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10775 SW ERROL STREET-1 C r J r 't 4 A 10775 SW Errol Street \ C I T`,w OF T I Gh R D J SEW[ R CONNECTION PERMIT - DEVELUPMENT SERVICES PERMIT#: S 1 00337 13125 SW Hall Blvd., Tigard, OR 97223 (5C3) 639-4171 DATE ISSUED: 12!10!020/02 SITE ADCRESS; 10775 SW ERROL ST PARCEL. 23103AA-01704 SUBDIVISION: ECHO HEIGHTS ZONING: It--1 BLOCK: LOT: 002 _ JURISDICTION: II(; _'— TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sever connection to lateral. Owner: ------ _ — -- FEES --- --- — ROSCH, MERIDETH ANNE 4- — --- - JOHN M Description Date Amount 0775 SW ERROL ISWUSAJ S,,rConnect 12/10/02 $2,30000 TIGARD, OR 97223 1SWUSAJ Swr Connect 12/10/02 $0.00 Phone: ISWINSPJ Swr Inspect 12/10/02 $35.!)0 [SWINSI'l S%\r Inslicct 12./10/02 $0.00 Contractor' - -- - Total $2,335.00 Phone: Reg#: Required Inspections Sewer Inspection This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amoi int paid will be forfeited If the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance o ven. If not so located,the Installer shall purchase a"Tap and Side Sewer" Perm Issued by: �� ,� / (,L/ /,� _ Permittee Signature::!� c�h Call (503) 639-4175 by 7.00 P.M. for an inspection needed the next business day Building Fixtures J?J mbiugPermitApplication Date received: a-/p-Q, Eet7rtit no. .rJ — City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 projecUappl.no.: Expire date: City of Tigurd Phone: (503) 639-4171 Fax: (503) 598-1960 Date issued:_ B_T., l_ Receipt no.: Case file no.: Payment type: Land use approval:_ -- (J I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement 0 New construction U Additionalteration/replacement U Food wn icr J ether: t Descvipliun Qty. Fee(ea.) Total Job address: /C•7 75 t v[:X le t:I � 7 -- ew I-and 2-fam ly wellings only: Bldg.no.: Suite no.: (includes too ft.for each utility connection) Tax map/tax Iot/acconnt no,: SFR(1)bath — Lot: 131^ •k—Subdivision: SFR(2)bath _- Project name: _ SFR(3)bath _- Cit /county: T/BAR a LIP: 9-722-3 Each a ditional ath,�:itchen Description and location of work o f premises: 3lteutlllsin CF !` nuc T/a_ Catch basin/area drain _-4 / _ -- Drywell�"arch line/trench drain — Est.date of completion/insrection: Footing drain(no, lin. ft.) t� Manufactured home utilities Business name: Manholes __ Address: Rain drain connector City: --- _ State: Sanitary sewer(no.lin, ft,) Phone: --j Fax: E-mail: stormsewer(ne-it�1_�j�� Nater service no lin. ft. CCB no.: _ Plumb.bus.reg.no: Fixture or Item: City/metro tic.no.: Abso: tion valve Contractor's representative signature: Back flow reventer_ Print name Dave: Backwater valve t Basins/lavatory __— Clothes washer _ Name: _ _ ----- Dishwas e-hr Address: Drinking ountain(s) Cit : State:_ 7.1 P E'ectors/sum) _ —�--- Phonc. Fax: E-mail: Exponsion tares / Fixture/sewer cap „ _ Floor c rains/floor sinks/hub_ Name(print): ME/d rd E:'-I-ti )Ct,, h_ Oarba e isposaT—� — Mailing address: /t7 7 75' s W E 40 CL- _ _ Hose bib _ City: 7—/4-4!e n State:D/Z I ZIP:"172-2-3 _ ice maker Phone: S 79 6!y 9/53 Fax: Email: Interceptor/grease trap _ n Primer(s) — willRbtl'fw*fly tftl,,ttN!Writenance and7ifptlWMde �r Roof rain(commercia) —. .�aa7. Sink(s),basin(s),lays(s) •{.r ,�.tit , aa.r�,Date: ii-ie -e j.- Sump Owner's si mature:__ _-- - Tubs/s ower/s ower pan MALI"I rine — — Name: _ _ — - ater closet Address: Water Fester City: State: ZIP: Ot er: Phone: Fax: E-mail: uta -- _ Minimum fee................S -- Non ali Jurirdlctioru arcept rndlr cards,please cell jurisdiction rot more WOM&Non. Notice: This permit application Plan review(al_••, %) S _ O Visa U MwterCard expires if a permit is not obtained State surcharge(8%).... S — -- credo within 190 days after it has been TOTAL........................ S _ ' ap res —' accepted as cumptete. A ame of car of r u ahnwn on c+edit c� s 0C.CU TJO�� � ( N Q Ct t uYV 44("616(OM COM) --'—• I er alanature — _Amount— ��.Q�(�-�'• 1 >3 5.(� �{� �35,oa PLUMBING PERNPIT FEES: �- -- PRICE TOTAL New 1 and 2-family dwellings only: FIXTURESIndividual__L-_ QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL _ Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT 18.60 for each utility connection) Lavatory + -- One 1 bath $249.20 _ Tub or Tub/Silmve•Comb. 18.60 Two 2 bath $350.00 _ Shower Only 16.60 $399.00 _ Water Closot _ 16.80 TUBTOTAL Urinal ' ~ 16.60 8•/.STATE SURCHARGE Dishwasher 16.6n PLAN REVIEW 25%OF SUBTOTAL TAL Garbage Disposal 16.60 O? Laundry Tray 16.60 Washing Machine 16.60 Floor Droln/Floor Sir 1860 PLEASE COMPLETE: 3° 16.60 4~ 16.60 uantit b- Water Heater O conversion O like kind 16.80 QWork Performed Fit Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed! Capped permit. MFG Home New Water Service 46.40 Sink _ MFG Home New:i.rn/Storm Sewer 46.40 Lavato - _ Tub or Tub/Shower Hose Bibs 16.60 Combination _ Roof Drains 16.60 Shower Only - Drinking Fountain 18.60 Water Closet --- Urinal _ Other Fixtures(Specify) 16.60 Dishwasher _.. Garbage Dis usal _ Laundry Room Tray - Washing Machine _ Floor Drain/Sind: 2" _ Sewer-1st 100' 55.00 -3^ Sewer•each additional 100' 46.40 4" - Water Service-1st 100' 55.00 Water Heater - .- Other Fixtures Water Service-each additional 200' 46.40 S eci -- Stone 6 Rein Drain-1st 100' 55.00 - - Storm 8 Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device27.55 Catch Basin 16.60 Inspection of Existing Plumbinp or Specially 62.50 Requested Ins ectioni Er/hr COMMENTS REGARDING ABOVE: Rain Drain,single family L.velling 65.25 Grease Traps 18.80 QUANTITY TOTAL Isometric nr riser diagram Is required It Quantity Total is >9 `SUBTOTAL STATE SURCHARGE -PLAN REVIEW 25%OF SUBTOTAL Re uired only if fixture My.total is>a TOTAL $ 71 *Minimum permit f♦p Is$72 S-♦B%stale surcharge,except Residential Backflow Prevention Device,which m .0.25+s%state Surcharge. "All New Commercial Bull,inns require 2 sets of plans with Isometric or riser diagram for plan review. 1:\dsts\forms\ptm-fees.doc 12/26/0 CITY OF TIOARD 24-Hour BUILDING Inspection Line: (503)639-4175 "NIST — INSPECTION DIVISION Business Line: (503)639-4171 _ -�- BUP ---- Received Date Requested �. AM BUP — Location _ ,/�7_? �� --� -. suite _ MEC -- Contact Peraon _ � - — Ph( ) �.� SrnZ PLM Contractor_ —. Ph(_ _) _ SWR BUILDING �� Tenanvowner _ _ ELC -- Footing Foundation ELC Ftg Drain Access' ELR Crawl Drain - --- Slab Inspection Notes: /, SIT Post& Beam Shear Anchors - - Ext Sheath/Shear int Sheath/Shear y — -- Framing __L= �� -- -- --- ------ -- Insulation Cryv .i Nailing Firewall / C, Fire Sprinkler � •--- Fire Alarm „ Susp'd Ceiling - - --_ Roof Other:—_— - — - -- Final --- 0� Ul-� G� r'✓`Q PASS PART FAIL PLUMBING_—B _ Post A Beam- - ---�- ---- KUndeLBIallj Water Service ---- —_� I ar ewer Rain rats J ---— ---— --- _ Catch Basin/Manhole Storrs Drain --- — Shower Pan Other: ______ -- Fi RT Mil _ Post& Beam — Rough-In - -------- --- -- - Gas Line Smoke Damoers Final PASS PART FAIL -- — - - -- ----- --- ELECTRICAL Service - --- - --- ---- --— — Rough-In UG/Slab -- --------- ---.__---- -- -- ---- Low Voltage Fire Alarm - ---- - - �-- � - - Final Fj Reins PASS PART FAIL pection tee of$ -required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE - Please call for reinspection RE: F-1 Unable to inspect-no access Fire Supply LineADA l I Approach/Sidewalk Dot• Inspector ,`/ ` ✓cam--- _— _ Other: �7 Final --�- — - DO NOT REMOVE this Inspeation record from the job site. PASS PART FAIL (rem. Sleve McBee Fair:+115031251-3020 To: Fick Bolen Far +1(503)6ie .311181 Pape 4 of 4 Friday,December 27,2002 11 1Y AM Ted McBee Ccs/110214 24hr (503)2R 1.0805 Boring McBee ,.y 11428 NE Sehuyler St Mobile (503)939.6248 Boring & Excavating, Inc. Pnrlleno,3R 97220 Fax (603)251-3020 lJ1dagr0rd BMV fcrSeACr,Wdtff&t $y Qrxlls December 27, 2002 City of Tigard Attn, Inspector Rick Bolen Tigard, OR Itldt SEPTIC ABANDONMENT -1©776 SW ERROL To whom it may concern This letter Is to confirm that the existing septic tank located at the above address has been pumped and then back filled with'/V minus granula,In compliance with State and City codes for the abandonment of on site sewage disposal systems If you have any questions or concerns, contact me direct at(503) 515-4452 or Steve McBee at (503) 939.5246, Sincerely, Chris Rugloski Estimates/Scheduling Ted McBee Boring&Excavating, Inc. CLRJolr I ir.Vr)ice 1 I1'l�'S Sl:l''1'il'; l:llVlCl: - Name -- - - - Date — — -- ,C -r�.Ll Ad7 f/2 _rL_.__ .t_ Phone-_ � ! `1G-- ------ City Initial - On Acct. .r' Zf State.-----�-1--- PCode_.._.__ ---- --—-- -- - Price Amount � A-- 51131 NOT RESPONSIBLE FOR DAMAGES PAST CURB LINE OR LANDSCAPING A service charge of 1.5%will be levied on all past due accounts. ToteL `L--"- • Returned check fee is$20.00. - • In case suit, action or arbitration is Instituted by either party for breach or to enforce any provisions herein, the court shall award reasonable attorney's fees and actual costs to the prevailing pa at trial or arbitration, or upon any appeal taken therefrom. Ap roya By: Customer Signature P.O. BOX 1136 Canby, OR 97013 DEO#37464 '�hillilk Yj)u (503) 263-2087 or (503) 632-6138 CCB# 104320