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10815 SW DERRY DELL COURT oLC tl- t_n in a r� r r c� U �3 e t i 0 10815 SW DERRY DELL COURT CITY OF 'TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST _ _- _ Date R ► I s I BLIP -_--.---_------ Requested _AM _ PM BLU Lo:ation 5 r Suite MEC _ Contact PersonTk-ij _ _ Ph ('c___2e ' 7�. PLM Contractor _ Ph SWR BUILDING Tenant/Owner ELC Retaining Wall Footing —� ELR Access: Foundation FPS � ,� J �� ) _ Ftg Drain ` !�`- Crawl Drain Inspection Notes: SGRi Slab _ _ Post& Beam �r - SIT Ext Sheath/Shear / �, 9 Int Sheath/Shear 7 —' Framing ' � r '� Y f� Insulation � Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling P Roof Misc: Final PASS PART FAIL PLUMBING Post& Beam — Under Slab Top Out — Water Service Sanitary Sewer ---- - - Rain Drains Final PASS PART FAIL MECHANICAL - �— Post& Beam Rough In Gas Line - --- Smoke Dampers Final - - ----- _ _PASS PART FAIT LECTRI(;AL -- -.. - -- --- ----- - - ---- --- Seroree -- Rough In �� ? UG/Slab Low Voltage — Fire Alarm Fin _— S ' PART FAIL �-- --- - --- ---- --- Backfill/Grading ------ - - - — - --- — Sani'ary Sewer Storn, Drain ( J Reinspection fee of$_, required before next Ins,,ection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire!-upply Line I ]Please call for reinspection RE._ _ [ ]Unable to Inspect-no access ADA Approach/Sidewalk Other Date �,-��-- f'," Inspector /l -,, Ext Final PASS FART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phone: 6394171 Date Requested: _ A.M. P.M. V MST: Location: Jr _ BUR Tenant: _ _ Suite: Bldg: MEC: 1-7,_ 01-31 Con rector: '7 G�. 1•J Phone: a7C PLM: owner: Phone: _ ELC:_ �1 t�11r 16 0 )6— ,_ _ ELR: _ SIT: BUILDING BLDG(con't)� PLUMBING IKECHANICAL ELECTRICAL SITE Site t'ost/Beam Post/Beam Post/B• Cover/Service Sewer/Storm Footing Roof UndFI/Slab I ou - Ceiling Water Line Slab Framing Top Out Rough-In IJG Sprinkler Foundation Insulation Sewer I I(XZZU-Z r Reconnect Vault Bsmt Damp Drywall Storm urnacc Temp Service MISC. Masonry Ceiling Rain Drain 1JG Slab Shear/Sheath Fire Spklr/Alm Crawl/Found Ir lice I,ow Volt Approved Approved Approved Approved Appr/Sdwlk Not Approved Not Approvedved Not Approved Not Approved FINAL FINAL FINAL FINAL C]Call f -rein- C3 Reinspection fee of S required before next inspection C3 Unable to inspect Inspector:_ _,_ Date: _ Page_ of _ CITY OF TIGARD MECHAN I F kL-. DEVELOPMENT SERVICES" PERMIT 13125.14 Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #. . . . . . . : MEG"-i7­0?3:1 DATE ISSUED: 05/14/97 PARCEL: ES103DA-.01800 SITE ADDRESS. . . : 10815 SW DERRY DELL CT SURD I V I S I ON. . . . - DERRY DELL r1l.-AT 2 ZONING: R--3. 5 BLOCK. . . . . . . . . . . . . . . . . . . . . . . . .. 18 JURISDICTION: TIG CL.ASS OF WORE;. . :ALT FLOOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF' USE. . . . :8F UNIT HEATERS— : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . : R3 VENTS W/O APPLi 0 VENT SYSTEMS: 0 STORIES. . . . . . . . .. 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 FUFL 0-3 HP. . . . : 0 DOMES. INCIN: 0 3­15 HP. . . . : 0 COMML. INCIN: 0 MAX INPUT: 0 BTU 15--30 HP. . . . : 0 REPAIR UNITS: 0 FIRE DAMPERS?. . : 30-50 HP. . . . 21 WOODSTOVES. . c 0 GAS PRESSURE_ : 504- HP. . . . 0 CLO DRYERS. . : 0 NO. OF AIR HANDLING UN I TS OTHER UNITS. : 0 FURN < 100K BTU: I <= 10000 cfm: 0 GAS OUTLETS. : 0 FURN ) =100K BTU: 0 > 1.0000 cfm: 0 Remarks: Installation of furnace. Owner,; FEES DOUG SAWKINS type antoltrit by date r-ecpt 10815 SW DERRY DELL CT F-",Rm"r s 25. 00 DRA 05/14/97 97-294532 TIGARD OR 97223 5 P(7.T $ 1. 25 DRA 05/14/9*7 97­-2947)32 Phone #: Contt,actot-: COLUMBIA HEATING & COOLING INC' PO BOX 230397 TIGARD ON 97223 Phone #: 624-2704 $ 26. 25 TOTAL Reg #. . t 000763 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Mechanical Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection applicable laws. All work will be done in accordance with Final Inspection approved plans. This permit will expire if work is not started within 189 days of issuance, or if work is suspended for more than 180 days. Perm i t t ept 1.1t-e- Jtft- Lad Tssi-ted By : Call for, inspection 639-4175 Plan Che CITY OF TIGARD Mechanical Permit Application _ 13225 SW HALL BLVD. Commercial ana Residential Date Rf-, TIGARD, OR 97223 ecd -- Date to P E (503) 639-4171, x304 Date to DST — Print or Type Permit s I U�__QOL Incomplete or illegible applications will not be accepted Called Nam o DeveiopmonuPrd Descnphon `-- Table IA Mechanical Code CTY PRICE AMT Job street A dress Suites A) Permit Fee - Address ) 1 I ' -0- -0 10.00 Bldgs restate1� zip B) Supplemental Pemw -` — -- l 1 !_ - - .00 Narne for name dr ousinessl I ) Furnace to 100.000 BTU Owner j I 600 ') P- '. Jay incl ducts&vents rdeihng Address 2) Furnace 100,000 BTI incl ducts&vents 7 50 tyr5ieie Zip Phone 3) Floor Furnace +'-- _ 6_00_ Name:u e tc•lame of busrni — incl,vent 4 ) Suspended heater,wall heater 6 00 or floor mounted heater Occupant Marling Address 5) Vent not incl.in --`- �- cityrstate appliance permit 3 CO Zip =Phone 6) Boder or comp,heat pump,air cond6 00 to_j HP;absorp unit to 100K BTU �� } 7) Boder or comp,heat pump,air cond 11.00 1y 3-15 HP;abso unit to 500K BTU 671 Contractor ( 11M19 Address l 6) Boiler or comp,eat pump,air cond /7 1500 15.30 HP:absurp unit 5-1 and BTU (Prior to M tea Zip Phone _. 9) Boder or comp,heat pump,air cond ss ance a copy 4 1 3 22u0 of all lk;colses are 0 Const.Coni,9oartl lic s 30.50 HP;absorp u_qrnl i t Esp Dna [ 10) Moder or comp,hea37 50 required /6 >50 HP;absorp un expired in C O 7 Cr*iAusnea{tex or Mevo a `xp.ONa _ --data base) ,S-`j .,(�I _ 11 ) Air handling unit to4 50 Architect Name I 10,000 CFM 12 Air handling unit7 50 or Mailing Address --- 10,000 CTM+ — t 3) Non portable4 50 Engineer C ryr5tete zip Phone evaporate cooler 14) Vent fan connected3.00 Descnbe work New O Addition O Alteration O Repair O V rl single duct P 15) VenblaUon system n4 50 to be done Residential ONon-residential O included in appliance permitAdditional Dphonowok - 16 _ Hood served by mechanical exhaust 4 50 Extstiny use oI — _ 17) Domestic incinerators— 750 �A 18 t Commercial or ndustnaRy pe 30450 -- 21) building or property incinerator 19) Repair units 4 Proposed use of 20) Woodstove building or property— �4 Clothes dryer etc _ _4 50 Type of fuel-re O natural gas O LPG O electric O 22) Other units 4 50 I hereby acknowledge that)have read this apphcatmr that the information given is correct that-1-am the owner or authorized agent of `3) Gas piping rine to four outlets 2.00 the owner, plans submitted are in compliance with Oregon State 24) More than a- -- laws / Per outlet (each) 50 fSign.. Owner/Agent D,re - - r l QT f.SUBTOTAL Contact Person Name 4 Phone 5%SURCHAP�E PLAN REVIEW 25%OF SUBTOTAL ------------`A—.TOTAL -� 1',dst\rnechpmtdoc (rev 7/96) 'Minimum permit fee is S25+5%surcharge CITY OF TIGARD DEVELOPMENT SERVICES ELECTRICAL PERMIT - PERMIT #: ELC97-0301. 13125 SW Hall Blvd., Tigard,UH 97223 (503)639.4171 DATE ISSUED: 05/2,0/1;'11 SITE ADDRESS. . „ : 1.081.5 SW DERRY DELL CT PARCEL: 2S 1O3llA-01800 SUBDIVISION. . .. . :DERRY DELL PLAT 2 ZONING: R-3. 5 BLOC:K. . . . . . . . . . LOT. . . . . . . . . . . : 18 JURISDICTION: TIG .j Pr-oect De s� t^i pt i on: INSTALL I BRANCH CIRCUIT// JOB # 516-007 -- -RESIDENTIAL UNIT- --- -----TEMP 3)RVC/FEEDER9-----_ 1000 S' OR L.ESS. . . . : 0 0 '00 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L 5005F. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE L.TG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : rr SIGNAL/PANE[._. . . . . . . : 0 MANE. Hbl/ SVC/FDR. . : 0 C01+amps--1000 vo I t'_s. : 0 MINOR LABEL ( 10) . . . : 0 -._.-.__SERVICE/FEEDER----- -----BRANCH CIRCUITS-------- -----FiDD' L INSPECTIONS.- 0 c:OO amp. . . . . . : 0 W/SERVIC:E OR FEEDER: 0 PIER INSPECTION. . . . . : 0 201 - 400 arr 1. . . . . . : 0 1st W/O SRVC OR FDR. : I PER HOU9. . . . . . . . . . . .. 4h 401 600 amp. . . . . . : 0 EA ADDr I_ IBRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 601 - 1OOr?r amp. . . . . : 0 ----._____._.___ _____-.._____.._PLAN REVIEW SECTION- 1000+ am P/v a 1.t. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 V,)LT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner-: - -- --- ---- ------__--- --- ------------ - __ --------_ FEES .JANE L FOLKERTS type amoi.tnt by date recpt 1.0815 SW DERRY DELL CT PRMT $ 35. 00 TAT 05/20/97 97-294774 TIGARD OR 9-227 SPCT $ 1.. 75 TAT 05/20/97 97-294774 Phone #: Contractor: ----_ WESTS I DE ELECTRIC $ 36. 075 TO-i AL 7518 SW MACADAM AVE REQUIRED INSPECTTONS PORTLAND OR 97219 Ceiling Cover Under-groi_rnd Cove Phune #: 145--3385 Wall Cover Elect' l Service Reg #. . . 000133 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Si gnat dt, e applicable laws. All work will be done in accordance with f/ 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. I s s i.r e d By -------..._OWNER INSTALLATION ONLY-- - __! .-•------.-•--_._._._-•------.__._____ The installation is being made on property I own which is not intended for sale, lease, or- rent. OWNER' S SIGNATURE: DATE, INSTALLATION S T GNATURE OF SUPk. ELEC' N: DATE LICENSE NO: Call for inspection - 639-4175 L^._ Community Developrneftt ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. Tigard, OR 97223 Permit # Date Issued _ Z l Phone (503) 639-4171 FAX (503) 684-7297 CITY C#, TIGARD TDD No. (503) 684-2772 Inspection (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Nurnber of Inspections per permit allowed Address/U rS � I �r�r ��� .._ Service includ^dItems Cost(ea) Sum City/State/Zip leI9 4a. Residential -per unit G / Each Sq. fl or less S 110 00 -�— Naine (or name of business) W -1'4� C 0 Each ionaddthee)f sq h or $2500 portion thereof —— � Commercial ❑ Residential Limned Energy $2500 Each Manurd Home or Modular Dwelling Service or Feeder $6800 2a. Contr!ictor installation only: 4b. Services or Feeders Installation,adoration or relocation Electrical Qgntractor 200 amps or less $6000 Addre G 01 201 amps to 400 amps �- $8000 _ 401 amps to Boo amps $12000 z City_ A Slate 7ip9 2 601 amps to 1000 amps $18000 2 Phone No. _ �J _ Over 1000 amps or volts $340.00 ---------- --_ Job NO. 'OU Reconnect only $5000 contractor's license NO. Z4 '(-3 S 4c. Temporary Services or Feeders Contractor's Eoard Reg. No. �_ .-___._ installation.alteration,or relocation Signature of 5upr. Elec'n 2a)amps or less 2 201 amps to 400 amps $5000 License No.1 _ one No. Z Y.T� 401 amps to 600 amps; $7500 — 2 Over 600 amps to 1000 volts $100 00 1b. For owner installations: see"b'above 4d. Branch Circuits Print Owner's Nam@_ __ .._. __ New,alteration or extension per pane Address a)The fee for branch circuits with City State Zip _ Each bre ch purcse of cheult a or ftssder fee. $500 Phone No. b)the fee for branch circuits without The installation is being made on property I own which is purchase of service or feeder fee. First branch circus $3500 3_ not intended for sale, lease or rent. Each additional branch circuit $5 00 owner's Signature __ 4e. Miscellaneous (Service or feeder not included) 3. Plan Review section (if required): Each pump or Irrigation circle $4000 Each sign cr outline lighting $4000 Signal circud(s)or a limned energy Please check appropriate Item and enter fee In st;ctlon 58. panel alteration or extension $4000 4 or more residential units in one structure Minor Labels(10) $100 00 Service and feeder 225 amps or more 14f. Each additional inspection over System over 600 volts nominal the all Classified area or structure containing special occupancy Per inspection in any of the above - — - as described In N E C. Chapter ter 5 $35 00 Per hour $5500 In Plant $5500 Submit 2 sets of plans with application where any of the above apply. Not required for temporary construction services. 5. Fetes: 5a. Enter total of above fees g NOTICE 5%Surcharge (05 X total fees) g PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ _ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter evof line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec 3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS 3ubtota $ COMMENCED. w.mcemamw. ffrTrust Account # 4 n,�sm• Balance Due $ / \ CITY OF TIGARD __ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2004-00258 13125 SW H,II Blvd.. Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/10/2004 PARCEL: 2S 103DA-01800 SITE ADDRESS: 10815 SW DEkRY DELL CT SUBDIVISION: DERRY DELL PLAT 2 ZONING: R-3.5 BLOCK: LOT: 018 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: UB/SHOWERS: SEWER LINE: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of 90 feet of sewer service to connect existing house to sewer lateral. Septic to-' !s to be pumped, filled & inspected. _ FEES owner: Description Date Amount SAWKINS, DOUGLAS S + - CAROLYN M II'LUMl31 I'crmit Fee 61101'L004 $72.50 10815 SW DERRY DELL CT fAX) 80%State Surcharl 6110/2004 — $5.80 TIGARD, OR 97223 Total $78.30 Phone : 50-624-5923 Contractor: THEODORE D. MCBEE 13691 SE WILLINGHAM CT CIACKAMAS, OR 97015-7253 REQUIRED INSPECTIONS Sewer Inspection Phone: 503-239-2909 Insp existing/capped fixtures Reg #: LIC 75511 Fina' Inspection 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. chose rules are set forth in OAR 952-0001-0010 through OAR 952-00u i-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699. Is ued B f ,�.►: Permittee Signature: s y Cell (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures I'illmbint! Permit Application -0 FOR OFFICE USE ONLY r, Received (;ity ul'"I iy,trd "sitHall iihd.,Tigard,OR 97223 Date/By: _ Phone: 503.639.4171 Fax: 5r -""'960 PI;n Review I Othcr permit No. KO���.- / Date/By- 3 Int Hour Inspection Line: 503.63" Date Ready/9y: Ju 0 see Page 2 for Internet: www.ci.tigard.oeus _ Notifled/Method / Supplemental Information TYPE OF WORK FEE* SCHEDULE -- -- - ❑New construction ❑Demolition For special infbrnarion use checklist -- _- --- Description _ pry Ea. Total ❑AdditiorUalteratior✓replacement �T ❑Other:_ New 1-2-family dwellings(Includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION _ SFR(1)bath 249.20 I-and 2-family dwelling ❑CommetciaL'industrial SFR(2)bath 350.00 ❑Accessory building ❑Multi-family SFR(3)bath 39900 [] NI;r;lcr builder Each additional both/kitcleen 45,00 -� L❑Other _ Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: �^ 1 ►� KKy r Catch basin or area drain 16.60 City/State/Zf 'C� ' -•72Drywell,leach line,or trench drain 16.60 Suite:/bldg./apt.no.: Project name: _i CJ Footing drain(no linear ft. ) Page 2 Manufactured home utilities 11000 Ci)ss street/directions to job site: Manholes 16,60 Rain drain connector 16.6C Sanitary sewer(no.linear ft.: Page 2 Storm sewer(no linear fl._)_ Page 1 Subdivi•')n. Lot no.: Water service(no linear ft: ) Page 2 'Tax map/parcel no.: Y Fixture or Item - --- — Absorption valve 1660 DESCRIPTION OF WORK -,- Backflow preventer Page 2 t,-'I--) - L i �( y't ��:`c �� l �j i �IZ f��-- Backwater valve 16.60 Clothes washer 1660 Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY [J TENANT Tvantc: ~`'a t , I Ejectorsisump __ 1660 - .-)C L; t' 6 r) L Ar n[`�.�/t\, r t t V) ice, Expansion tank 16.60 Address: C [j e� V `C -7D LL- C f Fixture/sewer cap 16.60 city/State/ZIP:--T—I � 1D '. 7 v-•';L� Floor drain/floor sink/hub 1660 Fax ( ) Garbage disposal 16.60 a .: " Hose bib 16.60 ❑ C(;OTACT PFRSON ' _ _ .�.��� --- -------------------- - Ice maker 16.60 Business name: -- ----- -- Interceptor/grease trap 1650 Contact name: _ �- Medical gas(value.S�) _ Pagt 2 Address: Primer 16 60 City/State/ZIP. Roof drain(commercial) ~- 16.60 Phone: Fax: Sink/basin/lavatury 16.60 ( ) :( ) F-mail: Tub.,shower/shower pan 16 60 Urinal _ 16.60 L ,i' Al.. Water closet 16.60 Business name., _ Water heater 16.60 Address: //''..��...., Other. -_— Ctty/StateZIP: ��a Subtotal S Minimum permit fee V250 Phone: Fax: �� Residential b.ckflow minimum permit fee $36 25 CCB Lic.: 1�� Plgmbing Lic.no.: _- Plan review (25%of permit fee) Authorized signature: v State surcharge(31%of permit fee) •`,�5 V _ _ TOTAL PERMIT FEE 3C LPrint name: —_JD3 J, j N G� Date: G X0,Cl This permit application expires if a permit is not obtained within 180 days alter It has been accepted as complete. *Fee methodology set by Ti -County Building Industry Service Board i�BnildinaTermt9\PLMF-PeaWAppdoc 12j0A 4e04616T(10/02LCoM/WU) Numbing Permit Application - City of Tigard 1 Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities �— Qty. Fee(ea) Total �S. ua a Footage: Permit Fee: Pouting drain- r,100' 55.01) 0 to 2,000 $115 00 - Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer-I st 100' _ 55.00 3,601 to 7,200 $210.0071 201 and greater $309.00 - - Sewer-each additional 100' 46.40 Water Service- Ist100' 55.00 Medical Gas Systems: Water Service-each additional 100' 46.40 ---�^tr-�---- ^---- Valuation: Permit Fee: _ Storm&Rain Drain-Ist 100' 55.00 $1 00 to$5,000.00 Minimum fee$72 50_- Storm&Rain Diain each additional 100' .16.40 r$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 51.52 for each Fixture -r YteI i' Qly• Fee(ea) Total additional$100.00 or fraction thereof,to and including$10,000.00. Commercial Hack Flow Prevention Device 46 40 $1U,001.00 to$25,000.00 5148.50 for the first 510,000.00 and$1.54 for Residential Backflow Prevention Device each add-tional$100.00 or fraction th..eof,to minimum permit fee$36.25 27.55 and mclL Jin $25,000.00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 or the first 525,900.00 and$1 45 for Inspection ot'existing plumbing or each additional$100.00 or fraction thereof,to s ec ally requested inspections- per Subtotal: and including$50,000.00. hour 72.50 _ -� $50,001 00 and up 5742.00 for the first$50,000.00 and$1.20 for Seach additional$100.00 or fraction thereof Fixture Work: Are you capping, moving or replacing existing fixtures? If "Yes".please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. -- I ltaanti b Fixture Work Performed Fixture'Type. Replace .New Moved E31sNna Capped Comments regardin-,, ll\tlll-e w'C, K: Baptistry/!-ont -- _ �-- Bath -Tub/Shower _ --- --- -- - -Jacuzzi/Whirlpool Car Wash -Each Stall - -Dtive Thru -- - - ---- - -- - Cuspidor/Water Aspirator _—_- _____— Dishwasher -Commercial -Domestic _ -- - Drinking Fountain Eye Wash _ Floor Thain/sink 2" - ---- --- _---_ Y 4,. -- 1 Car Wash Drain _ Garbage -Domestic Disposal -Commercial *Note: If the fixture work under this pertrut .esults to an -industrial lee Mach.iRcfri .Drains - increase of sewer EDUs,a sewer permit will be issued and Oil Separator(Gas Station - - fees assessed for the sewer Increase must be paid before the Rec.vehicle Dump Station _ plumbing permit can be issued. Shower -Gang -Stall _ Sink -Bar/t.avatory Quantity_ ua;pity Total -Bradley -Commercial - Isometric or riser diagram is required if fixture quantity -Service _ total is>9. Swimming Pool Filter _ Washer-Cloth s i Water Extractor Plan Re%ie%% Water Closet-Toilet ,wit review is required it fixture quantih total is -- 1). Urinal Other Fixtures, I tuddiea,Pem tvTLM.PentuiApp dx 101 CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2004-00153 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 D. :'E ISSUED: 5/25/2004 SITE ADDRESS; 10815 SW DERRY DLLL CT PARCEL: 2S103DA-01800 SUBDIVISION: ISI klt5' DELL PLAT 2 ZONING: It 3 _ BLOCK: LOT: M JURISDICTION: tic; TENANT NAME: USA N0: FIXTURE UNITS: C -ASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: S'F NO. OF BUILDINGS: INSTALL TYPE: L PSWR IMPERV SURFACE: Remarks: Sewer connection (line tap) to lateral. Owner: — SAWKINS, DOUGLAS S + __. - FEES — CAROLYN M Description Date Amount 10815 SW DERRY DELL CT [SWUSA]Swr Connectit 5/25/2004 $2,400.00 TIGARD, OR 97223 [SWUSA]Swr Connectii 5/2.x/2004 $0.00 Phone: 503-624-5923 (SWINSP] Sewer Inspeci 5/25/2004 $35.00 Contractor: [SWINSPI Sewer Inspcei 5/25/2004 $0.00 Total $2,435.00 Phone: Reg #: Requirt d Inspections 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 amount paid wail be forfeited if the permit expires. The Agency does not guarantee t, the accuracy of the side sewer laterals. If;he sewer is not located at We measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Orec,on Utility Notification Center. Those rules are se 'orth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct question;,to OUNC by calling (503) 246-6699. Issued by: Permittee Signature:{ Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next busAess day Building Fixtures Ply nb' >tyialxfi> lication + ONLI City of Tigard I RcceivDate/Bea Pertnit N . 07 �/5 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie, Phone: 503.639.4171 Fax: 503.598.1960 -Date/By: Other Permit No 4•Hour Inspection Line: 503.639.4175Date Ready/By: lurit ® See Page 2 for^ Internet: www.ci tigard.or us Notified/Method Supplemental lnformar6m construe ,TYPE t)IF WORK` Ej*` CIIEV E ❑New ---- tion ❑Demolition �- For spec al injormadon use checklist. Description I Qty I Ea. Tutal ❑Addition/alteration/replacement — ❑Cithei New 1-2-family dwellings includes 100 ft.for each Utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 EJ l-and 2-family dwelling ❑Conunercial;uidustrial SFR(2)bath 350.00 ❑Accessory building ❑Multi-family SFR(3)bath 399.00 , ❑Master builder ❑Other: Each additional bath/kitchen 45.00 _ Fire sprinkler( sq,ft.) Pagi JOB Sf�E INF(�T<tMATI ATI Site utilities Job site address: (I ,I C VV) Catch basin or area drain I 60 City/State/ZIP: Drywell,leach line,or jench drain 1fi 60 Suite/bidg./apt no.: Project name: Footing drain(no.linea t ) age 2 -- Cross street/directions to job site: Manufactured home utilies 10.00 Manholes 16.60 Rain drain connector r 16.60 Sanitary sewer(no linear ft.. Page 2 - Storm sewer(no linear ft Plite 2 (— Subdivision Lot no.: Fixture or Item Water service(no,linear ft ) Pege 2 Tax map/parcel no.: ,�$ ,'� j OG' Absorption valve I6,60 bESCRIPT11)N OF WORK Backflow preventer Page 2 Backwater valve 16,60 �ez 1,22—t-7 / Clothes washer 1660 T Dishwasher 16.60 :, VRTYrOWNER - -- Drinking fountain 16.60 � . -- ❑_TE.YANT /� -- Ejectors/sump 16.60 Name: &L": / J)":,// � _ Expansion tank 16.60 Address: ! �S I C� �V ,a P( /J r bf ig// our' Fixture/sewer cap 16.60 City/State/ZIP: Floor drain/floor sink/hub 16.60 _ re Phone (SL)✓7 ,�j` 7 Fax:�.--j--- - Garbage disposal 16.60 Nall` PERSQ)Y` �` Hose bib_ _ 16.60 ----;, Ice maker 16.60 Business name: - -_.____ Interceptor/grease trap 16.60 Contact name: Medical gas(value S ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain(commercial) 16.60 Phone:( ) — Fax: :1 1 Sink/basin/lavatory 6 60 - Tub/shower/shower pan 1 .60 E-mail Urinal 16 0 i rd, Water closet 16.6 Busin ss name Water heater 1660 Addr s: / Other City/Late)ZIT: - _- -- - _ Subtotal - -- Min im permit fee $72.50 —-� Phon ) Residential back! olow minimum mit fee S36 25 CCB Plum tc.no.: Plan review (25%of permit fee) State surcharge(8%of permit fee) Authorized signature: L 46- TOTAL PERMIT FEE � Print name: r k'CL )S Date: : This permit application expires if a permit is not obtained within --r--- 180 dsy4 after it has been accepted of complete. "Fee methodology t by Tri-County Building Industry Service Board i\Aut1dinjTermiu\PLMF-PmmtApp doc 17/03 4-'OJ616T(101021COMNMA) plumbing I ermil ;application - City of Tigard , Page 2 - Supplemental Inf'orniation Fee Schedule: Residential Hire Supp ession Systems: Site Utilities Qty, Fee(ea) 'total u'ae 1�!oote: _ Permit Fee: Footing drain-I"100' 55.00 0 to 200 $115-00 Footing l15.00Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 _ $220.00 Sewer- 1st IOG' 55.00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water Service- I st 100' 55.00 f (Medical Gas Systems' _ Water Scrvice-each additional 100' 46.40 Valuation: _ Perm t Fee: Storm&Rain Drain-Ist 100' - 55.00 $1.00 to$5,000.00 Mtntmum fee$72.50 Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each Fixture or Ite,tn Qty. Fee.(ea) Total additional$100 00 or fraction thereof,to and including$10,000.00. COMMUL 1.11 Back Flow Prevention Device 46.40 $10,001.00 to$25,000 00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27.55 and including$25,000.00. Rain[rain,single family dwelling 65.25 $25,001.00 to$50.000.00 $379.50 for the first$2.5,000.00 and$145 for each additional$100.00 or fraction thereof,to Inspection of existing plumbing or and including$50,000.00. speciully requested inspections-per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1 20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping, moving t"r replacing existing fixtures? It "yes",please indicate work performed by fixture. Failure to accurately report fixlureF could result in increased sewer fees*. uantity by(Fixture Work Performed Fixture Type: Replace New Moved t3al,uag capped Comments regarding; fizttare work: Ba iia Tom _ -- --- -_---- Bath -Tub/Shower i ---- -- - -_�T -Jacuzzi/Wh,ripool - - Car Wash -Each Stall -Chive Thru - Cuspidor/Water Aspirator --------- - Dishwasher -Commercial -Domestic - - Drinking Fountain -Eye Wash _ Floor Drain/sink .2" 3„ - -- --- 4" -- Car Wash Drain -- Garbage -Domestic Disposal -Commercial *;Vote: If the fixture work under this permit results in an -Industrial Ice Mach./Refri .Drains increase of sewer F1DUs,a sewer permit will be issued and Oil Separator Gas Station fees assessed for the sewer increase must be paid before the Rec.vehicle Dump Stauun - plumbing permit can be issued. Shower -Gang - -Stall Sint -Bar/Uvatory Quantity Total -Bradley --- Isometric or riser diagram is required if fixture quantity -Commercial total is?9. -Service Swimming Pool Filter Washer-Clothes Water Extractor Plan Review Water Closet-Toilet [Ilan review is required if fixture quantity total is>9. Urinal _ Other Fixtures' i,Bwldma�Peroaa,PLM Peim tApp doe V03 ,y/�\ W� , - �+� r' a.. _+!. '. •�' rp.^�+A'�F�F"'?.."'•w�Jrnt q. INVOICE 46913 P.O. Box 2349 Oregon City, OR 97045 CompleteNew Installations Industrial Repair Existing Systems ■■ i "" ■■ -■■ Waste Sewer Connections :■■■ N� ,■ ■�'�■■ ■ ■■ ■ Removal Drainfields ■■ ■■■■■ E^■■■ ■it■■R M■■ Septic Tank Cleaning Cesspools Sump Excavating Line Cleaning Richmond Construction Ent., Inc. (503) 253-7587 A-,nt 10-11 : 00 a.m. Customer P.O.# - - - Date '/10/0 4 Billing Name ._ McBee Fxcay._it :Ley i Address_ _ II - Job Site# City State -- _ Zip Code Ordered By r11 kePhone# 502-3 51 1 Date 5/9 It 4_ Job Leration 1081 5 SW r)aff-y Dell Ct. /Tigard Servir.a Call $ Labor_. — - -- $ ti tie r. 5000G Pumping sapti 1000 $ 24-60 re 0 Misc Gv Conditions of tank/Distribution Bo>+�� t✓7 -s✓�/�� �i� ?_Ole TOTAL CHARGES:* ,9. Enviroclear is in no way responsible for damage to IhP septic tank or lids on the system, E RMS Net 10 deys.1-1/2%per month will be charged on past due accounts.(18%per annum). A. Customer's Signature: Service Driver's Si t , 9 Time na er e Date -------- 1 ERMS AND CONDITIONS ON REVERSE SIDE REDEEMABLE IN ALL COUNTIES I'� tERMS AND CONDITIONS THE CUSTOMER AGREES TO PAY ALL INVOICES ARISING OU I OF PUMP ING SERVICES. AND ANY OTHER SPECIAL SERVICES HEREIN WITHIN to 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 PUMDING SFRVICES 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 ENW ,OCLEAR FINDS IT NECESSARY TO ADD LIQUID TO THE TANK ON JOBSITL. CUSTOMER WILL BE CHARGED FOR THE ADDITIONAL GAL- LONAGE RESULTING FRON4 THESE CONDITIONS. CUSTOMER AGREES TO REIMBURSE ENVIROCLEAR SERVICE FOR ALL REASONABLE. ATTORNEY'S FEES, COURT COSTSAND OTHER EXPENSE INCURRED BY SAID COMPANY TO ENFORCE COLLECTION OR TO SERVE THEIR RIGHTS UNDER THIS AGREEMENT. CUSTOMER AGREES TC THE ABOVE CONDITIONS. RECEEMABLI- IN AL._COON CIES. l