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Permit II CITY OF TIGARD PLUMBING PERMIT t -- COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00394 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/28/2007 PARCEL: 2S103BC -02900 SITE ADDRESS: 12180 SW ALBERTA AVE ZONING: R -4.5 SUBDIVISION: CANOGA PARK LOT: 003 JURISDICTION: TIC PROJECT: WILLSTATTER Project Description: 30' of sewer line to connect to sewer. • CLASS OF WORK: OTR 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: 30 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES STEVE WILLSTATTER 12180 SW ALBERTA ST. Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 8/28/2007 $72.50 [TAX] 8% State Surcha 8/28/2007 $5.80 Phone : 503 -590 -4948 Total $78.30 Contractor: PIPELINE PLUMBING PO BOX V -108 333 S STATE ST REQUIRED ITEMS AND REPORTS LAKE OSWEGO, OR 97034 Contact # : PRI 503- 624 -1906 FAX 503 -624 -1926 Reg #: LIC 158260 PLM 3 -510PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. // Issued /� �� ��/ Permittee Signature: S � � r - �� D � �IC/�,h(lY �P Call 503.639.4175 by 7 :00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 03/1412004 06:58 5036997988 PIPELINE PAGE 02 f C'N RE Plumbline Permit A�pplicatidnt cit or Tigard AUG 2 7 2007 Received S t,v3 1'e:}pitlJO.: LM Z ooh - (S03 13125' SW Hell Blvd.. Tim OR 977.23 1 a NE II I i 1*. . Phone; 503. 639 -4171 Fax: so3Sq$ -l C f, ii D _ otncrc t j v(22o -�� 1� Inspet.slon Line; 503.639.4175 ill UILDINGDIVISION 7.1 t.:: \ RD i tern www.ti Ready/BY: brims 9cc Pogo T for gird- or.gov mod 1 Cam sa, . lemeutal iufermatioa TYPE OF WORK FEE* SCHEDULE • o New eooskuction U] Demolition For *timid information we checklist Description I Qty. 1 La ( Total *Additionta1terationIrep1acemc[ t ID Other. N )C - ew -2r Jy gyp' (includes R. for cacti utility connection) ill CATEGORY OF CONSTRUCTION SFR (1) bash 24920 1 - and 2 dwelling ❑ Comtuen al<mdtrsacal SFR (2) bail 350.00 [f Accessory building 0 Multi-family SFR (3) bath 399_o0 © Master builder ❑ Other F additional bath/kitchen 45.00 JOB SITE I�IF'ORMA rION MO) i oCii t[ON F �'- ft.) 2 %le utilities Tob site addre l Catch basin, or area / _, drat 16.60 City/State/ZIP: � r t ((� -l� 3 D L leapt tin4 or trench drain 16.60 '\ 3 Page pkl eCt name= footing drain (no. linear �: ) 2 SuiteAddg.fi t. no.: Pr Ctoss street/d ions to job Bite: � t 1 SP Manufactured home utilities 110.00 �� 1 �. Manholes 16.60 Rain d[aia connector 16.60 Sanita s ear (Ito. linear R: Page 2 Storm s e w e r ( n o . lm= f : ) Page 2 Subdivision: Lot no.: Watxa service (no. linear 11: _) i Page 2 . 1 ax maptparecl no,: Minim or item ,f� c DF$( IL�'[IiQN OF WORK moo`{ valve 16.60. 1 � � �k @ow pnw�iw • Page 2 Backwater valve 16,60 Clothe walla NM 16.60 Dishwasher 16.60 0 PROPERTY OWNER © rENANr Af mlciltg fountain 16.60 Name: E sJs 16.64 Address: Expansion tank 16.60 Fi'Rx`rdse`rorcaP 16.60 City/State/ZIP: Flour drain/Boor sink/hub 16.60 Phone; ( ) Fax: ( ) Garbage disposal. 16 -60 0 Arm ICANT Li CONTAcr PERSON Hose bib 16.60 Business name: Ice maker 16.60 Contact name. Medical Interceptor/grease trap MEI 16.60 - l4fedic gas (value: ) k . Address: - Prue 16.60 City/State/ZIP: Roof drain (commercial) NM 16.60 MI Qhone ( ) Fax: ; ( } Sinklbaslnnavatpry 16.60 , 1✓-miath Tub/shower/shower pan III 16.60 Mil r CONTRACTOR OR Water Urinal 16 60 Business name: c.), ' t Y� 1111 1 t w wt 1 6.60 MEI ` 16.60 Address: , +. other City/ O 2_ _ Subtotal IMO ) (�r� � - ��l -ill Fax (C ) L n /�, - Minimum permit fee: $72.50 (ci { (Q Reside. backtiow minim.. permit fee: $36.25 CCB Lie_ 5 » a t C7e, Plumbing Lie- no :' Authorized sib'` °� � (�� -'� Plan review (2596 of permit fee) IIIIIIN State surcharge ($So of permit fee ) TO 1'riut acme: TOTAL PERMIT FEE -�-. Z t INS Oa I (4V 1- S.- Date: . . • p • ji 'Pitts permit appiuion expire if a permit its not obtained within I90 days a11ke it hss been a ccepted as cgtppiete *Tee methodology set by Tri- County Building Industry Service Board_ O VVLL T CAE JOB INVOICE TVER'S SEPTIC TANK SERVICE, INC. P.O. BOX 549 OREGON CITY, OREGON 97045 (503) 656-332S CUSTOMERS ORDER NO D§TE 1,8E007 ORDER TAKEN BY D E P ISED ❑ grace �- �� A.M ❑ P.M. . BILL TO Steve wil.lstatter P OpI_E -4948 ADDRESS MECHANIC 12180 SW Alberta St. CITY H PI R JOB NAME AND L C O > 97223 • ', S ❑ DAY WORK ' ❑ CONTRACT DESCRIPTION OF WORK y�. _ ` • `, v: ❑ EXTRA C 2 761 • QUANT DESCRIPTION OFMATE,RjA{iII�E PRICE AMOUNT ck..Ck_._ Tank pumping .Z5 O0 Abaxadon- > HOURS LABOR AMOUNT TOTAL _ MECHANICS @ MATERIALS HELPERS @ TOTAL LABOR I hereby acknowledge the satisfactory TOTAL LABOR TAX completion of the above described work. SIGNATURE DATE COMPLETED / / TOTAL rs1°11 PLI1 9-007- 39 rr'C 00 Y c sEp 25 2001 9/24/2007 12.41 PM Sales Order #2404 Store: 1 Ordered 9/24/2007 L Associate EvinG 1:11:1\111SIRDION Valley Landscape Center 18230 SW Pacific Hwy BUTIDIN Tualatin OR 97062 503-692-0606 Bill To: Willstatter 503 590 4948 Ship To: Steve Willstatter 12180 SW Alberta St. Tigard, OR 97223 503 590 4948 INSTRUCTIONS. Cross- 121st Order Status: Open Product 3/4" minus crushed rock 5 Yard(s) Yard(s) $27.00 $135.00 Delivery - Zone 1 Dump 1 $30.00 $30.00 • 1-3 pm delivery 1 $000 $0.00 Total Item(s) Ordered: 7 Total Item(s) Delivered: 0 Total Item(s) Due: 7 Subtotal $165.00 TOTAL: $165.00 Deposit Balance: $165.00 • Balance Due $0.00 Percent Unfilled. 100 Deposit History Date Receipt # Amount Payment 9/24/2007 19206 $165.00 Check All deliveries inside curbline are at the direction and risk of the customer. • • CITY OF TIGARD BUILDING DIVISION PERMIT #: PIA/12007 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 18128/2007 Phone: (503) 639 -4171 A �iea Inspection Requests (24 Hrs.): (503) 639 -4175 L. • �.. INSPECTION WORKSHEET FOR DATE: 9126/2007 TIME: 7 :01AM PAGE: 56 SITE ADDRESS: 12180 SW ALBERTA AVE CLASS OF WORK: SUBDIVISION: CANOGA PARK LOT #: 003 TYPE OF USE: PROJECT NAME: WLLSTATTER DESCRIPTION: 30' of sewer line to connect to sewer. OWNER: WILLSTATTER, STEVE PHONE #: 03.59041948 CONTRACTOR: PIPELINE PLUMBING PHONE #: 503 Inspection Request Scheduled For: Date: 91261 3007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 056363 -01 503-624-1906 Y Corrections /Comments /Instructions: w PASS ❑ PARTIAL APPROVAL I I CANCEL I 1 NO ACCESS 1 1 FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 0 �'" 1 ' -" -- Date: or 1 /b Phone #: (503) 718- CITY OPTIGARD BUILDING DIVISION Y PERMIT #: PL,12007-o0• ;94 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/2812007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8131/2007 TIME: 1: ;OAM PAGE: 44 SITE ADDRESS: 12180 SW ALB R TA AVE CLASS OF WORK: SUBDIVISION: CANOGA PARK LOT #: 00 TYPE OF USE: PROJECT NAME: WiLLSTATT EP, DESCRIPTION: 30` of sewer line to . onivect t sewer. OWNER: AILLSTATTER, STEVE PHONE #: 503 500 CONTRACTOR: PIPELINE PLUMBING PHONE #: 501 Inspection Request Scheduled For: Date: 8/3112007 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Misc. inspection 054938-01 503.624 -1906 N Corrections/Comments/Instructions: " A V J �t. , fr i y --i-c, 1•�r�. .c" t p + v c 17„ mo S i AC_ C o n j P u . _,� 1L. v c_ . i t° 1 PASS yi PARTIAL APPROVAL ❑ CANCEL l I NO ACCESS FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: Cr() -� �. L.� , 1 ti db--` ' p Date: � I J J { 3 - 'a Phone #: (503) 718-