Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00098
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/15/2005
PARCEL: 2S109DD -00100
SITE ADDRESS: 12635 SW BEEF BEND RD ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Connect existing house to new sewer lateral. Septic tank is to be pumped, filled and inspected.
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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 50 ft
Owner:
FEES
RIVERSIDE HOMES Description Date Amount
15455 NW GREENBRIER PKWY #140
BEAVERTON, OR 97006 [PLUMB] Permit Fee 3/15/2005 $72.50
[TAX] 8% State Surcharl 3/15/2005 $5.80
Phone : 645 - 0986 Total $78.30
Contractor:
NORTHWEST EARTHMOVERS INC
PO BOX 1467 REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone : 503 624 - 0363
Reg #: LIC 62761
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 -a ! I through OAR 952- 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 03-246-60•9 o 801 332 -2344.
Issue. By: a 4,4,64434_4' Permittee Signature: !G c
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.
•
I
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Date /B Received �D P No.: ' 6 4:22c-j ig
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I � Date /B Other Permit 6,441205
24 Hour Inspection Line: 503.639.4175 ■ V O. y . Juris'
Internet: www.ci.ti ard.or.us � 2 ° .. Date Ready /By: Ed See Page 2 for
Notified/Method: /d
mation
a�
I.,,, , . r. ,, T E4YPE4OF WORK.,,,, x . . -,;; .r�- �'t ,,F.EE- 1IED E,�:r x.
s-
® New construction ❑ Demolition For special information use checklist.
Description I Qty. Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
`i' 's ` '- CATEGORY.OF CONSTRUCTION. h`'°y. r SFR 1 bath 249.20
® l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ O ther:
,c„ tt > : -, ;,.:••,.,. >:•, .r.,,d -. -., - , ». a Fire sprinkler ( sq. ft.) Page 2
dO SITE INFQRMATION, ,,t1ND, LOCATIO ', „
'i•.: - -- .. ,_..::z _;... , .. 3,;,,F , - ,;,,,,„„„t„,,,,7:-,::-
..\ - -_ Site utilities
Job site address: 12635 SW Beef Bend Road Catch basin or area drain 16.60
City /State /ZIP: Tigard, Or Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: J Project name: Bella Vista Subdivision Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Beef Bend Road to New Subdivision
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Ao ) Page 2 125 ,
" f Storm sewer (no. linear ft.: ) Page 2
Subdivision: Bella Vista I Lot no.;2u Water service (no. linear ft.: _ Page 2
Fixture or item
Tax map /parcel no.:
� . ion valve Vii; .. , - ti -.- ,•,; A orpt 16.60
, AESCRIR.TION'OTi:: 12 ;;;
y x•
,rr, - , -- -,.. _,�.�, d' E:..,,... -..: :;��•,: ,; :,,,, . .. ., . r.. - - ?�ai; , �. - �:;�, Backflow preventer Page 2
Connect Existing House to NewSanitary Sewer Main Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
,,;... - < <;; �, Drinking fountain 16.60
� Ems- ��;�::� _ -:� e, ., � - -; D �nng
®$ OPERTY`OWN ❑'TEN `'e'
<:..,.„ ,,.,..,. „r.. - f ;;,,,,. - E - . Ejectors /sump 16.60
Name: Riverside Homes Expansion tank, 16.60
Address: 1925 NW Amberglen Parkway Fixture /sewer cap 16.60
City /State /ZIP: Beaverton, OR 97006 Floor drain /floor sink/hub 16.60
Phone: (503)645 - 0986 Fax: ( ) Garbage disposal 16.60
;; , F ;:< -, .. <M k r Hose bib 16.60
��� s��`,APPLICAjV'T'.'� � CO1V 1?:ACT . P ER S O N: � E :
, Vii,:; -., - .ate.., - - . -. - ,<.
- Ice ,,,. -,. -> � I maker 16.60
Business name: Northwest Earthmovers, Inc. Interceptor /grease trap 16.60
Contact name: Mike Ober Medical gas (value: $ ) Page 2
Address: PO Box 1467 Primer 16.60
City /State /ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Phone: (503) 624 - 0363 Fax: : (503) 639 - 1634 Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E - mail: mober @nwearthmovers.com
Urinal 16.60
� Water closet 16.60
C NTRACTOR; '
''',' N = ,
"� �, a . O ,,x , , ,�, . ,�,�. y��::
,a;
Business name: Northwest Earthmovers, Inc. Water heater 16.60
Address: PO Box 1467 Other:
City /State /ZIP: Tualatin, OR 97062
Subtotal
Minimum permit fee: $72.50 79
Phone: (503) 624 - 0363 Fax: (503) 639 - 1634 Residential backflow minimum permit fee: $36.25 l
CCB Lie.: 62761 Plumbing Lic. no.: 34 - 464PB Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) 5. au
TOTAL PERMIT FEE gt ,
Print name: r" 1 i Date: �. 1 S �� Phis permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri County Building industry Service Board.
i \ Building \Permits\PLM- PermitApp.doc 12/03 440 -4616T(I0 /02 /COM/WEB)
1 1k25/2005 10 : 51 NORTHWEST EARTHMOVERS - 5035981960 NO. 693 D02
, , •
ALOHA SANITARY SERVICE
INVOICE NO.
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9
503-644-2797 • 503-648-6254 * 503-639-5188
- --
N AME: .a.e., A . _L.' _A d...4.....1/...1,,/,....66.....a..." 2. A.A. i
1 / '
ADDRESS: ..... A I ii. , _ ...1.../ _
--,
Cmi: i STATE: tit A ZIP: 77
.. )
HOME: ‘ze/-4:0 63 • WORK: CELL:
, JOB SITE: __Ei ,(.2---- PAC
-
I
' PAID By CHARGE CHECK LI CASH 0 CREDIT CARD CI
DATE 4 _ 5 DRIVER DN-- 74,44 If.rud AMOUNT
PUMP SEPTIC TANK
LI LINE OPENING
i
_
LI INSPECTION FEE
. .
LI SERVICE CALL
0 LABOR, LOCATING, DIGGING, BACKFILL
LI MATERIAL P.
_ _ .
- 4 . (5i
— 3 c3::N cs
- - TH/S IS NOT A SEPT SYSTEM INSPECTION REPORT - - TOTAL $
,_ ____. . . _. _ .......... —...,..._ —
REMARKS .
TYPE OF TANK: 7 EEL D \ ONCRETE CI PLAST ' Cl HOMEMADE LI
\
HORIZONTAL 0 V 1TICAL 0 RE•^ ANGLE LI LI OTHER
SEE OF TANK: 350 LI 500 0 .00 101 2 LI 12500 1500 0 20000 3000 0
LID LOCATION: INLET CI OUTLET li IDDLE 0 ENTIRE TOP CI
TANK CONDITION: GOOD LI FAIR 0 POOR 0
FITTINGS: BAFFLES 0 CONCRET CAST IRON LI PLASTIC 0
NEEDS NEW LID? YES 0 SIZE
GROUND COVER OVER TANK AIM
COMMENTS ON CONDITION OF DRAINFIELP TC.
/ /
, /,‘••/ . .:-.r.t..,.of...11 1 .–.. .4
i AMAIEWINITAIIIMI_Mr
$16NED BY - \ aAt- Nit k c— k 't 2 1 DATE
.....--_,--.-
\ gindoo,5-aoo q 0