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15970 SW 76TH AVENUE 15970 SW 76th Avenue CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - -- BLIP - --__ Date Requested -- AM __PM — BLD Location � ' �d -�� ---------- — Suite -- — MEC — - Contact Person Pt. Contractor _ -_ Ph _ WI _-_q 00/011 BUILDING Tenant/Owner ELC Retaining Wall V - - .— ELR Footing Access- Foundation FPS Ftg Dain �--.— SGN Crawl Drain Inspection Notes ----- -- Slab _ _ SIT Post&Beam -- - - Ext Sheath/Shear Int Sheath/Shear — Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm - Susp'd Ceiling Roof Misc: -- - Final --- PASS PART FAIL - ------------ PLUMBING Post&Beam Under Slab Top Out Water Service Sanitary Sewer -- Rai rains ART FAIL ------ ----- — -- - - CHANICAL Post& steam - -- Rough In Gas Line ----—- -- — --- Smoke Dampers Final PASS _PART FAIL ELECTRICAL — ----_-- ---- Service Rough In UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL _SITE Backfill/Grading - — -- Sanitary Sewer Storm Drain [ j Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ J Please call for reinspection RE: [ J Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewalk pate ,,.��"� �2 Inspectors - -- Ext Other _ -i-- --- -- -- Final PASS PART FAIL DO NOT REMOVE this inspection record frotif-it'he joh sit-P. CITY OF TI GAR® PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: P 00672 "M 11116 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12//28/01 28/01 PARCEL: 2S112CD-00800 SITE ADDRESS: 15970 SW 76TF-I AVE SUBDIVISION: DURHAM ACRES ZONING: R-12 BLOCK: LOT: 001 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: v URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TLIB/SHOWERS: SEWER LINE: tt WATER CLOSETS: 1 WATER LINE: ft DISHVIASHERS: RAIN DRAIN: ft Remarks: Installation of new, additional(l) lav and (1)water closet______________________ __ FEES Owner !. - --- Type By Date Amount Receipt HAVERY, JOHN W MADELOfJ PRMT CTR 12128/01 $72.50 27200100000 15970 SW 76TH AVE 5PCT CTR 12/28/01 $5.80 2.7200100000 TIGARD, OR 97224 — 'Total $78.30 Phone 1: Contractor: — _— RAYBORN'S PLUMBING INC PO BOX 69 TUAL.ATIN, OR 97062 REQUIRED INSPECTIONS Rough-in Insp Phone 1: 503-692-4139 Final Inspection Reg #: LIC 87852 PLM 34-166PB J 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 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: i L., . ` t C- 111a� _ Permittee Signature: _ Call (503) 639-4175 by 7:00 P.M.for an Inspection needed the next business day Data 3n 01 13 a loll tja!1,1aa'.tajq( a DjLAty W i1a', fIs,d . 111001101331--lo04"j'?1� D _ 01 Phimhi ng Permit Application —_.- Datereceived: _ Permit no.: City of Tigard Sewer permit no.: Building permit no.: rn,.tJTrr..nd Address: 13125 SW Hall Blvd,'Figard,OR 97323 --- fhutto. (>u.3) 6XV-41/1 Pit SiMI/Al Fill,IKI.. .__-- Cxvlrcdate- rax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: _ — — Case rile no.: — Payment type: ❑ 1 dt 2 family dwelling or accessory U Commerclavindustrial n Multi-t,uluty tU Tcuant irnt,Ivvcmcnt U New construction U Add IIlon/altcrauowreplacemem r)r-,,,-..1 ,ri.i. U Other: 1(m a&Klrts&a. I a d IV W - d'" tn...,t�N.+.+ I t)ty VPPIPS.l New 1-and I-family dwei14tg5 aril): Tax map/tax lot/aCCc.nl iiC.:T Q..I..'t^tee n.r.—1—tint, .........1..,,1 —_--- __ Loc: Block: Subdivision: SFR(I)bathSFR(-- — P jeet name: --T' I RFlt(3)bath . City/county: _- 'LIP: Cath additivual t'ati�Ficn Deacriplion and location of wn,+nn timmict't• - Slteudlill": - _ C'at,+hvicin/an•a drain Fst.date of completion/inspcction: _ -- Drywells/ieach line/trench drain -- FuuUng drain(no. lin. ft.) t�nnufaotund home utililirr Business name: Ar,q be �y�,„� Mho es _ Address: y _ 6 Rain drain connector City: :, State: ZIP: 0 L Sanitary sewer(no.lin.ft. - ot..... C G+ _t1 1's: jU j I E-mail-. Storm&ewer(nu.fin.ft.) My no.! f 7 P1111111),Iris.me,no: %!I iv alcl �ci r14�_`ur.Ill..Pl City/metroTte.no.: ► p - t•ttrttwo nr it mt - Cont1•actor'e to waantativtt aienature• ons( Ion valve tl.w uw Nrcre ntt:r Print name: Date: Backwater valve Basins/lavatory Name: tjotnes washer Address: Dimes wase ie-r City: State: ZIP: Drinking fountain(s) �jcctors/autnp Phone: — Fax: E-mail: .xpanss/s tan rietu,,amcwcr cap Name(f rine): Floor drains/floor sinks/hub MaWnS address: City: _ State: Hose hibb ZIP: ice m east r-VR —� — )ne- �_ r•Kx- t)wner inoallation/residential maintenance only: The actual inuallation Primer(s) will ne made ny une of the IllalntOttatlw atkt mpair made by m% regular l_o07 M"n(rommer'.ia1)employee on tLc propcny I own a&pt:t -UK.'r Chapt%a 4.47. 31n (a), Kulo(a)+ vale) LIData: uunt J � u s/stiowermiower pan` nna atcl u+ctWAdealnr arlrd Cit Other! — .. Phone- TOW — 7 Fat1 E-trail: -- W Total --- Mtn a0JtrU etleti wt 1pr rlldll aaaG.PWW n111)MUdkaw rul nw.larp„r1— Notice: Itlla pulli t appliuUun Minimum fee................$ n Vtaa 0ManuGtdPlan review(at _ %) $ _ exniros if a tlelmit is not obtained CINAIt cold washar: �. _ .�, / within 180 days alter it has been D'art surcher6o(94t)....0 —� r1... accepted as complete TOTAL ...................... t _ s _ &sp'a't' _ �'°"'" uu4ete ttwocceti CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2002-00024 13125 SW Hall Blvd., 'rigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/25/02 SITE ADDRESS: 15970 SW 76TH AVE PARCEL: 2S112CD-00800 SUBDIVISION: DURHAM ACRES ZONING: R-12 BLOCK: _ LOT: 001 JURISDICTION: TIG CLASS OF WORK: ALT 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.: 94 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: 94 ft. line work for sewer connection SF. Owner: --_v---FEE S _ _ —— __ _ _ HAVERY, ,JOHN W MADF_LON Type By Date Amount Receipt 15970 SW 76TH AVE 5PCT CTR 1/25/02 $5.80 27200200000 TIGARD, OR 97224 PRMT CTR 1/25/02 $72.50 27200200000 Total $78.30 Phone 1: Contractor: GREG SCHROEDER 9812 SE WICHITA AVE. MILWAUKIE,OR 97222. REQUIRED INSPECTIONS Phone 1: 503-654-4734 Sewer Inspection Reg #: Final 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. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issu d By: Permittee Signature: -r, L L �,� _ _. Call (503) fi3 -4175 by 7:00 P.M. for an Inspection needed t e n t business P s Hess day Plumbing Permit Application Date received. Permit no.: U City of Tigard Sewer permit no. Building 9ddress: 13125 SW Ifall Blvd,Tigard•OR 972''? p _ _ gpermit no.: Cit o/ThKar`l 1111one: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503)598-•1960 Date issued: Bya2,) Receipt no.: Land use approval: Case file no.: Payment type: 1 J I &2 family dwelling or ac essory, U Commercial/industrial ❑Multi-family U Tenant improvement U New construction U U Food service J Other: 1 t 1 1 ---- 1ob address: 5�_�S ' �h T'I 1,e/ Description_ � •]d Li .. P Qty. P'ee(ea.) Total Bldg.no.: Suite no.:' New 1-and 2-family dwellings only: Tax map/tax IoUaccount no.: (includes 10410.for each utility connection) SFR(1)bath Lot: I Block: Subdivision: SFR(2)bath - Project name: SFR(3)bath - City/county: ZIP: Each additional bath/kitchen Description a9d location of work on premises:- oust Siteutililies: r c Cort a!e c ! 4c C�ed N _ Catch basin/area drain Est.date of completion/inspection: Drywells/leach line/trench drain mmommid Footing drain(no.lin. ft.) -- Manufactured home utilities -- - Business name: �� , __ _ Manholes - Address: !IW14 sty ,peylh 4py _ Rain drain connector City: �0/i l k4MINtl State: ZIP: yy Sanitary sewer(no.lin.ft.) Phone:03 6s Y- 175-V I Fax: S.;1-Z 1),P E-mail: Storm sewer(no lin.ft.) _ CCB no.: y Plumb,bus.reg,no: water service(no.lin. ft.) City/metro lic.no.: j3pq Fixture or item: Contractor's representative signature:G' .a✓z-- Absorption valve Back flow preventer Print name: I -6- Scs ,tetac4 Date: Backwater valve Basins/lavatory Name: Cloo es washer _ Address: Dishwasher City: State: 7.IP: E'ecDrinkin fountains) _ torslsum� Phone: Fax: E-mail: Expansion tank _ Fixture/sewer cap Name(print): flair drains nor sinks/hub �. a e r Garbage disposal —� Mailing addre�s: / s 9 J(� 5 t Hose hibb City: Q r I _ State:Q Z[P 22 Ice maker— on, aker --- Phone: _ Z Fax: E-mail: Inter tort reage trap - Owner installation/residential maintenance only: The actual installation Primer(s) ^` will he m,ide by me or the maintenance and repair made by my regular —If Ifo f drain(commercial) --- employee on the property I own as per ORS Chapter 447. Sint(-s),basin(s)Iays(s) Owner's signature: Date: _ Sump -Tubs/shower/shower pan Name: lrinal L zOr�-- ---- Water closet Address: s le7b Water heater - City: or ati -1 State tf ZIP: jp Other: Phone: 7 7/ -,f 471- Fax:77Y-f(&[ E-mail: ora Nd all JutiadicUma weep credit atde,place call)udWicam rot tnae information" Notice:This permit application Minimum fee................$ O Villa U MatetCard expires if a permit is not obtained Plan review(at __ %) $ Credit end nunth": _ _-Px�� within 180 days efler it hes been State surcharge(8%)....$ Nii of cid oldrt a dawn on credit c�-_ accepted as complete. TOTAL, .......................$ cardholder r ilimme Amann 4404616(60WOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only. FIXTURES (individu I QTY_ ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY .(ea) AMOUNT ---—� --- 16.60 for each utility connection— Lavdtory One 1 bath _ $249.20 Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00 Shower Only 16.60 Three 3 bath $399.00 Water Closet 16.60 _ _ SUBTOTAL Urinal 16.60 8°/.STATE SUR_CHARG_E Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 __ —__ TOTAL Laundry Tray 16.60 Washing Machine 16,60 Floor Drain/Floor Sink 2" 16.60 _^_ , 3" -- - 156i� PLEASE COMPLETE: 4"-- 16.6(1 --- — -- Water Heater O conversion O like kind 16.60 _ — Quantity b Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ "mill. — _ _— — Ca ed MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 16.40 Lavatory Tub or Tub/Shower Hose Bibs 1660 Combination Roof Drains 1660 Shower Only —__ __ Drinking Fountain 16.60 Water Closet Other Fixtures(Specify) — 16 Urinal 80 -- Dishwasher Garbage Disposal - -- Laundg,Room Tray — Washing Machine — Floor Drain/Sink: 2" _— Sewer-1st 100' 55.00 SS OCA 3" v __ Sewer-each auditlonal 100' — 46.40 4" _ Water Service-1st 100' 55.00 Water Heater Water Service-each additional 200' 46.40 Other Fixtures S eGt _- Storm&Rain Drain-1st 100' 55.00 ^_ Storm&Rain Drain•each addlGonai 100' 46.40 Commercial Back Flow Prevention Device 46.40 — — Residential Backflow Prevention Device' 21.55 _ Catch Basin 16.60 - Inspection of Existing Plumbing or Specially 62.50 Requested Inspections r/hr ;OMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 -- QUANTITY TOTAL — Isometric or riser diagram Is requlred It Quantity Total Is >g 'SUBTOTAL — �— 8%STATE SURCHARGE S Y "*PLAN REVIEW 25%OF SUBTOTAL �Y — Required only my if nx E!_Ut total Is>g _ TOTAL S 1 *Minimum permit fes Is$72 50•B%slate surcharge,except Resklentlal Backflow Prevention Device,which Is$36 25+e%Pint"surcharge "All Now Commerclal Buildings requlrs 2 sets of plans with Isometric or riser diagram for plan nvlew. I\dsts\forms\plm-fees dac 12/26/01 CITYOF TI GA D —SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: S 25/02 Ooo18 DATE ISSUED: 1/25/02 13125 SW Ball Blvd., Tigard, OR 57223 (503) 639-4171 PARCEL: 2S 112CD-00800 SITE ADDRESS; 15570 SW 76TH AVE ZONING: R-12 SUBDIVISION: DURHAM ACRES JURISDICTION: TIG BLOCK: LOT: 001 -- -- TENANT NAME: FIXTURE UNITS: USA NO: CLASS OF WORK: NEW DWELLING UNITS: 1 NO. OF BUILDINGS: TYPE OF USE: SE INSTALL TYPE: LTPSWk IMPERV SURFACE: Remarks: Connect existing residence to newly installed sewer lateral. Septic tank must be pumped, filled and inspected or removed. Owner: _ FEES HAVERY, JOHN W MADELON Type By Date Amount Receipt 15970 SW 76TH AVE. TIGARD, OR 97224 PRMT CTR 1/25/02 $2,300.00 2.7200200000 INSP CTR 1/25/02 $3500 27200200000 Phone: Total $2,335.00 — —�— Contractor: Phone: Reg#: Required Inspections Sewer Inspection Septic Tank Filled This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 160 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the the accuracy tionsf orntFerd�istanlce given.s, If the sewer If otis not so locaocated ted,hetmea given. prospect instahall purchse a"Tap a d S de Sewer" Perm 3 feet in all directions "j) ''yJ�j e �/,�� Iss d by: _ Permittee Signature:_u LL -:.1::SILC1:3i= ,1-1 Call (503) 175 by 7:00 P.M. for an inspection needed the next uslnesa day JOB INVOICE I ORVALL T. CARE FjYER'S SEPTIC TANK. SERVICE, INC. P.O. BOX 549 OREGON CITY, OREGON 97045 CUSTOMERS ORDEH NO DATE O R9ERED Z ;503) 656-3326ORDER TAKEN BY DATE P90MISED ❑ A.M. �Ye _C ❑ P.M. PHONE BILL TO �.' s2 c Q R 1 �T _ If — ADURESS MECHANIC JOB NAME AND LOCATIOL�. —� .X l w ❑ aAY WORN _�. C CONTRACT DE&CRIPTION OF WORK �� EXTRA QUANT UESCRIPT ION OF MATERIAL USED PRICE AMOUNT NOUF49 LABOR _-�'----.— AMOUNT TOTAL. MECHANICS a MAURIALS TOTAL HELPERS ® LABOR I hesby Acknowledge the ambelactoryjOjAl LABOR TAX camplNlon at the above deecrlbod work. _ nlo____NA URr_ _ ____ `nrfce trr TOTAL