Permit SEP -21 -2004 05:58A FROM: TO:5035981960 P:3'3
r
CITY OF TIGARD • PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00428
"�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/15/2004
SITE ADDRESS: /0!096 .5 / Sf PARCEL: 2S103DA -00700
SUBDIVISION: DERRY DELL ZONING: R -3.5
BLOCK: _ LOT; 007 JURISDICTION: TIG
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Reverse plumbing under house.
Owner:
FEES
Description Date Amount
13AI HATCH
13205 5 SW WATKINS [PLUMB] PLUM Permit Fee 9/15/2004 $72.50
SW
TIGARD, OR 97223 [TAX] 8% State Sunhat! 9/15/2004 $5.80
Total $78.30
Phone : 503- 639 -5639
Contractor:
MCROOTER DRAIN SEWER & PLBG SVC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS •
Phone : 503-255-4505 Final Inspection
Reg #: LIC 103682
PLM 26 -724PB
•
•
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- : 40. You may obtain copies of these rules or direct questions to OUNC by calling (503)
24 -6699.
� •
Is ed B %�
Y /�� JAL! Fermatas Sign. . `/_
Call (503). • 39 -4175 by 7:00 P.M. for an inspection needed the next • �if ess day
SEP- 21 -2Q04 05:58A FROM: TO: 50359E11960 P:1'3
FOR OFFICE USE ONLY
' Plumbing Permit Applittion Received Plumbing
Dateni : Permit No.: /(/ `i d v `f2 •
' City of Tigard `� Planning Approval F ewer
DDate/13 Fcrtrtit No-:
13125 SW hall Blvd. * 'LOD\1 A Plan Review Other
Tigard, Oregon 97223 Ts C 9 �\ • Da : PcnmtNo.:
Phone_ 503. 639 -4171 Fax: 503.5 e Post- iteview Land Use
� \ %.• '.' � IA
j
Internet: www.Ci.tlgllyd.or.us 0 • • c•1 � Date/B .
� ti
i Contact No.:
et Juris.: •:, Sce Page 2 for
24 - hour Inspection Request: 503 � ""° Name/Method: Su. . tcmental Information.
...:.... :. :'. :: 4 ;::f -ii k; ;- • :...TYPE':OF WORKo ;,:.•,:,..:' . , .. >. ,.. :'.... "?,€; .' k'EE * SCI DULE:(for sPecl_a_ 1!luformatton use bhecklIst)
❑ New construction ❑ Demolition Description _I Qty. I ee(es.) I
F Total
Addition/alteratitm/rcplacement [i Other :::.:; New'1- & 2-family -d elli •
,, LCATEGORrO31VONSTRUCTI,OP„ii� ;1 :: {l etu ca 10.0 t!. for CAt tl. utility connection)
" 1 & 2- Family dwelling Commercial/Industrial SFR (1) bath 0 0
❑ C l/Idtri SFR (2) bath 350.00
AcCessofy Building Multi- Family SFR (3) bath 399.00
Master Builder Other: Each additional bath/kitchen 45.00
..::: : .,1OE SITE"INF,ORMATnON antis .ATION' ':' : oi:a Fire sprinkler - sq. ft.: Pa�c 2 _
Job site address: , - d e' k/ rj i:;;,_:. • , ..i... .. j! : : :Sit Utilities::• :.: ° .. ..:.:....
Suite #: B1dgJApt. #: _ Catch basin/arca drain - I 16.60
-
Project Name: Drywcll/leach line/trench drain 16.60
Footitdrain (no. linear fl.) Pa e 2
Cross street/Directions to job site: Mtmu l'actured home utilities 110.00
Manholes 16.60
1
Rain drain connector 16.60
Sanitary sewcri o. linear ft.) Pagc 2
_ Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear fl) Page 2
1::: Ii. •.„u f :(ir,l4�r5�i •.�. :; ";. . :r .... Fizil3r:QC:3IClit(. ".:;'. ti :,:':i .' •...
, . , D)ESG',1t1,1'TtON:O.F :NtrOa. . I: ' li, . on valve 16.60
/ : Absorption
4�l; w 0 i / Z / v75 'e.- ' Sackflow preventer Pagc 2
Backwater valve 16.60
- � q)\ , , 11 Clothes washer 16.60
Dishwasher
nk
I it .PERTY:. :0.WNERIIG�l ° r: , ; RIM �TEP�A'TIU'?iMl.- . igliia :.•.:. D n 16.60
fountain l6. 0
Ejectors/stmtp 16_60
N ame: C'4 'T ,/L - J �U.. �Cc�d/ /57 Expansion tank 16.60 -
Address: i 4 6 ye 5 e4, P,4/ajC Fixture/sewer cap 16.60
City /State /Zj _l, /Ci d .C -eice - Floor drain /floor sink/hub _ 16.60
Garbage disposal 16.60
Phone: .53- 2, o? Fax: !lose bib 16.60
:. li'I"IP:I,,ICANT�I ?` . 3iP,l<'.iL ~ 'ii :;l! :1ZICONT CTERARSON' Ice maker 16.60
Name: //J, c /CU<J•VS7if .4.,,fi .t/f . Interceptor /grease trap 16.60 -
Address: PO ‘i . Z/7/ Medical gas - value: $ Page 2
City/State/Zip: / 4 7z.. ix Glee d� Pnm� 16.60
Roof drain (commercial) 16.60
Phone:? l- 7 - 9I 7, 1 Fax: Sink/basin/lavalory 16.60
E-mail:. Tub /shower /shower pan 16.60
11 ....:.,,, ::'
" „ � - i: : Urinal • 16.60
' <, .�';+'J�N� '. � ;I ��:K:• ::.: •..: 1 Vl'V�`:� ;: S� � ��� ! i. r.:.. Uri
Business Name: e /seerizz 67.•Q//` r >qa�0 k Wa ter closet 16. ,0 •
Address: Water heater 16.60 _
Q 7 r �d/ y/� Other:
City /State /Zip: k'./ Oi'793 Othcr: //4!7<01 S /->r/ -
Phone: /- g - .-S/ 5•4 7R. Fax: r. :: • ' 1 . Fluttitil'MM!!i a imlt'Fccs" . " rug ,.,•.. : ..,:
CCB Lie. #: -/a - (� - - Plumb. Lic. -; 7a yp s$7 $ _
Authorized / M inimum Permit Fee $722.50 .50 $
Residential Backflow Minimum Fcc $36.25
Signature: % .� , _ _ 4. - Date:5.'. 4 / Plan Review (25% of Permit Pee) $
1-,��/ ` �: , f �� . State Surcharge (8% of Permit Fee) $
/ (Please print name) TOTAL PERMIT FEE $ -
Notice: This permit application expires If a permit Is not obtained within MI new commercial buildings require 2 acts of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by TrI- County Building Industry Service Board.
i:\Dsts\Pcrmit 1'omsc'PlmPermiiApp.doe 01/03
,....„.-/, ! INVOICE
. .- 4823
P.O. Box 2349
Oregon City, OR
97045 y ., r
Complete
New Installations F O ci Industrial
Repair Existing Systems . . • • . • • . • Waste
Sewer Connections . . mu • • . . m Removal
Drainfields m m mm __ a . . . w • Septic Tank Cleaning
Cesspools Sump
/ Excavating Line Cleaning
Richmond Construction Ent., Inc.
(503) 253 -7587
. Appt 9 °00 a.m. 1
Customer P.O. # Date 9 /20/04
Billing Name McBee ;Excavating
1
Address
Job Site #
City , , State Zip Code
Ordered By "a,:a % 'Phone # 502 -351 1 Date 9 / 1 7
Job Location 1 0590 ;II Park St. /Tigard
Service Call $
Labor $
Pumping septic gallons 280.0($ OG
pr�la.
Misc $
Conditions of tank/Distribution BoxP 4 "/, /Air Se:474 " %av k
/� OV
Phi 1S P-0 ea 0 m /s /a w TOTAL CHARGES QC •
Enviroclear is in no way responsible for damage to the septic tank or lids on the system.
0 TERMS: Net 10 days. 1 -1/2% per month will be charged on past due accounts. 18% per annum). emisimaimmor
v
Customer's Signature: ii., .rte /i , \
Service Driver's Signa ur /kJ Time / Date !'o?A-# ci
TERMS AND CONDITIONS ON REVERSE SIDE REDEEMABLE IN ALL COUNTIES
4 6 0 ( : )1 0 61 1; 1 6 : 0 1 6 0 C1 ; 1 0;q:e1 4C;i3:211
F , •
TERMS AND CONDITIONS
THE CUSTOMER AGREES TO PAY ALL INVOICES ARISING OUT OF PUMP-
ING SERVICES, AND ANY OTHER SPECIAL SERVICES HEREIN WITHIN 10
DAYS FROM THE DATE OF INVOICE.
THE CUSTOMER AGREES TO PAY SUCH EXTRA AND OVERTIME
CHARGES AS MAY BE INVOICED FROM TIME TO TIME FOR SERVICES
RENDERED, OVER AND ABOVE THE NORMAL SERVICING SCHEDULE, ON
BEHALF OF THE CUSTOMER.
THE CUSTOMER AGREES TO ASSUME RESPONSIBILITY FOR ANY DAM-
AGE TO CUSTOMERS OWN REAL OR PERSONAL PROPERTY ARISING
FROM PUMPING SERVICES WHICH TAKE PLACE ON CUSTOMERS PREM-
ISES, WHERE THE DRIVERS AND VEHICLES OF ENVIROCLEAR HAVE
BEEN INSTRUCTED TO ENTER. THIS INCLUDES, BUT IS NOT LIMITED TO
DRIVEWAYS, TREES, POWER LINES OR POLES, AND BUILDING STRUC-
TURES.
IF ENVIROCLEAR FINDS IT NECESSARY TO ADD LIQUID TO THE TANK ON
JOBSITE, CUSTOMER WILL BE CHARGED FOR THE ADDITIONAL GAL-
LONAGE RESULTING FROM THESE CONDITIONS.
CUSTOMER AGREES TO REIMBURSE ENVIROCLEAR SERVICE FOR ALL
REASONABLE ATTORNEY'S FEES, COURT COSTS AND OTHER EXPENSE
INCURRED BY SAID COMPANY TO ENFORCE COLLECTION OR TO SERVE
THEIR RIGHTS UNDER THIS AGREEMENT.
CUSTOMER AGREES TO THE ABOVE CONDITIONS.
REDEEMABLE IN ALL COUNTIES.
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lille: (503) 639 -4175
INSPECTION DIVISION Business Line; (503) 639 -4171 MST
BUP
Received qI 2 2/ 0 y Date Requested 9 12-21 D -I AM PM BUP
Location / o (, 9 0 Si.) PA ✓K S 1 Suite MEC
Contact Person Ph ( ) PLM 9 00 `( — 0042E
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Framing Sheath/Shear rPI tit , -6.x.5 it vearrc -dl N,..h S - c.
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PART FAIL
PLUMBIN
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
. ASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date GI I2 (4 Inspector CM 1 1A-' (A- ti Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL