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Permit CITY TIGARD PLUMBING PERMIT PERMIT #: PLM2000 00300 � , DATE ISSUED: 8/15/00 DEVELOPMENT SERVICES ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12370 SW 121ST AVE PARCEL: 2S103BA 01002 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY 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: 108 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Connect existing residence to sewer lateral. No reverse plumbing. FEES Owner: Type By Date Amount Receipt MANSON, GARRY D PRMT DEB 8/15/00 $70.00 0004492 ROSALIE 5PCT DEB 8/15/00 $5.60 0004492 12370 12370 SW 121ST AVE TIGARD, OR 97223 Total $75.60 Phone 1: Contractor: EMMONS INC 143 SW WALNUT HILLSBORO, OR 97123 REQUIRED INSPECTIONS Phone 1: 503-648-1242 Sewer Inspection Reg #: LIC 73648 Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable 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 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 ob tain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. z i Issued B k le > / C-CC atm Permittee Signature: / /,..--vg-} , , 9 .------ 7 -i..--s,--.--, Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application Plan C eck# 13125 SW HALL BLVD. Commercial and Residential Rec'd :y J11' TIGARD, OR 97223 Date Rec'd ,Q - /S-C" (503) 639 -4171 Date to P.E. Print or Type Date to D T Incomplete or illegible applications will not be accepted Permit #� �N� ��oo Related SWR #1t-'23 Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT J Sink 11.50 Address Stre Address J2 Suite Lavatory 11.50 /,337c.) 4. . Az /,9 ✓e Tub or Tub /Shower Comb. 11.50 Bldg # Cit State Zip Shower Only 11.50 y -pf�/ de g , - Y7 Water Closet 11.50 Na !� .:� v / ), /1��J t Urinal 11.50 Owner / Mailing Addree / Suite Dishwasher 11.50 /2.77ct _S: k 1- ' / //1/e Garbage Disposal 11.50 City / tate Zip Phone / p d d - /7123 cJ7O - 7ereo Laundry Tray 11.50 ,j Washing Machine /Laundry Tray 11.50 N ,42,c7 J 7 ; fr1 { Floor Drain /Floor Sink 2" 11.50 Occupant /Maililing- n! � Ad resss s , Suite 3" 11.50 �C l 3 /�/ 4// I ,40 4" 11.50 � Cit /State A Zip Phone �/ 4e Ile _ 1 R , � 90 • 1 / 0 0 Water Heater 0 conversion 0 like kind 11.50 e J L� Gas piping requires a separate mechanical permit. 4f `4/ rfwee /L 6 ce , MFG Home New Water Service 32.00 • Contractor Mailing Address 7�'� i Suite MEG Home New San /Storm Sewer 32.00 /y3 J;� wAA uT ST Hose Bibs 11.50 Prior to permit I /State //�Zip Phone Roof Drains 11.50 issuance, a copy /�7Wsi30RQ AI: 97/13 £ Yt-/2y,�' / Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if o 73 6 y e 6 -d y -Q/ Other Fixtures (Specify) 15.00 expired in COT Plumbing Ljc. # _ Exp. Date database 1///1" ' Name Architect Sewer- 1st 100' /C8' (` 38.00 sg - - or Mailing Address - Suite Sewer - each additional 100' / 32.00 1,9, Water Service - 1st 100' 38.00 Engineer City /State Zip Phone 9 Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New Ql Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Resi ential Commercial 0 Additional description of work: Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device* 19.00 Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No 0 Inspections per /hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. - I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 given is correct, that I am the owner or authorized agent of the owner, and UD that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL ..7e Sture of Owner /Agent Date 8% CI) d.�.o�� Y - / �_ v0 8/o SURCHARGE S,(p0 C P o n N e / / Phone -( t.- �yQ -7 Po * *PLAN REVIEW 25% OF SUBTOTAL I ATH HO SE $178.00 Required only f fixture qty. total is > 9 2 BATH HOUSE $250.00 TOTAL / D. Co 3 BATH HOUSE $285.00 (This fee includes all plumbing fixtures in the dwelling and the first 'Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention ' 100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge �� "All New Commercial Buildings require plans with isometric or riser diagram and - plan review. r \dsts \forms\plumapp.doc 11/18/99 ••. -/'• JcN.✓ &C 77 A/ PE-E" A300, DO sEu)6 2. //vsPE 7'70 / / 6" / 35, 0 e PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Urinal Dishwasher Garbage Disposal Laundry Room Tray _ Washing Machine Floor Drain /Floor Sink 2" 3" 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I:\dsts \forms\plumapp.doc 11/18/99 CITY OF TIGARD BUILDING INSPECTION DIVISION M T 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 . L /� �/ UP /, to t �� / Date Requested v 7 �d AM � � PM B LD Location r 2:7216 (,() /7_10 4'i✓ Suite MEC Contact Person Ph SP 7 & 76) M Oaa--003ce, Contractor 6 Ph 4g/ WI 0a 37 BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: i Slab 1 SIT Post & Beam Ext Sheath /Shear Int Framing Shear \,v ,z` ► C'� M 4 Insulation 41/0 C^ . 0 O 3 -¢- Drywall Nailing � ��- r✓2 t f 2/� Firewall Fire Sprinkler A Fire Alarm v" v' - �L.I '") 13 y1 Q o Q3 oo Susp'd Ceiling I�t C. V Roof n ^ p� J� Final PASS PART FAIL Post & Beam Under Slab 0 4,`-^-12- Top Out , / W Service \ .j tiitary e . Drains 'U PASS 11 0, FAIL MECHA Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk � � D Other Date Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. i Vr • 1 INVOICE t — - -- — __ -- M 2523 _.. ox 234 B9 TIGARD P.O. P.O.B City, 9 D & INC. 9 70 45 . SAN � ! a TONOUIN AND STAFFORD QUARRIES ® : , Complete New Installations Industrial • P.O. BOX 413 • TUALATIN, OREGON 97062 c 4 Repair Existing Systems .. Q. .. . .. a no Waste PHONE 692 -1800 Sewer Connections •• . wi w v ` w w n _ - • w w • ■ ■ .. . . . , . us 4 Removal D • • w • • w w _ - . o ■ TICKET NO.: ■ 0. .. . .. .. IN ■ Septic Tank Cleaning DATE: 1 E ' 77-5K-1, Cesspools Sump Ly , ,� • SOLD TO: T S ( COD COD z ; T IME 1 . 3 ' 200171 Excavating Line Cleaning JOB NO.: 'X? - 21 ti Richmond Construction Ent., Inc. JOB: TRUCK NO.: Btwn. 8:00 -10:30 a.m. m. (503) 253 -7587 DELIVER TO: ORDER NO.:' ` , I: l,i� g . 00 3 © 6 t�lf�NSO 590-7800 LW Z. �--1� `Z � , 12370 sip: = ST Orr 4PL.Nifr 1 c1fAR - ��� Z p Ooa 3 7 Y Customer P.O. # Date 8/29/00 Tue_s . WEIGHT QUANTITY AMOUNTS Billing Name Garry Manson R PTION UNIT PRICE TOTAL ICYARDS MATERIAL DES C I GROSS TARE NET TONS CUB , R O Address 12370 SW 3�;,0 ti k�.••i6 @1?+ - 12.400 6. w4?I 5,. ('_►4i FILL stHI',L $ 111,. ;f $J 3 r ,. f 71 / a / 6 -U -e_ I Job Site # F Net wizia t� i�:. T�:,t, =: Job Total: l $> i f a = V+:'' City Tigard State OR Zip Code 97223 J ., J i Garry 590 - 7800 8/25/0 `' RECEIVED BY: r _ / - - - - -- Ordered By Y Phone # Date WE MAKE DELIVERIES INSIDE THE CURB LINE AND ON THE LOT AT THE CUSTOMER'S RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR DAMAGE Job Location Same -X- S t . Walnut 1 RESULTING FROM SUCH DELIVERIES. ALL CLAIMS FOR SHORTAGES MUST BE MADE IN WRITING WITHIN 5 DAYS FROM DATE OF DELIVERY. FREE UNLOADsNGTIME OF 10 MINUTES FOR A SINGLE TRUCK AND 20 MINUTES FOR A TRUCK AND TRAILER IS ALLOWED. EXCESS TIME WILL BE CHARGED AT EXISTING RATES. CUSTOMER COPY Service Call $ • Labor $ Pumping septic gallons 1000 $ 275.00 Misc $ C Lr , IC) G 15 $275.00 • Conditions of tank/Distribution Box C c w S 5'', TOTAL CHARGES Enviroclear is in no way responsible for damage to the septic tank or lids on the system. TERMS: Net 10 days. 1 -1/2% per month will be charged on past due accounts. (18% per annum). X Customer's Signature: I tar "/ `? Service Driver's Signat re _ M% Time/1r.0-0 Date 7 2 vv TERMS AND CONDITIONS ON REVERSE SIDE REDEEMABLE IN ALL COUNTIES o cm c• oe -oCi 0..) dcwie• , . • , _________