORT— TOTAL - - 1EMARKS - - TYPE OF TANK: L La CRETE D / PLASTIC D HOMEMADE HORIZONTAL l VERTOC ❑ RECTANGLE Cl OTHER SIZE OF TANK: SSO O 500 Cl 0 1000 01250 O 1500 G 2000 O 3000 Cl LID LOCATION: INLET O OUTL MIDDLE O ENTIRE TOP D TANK CONDITION: GOOD O F POOR O FrMNGS: BAFFLES I CONCR TE O CAST IRON Cl PLASTIC O NEEDS NEW Lio? 0 YEs SIZE ?- GROUND COVER OVER TANK J COMMENT ON CONDITION OF DRAIN EL T !SIGNED BY i DATE