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Permit CITY OF TIGARD PLUMBING PERMIT 11 11 •• COMMUNITY DEVELOPMENT Permit# PLM2011 -00319 TIGAILD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 10/25/2011 Parcel 2S103DC00807 Jurisdiction Tigard Site address 13610 SW 115TH AVE Project Rivera Subdivision VIRGINIA ACRES Lot 5 Project Description Connect existing house to sewer service, less than 100' Contractor A AFFORDABLE SEPTIC SERVICE Owner RIVERA, EUSEBIO E & SHIRETTA PO BOX 1130 13610 SW 115TH AVE WILSONVILLE, OR 97070 TIGARD, OR 97223 PHONE 503 - 684 -1615 HONE 503- 969 -9548 FAX 503 - 570 -0779 FEES Quantity Description Date Amount 75 If Sewer Service 10/25/2011 $62 54 Specifics • 1 12% State Surcharge - 10/25/2011 $870 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 10/25/2011 $9 96 Plumbing Class of Work ALT Type of Const Occupancy Grp Stories Total $81 20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law 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 the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090 You may obtain a copy of the rules ns to • • C . or direct qu ailing 503 232 1987 or 1 800 332 2344 Issued BC Permittee Signal \\ —St -Signal /!/ _Ali . — A_ 411W . are/ Call 503 639 4175 by 7 00 a m for the next available inspection date 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 10/25/2011 11:58 5035700779 WTP PAGE 02/02 10/25/2012 13:38 0030951950 CITY OF TIGARD PAGE 02/02 tom Penton • ATED Site utilities 11 City OCTigard FOR Orrin( Orrin( (E oNf e 13123 6W Rail r31v& Tig (R OCT 2 72,23 5 2011 U J+v, o J � ' • _ PMont: 503.712202 lra . n 19n review Posit*, Ao //7?0 3/ • 7 l : u 1, 1.2 tlLbw sna.u32.n j '' HOARD Pr n �� 1 — �� bnanett Vs.°ti&ttd.n�ILDING DIVISION r ° • - wR !l 1. • , TYPE OP IVORR Parezn. . .y lanr-n t lalkonni,r e New oronri ncli m 0 Dewitt/on - 717,: PE fC flF ur,E 0 A d thtion i nllnry111utVrc07aeem cn �` r° r 2 a nnan. �� Other, Do. b ion Cadbl CA3`I;' ©OkY dA 1 0'075 ! l O t dwcltl n En o[ni tjG71i,R SF.R (1) kth tl^' t (oxdada 100 p. Poe etch 00:0 cmmclUOn [.r 1' and 2•farnflr drvclime 112, �_,....�. Commcrciel /indnvttfn! mldiep� [[ 43778 0 Acccaapry b M Sfl (3) hnh ❑Marier bulldcr 0 Ot Pmy n dM(7913n1 bathnatohen, 50032 fer 25.02 lint iiiii Job Bite nddrdtry: 13610 SW tit A,v . MIMI Mm xLr*: ` 2 - -. City /Store /T,ik T r0, Catch _ mxit drain _ ca OXt, 07723 Suitefhlelp ;RA no.: 1"m nitt vin 773 773 c � (;rOAa 41 LeC 1 /diM6tiM9 In Job Wiic! liaiNaat Wriaftehlred bdme wilifisn 50.Ob Cnane t0 city setrcr, R anholaa Rain earn a .18.7 anw:Por 7 &7d ""---.--_ Sanit rynmxer (no. linear 0 In Mtn Simi mom' (uo.linear R. _) MI ncrvl Snbdivleivn• VliOnin An �""` - -�-- Wow cn Pngc z L,OI nc.. (110.1 R.: ) Pnge2 Tan map/parcel rat - 2 v13dn.0011117 ��" 17x1 it ern --• DESCRIPTION dP WORK _ i` cfic ,.. 3 1. 27 _� Connect (O L� SVlvc "".� n"` 4en'cr �� Oat net- S 07 Ircr 1 ,_, Dietnim:kcr 25 v7, �'' 2S 62 r)nnhlnp. Faamam al 2502 Igi PROPERTY, OWNER , ice a /imp �} TENANT entan 2s.02 al Hama; Shen* Riirera Expaxlaik Pinurc/acwer cap 12 t P /uld rea _,,, �_ tg SW I le Av ,� . �i`_ Moor dm1M[luar xink/hatt �• 29 02 City/S1nm/ZIP; 7'ilenrd, OR 9'1; Garbage diem:eel 2.502 7 ,,,�_, I' nl Hnec itl "` 29-02 0 APTLCC,'AN1 Icrm•kn 2 — �..`_."," -.- Q t-VMf+AC7' rumor; rm IJUni n mo; °'1 :al gae 1 strap cartact name; 4fctrical ppy (nmlyc: y 25 02 Address � �. ___. ' au, Rotd'[Iram (come ne00: CilylStateylp- Siek 100 1291 Phn` ( y Sn1nr a 29' NMI --� „ f , : (( ) Nix (PnWtte'a•tmri P ma0 7ub5.,— ..inlwy/ca.pan EMI U " �” CONTRACTOR 29 0] n Boonton Home, A A71i1Mmhtnyl.Ptle Gnkr, Mt 2,5 02 Addrevs• pry 1130 37.92 MB City /State ,Cp• grl7sarl •�. ohm 5d.23 dtflb OR 97070 lilt Pitonc (Sp3)0,42 •�-- -� ��"^' 25. rat( ) J 077 -- — _. ---- .�._ tnlnaai CC Lie,, IS$24G MiOimam 04Tmit fee: 572.90 '"--- Mumbmgl.ic nn„ Au111cmctl mgnma Ptan review (y7 arpelrntt fee) ��� State no (1 %ofpermll fee) 0 win s .20 i 1 'v n 4 nFy2MIT PEE ^ Dm 10.251 Snit permit nimitMtiaa op/a- n iln pemdt b ant M.iacd nmlin 1pn darn aner k Mee tntn ncccptrd 1t, couplfm i 43mhle I 'Fee mclh elnlogy Set by Tr e0wre 0n0dfrg laun dry netwca Bony B Mrmi tITIMy - penMllp,yt. CJ /mldh 4 10/011 a4•a,tn, h , .--^ !A-AFFORDABLE - - ,,. . . SEPTIC SERVICE r P.O.BOX 1130 ' -_ WILSONVILLE, OR 97070 ', ,,, , ,(503) 682 -1929 FAX (503) 570 - 0779 ,: s: -, ; www.aaffordablesepticsvc.com- 4 h- CUSTOMERS ORDER NO. PHONE DATE / / — /l / NAME � = , ,, ADDRESS _ ,� t 1 E; k:u 1 ,4 1 D� c j 7z.2.3 SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSERET'D. PAID OUT y i :i .;, : OTY. DESCRIPTION ' PRICE AMOUNT f --,C7-f / JF° (1 O a4114 /45/x.( l •_ J 1 4• -_ ti • v t. PLM2811 —O0319 v • 0 • TAX • RECEIVED BY TOTAL It's the purchaser's obligation to clearly mark underground utilities and underground ... irrigation systems. A- Affordable Septic Service is NOT responsible for unmarked 1 utilities and /or irrigation systems. SIGNATURE DATE Y., All claims and returned goods MUST be accompanied by this bill. THANK YOU DELtDXE FOR BUSINESS 1- 800 - 888 -6327 Rel. No: G 50-Tic I01 'i`