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CITY OF TIGARD BUILDING INSPECTION DIVISION 0L'-1/MST
24-flour Inspection Line: 639-4175 Business Line: 639-4171
BLIP
Date Requested_ -V&D _AM Pro �3 d BLD
Location 12—'i>30 U 1A- 10C Suite _ MEC _
Contact Person j' Ph C ` 5 C `� PLM
Contractor Pit WR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain 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 :veiling
Roof
Misc. --
Final — -- - -- -
PASS PART FAIL ---------- -
MBIN�
Post& Beam - -- - --
Under Slab \
Top Out
Water S rvice
Rain Drains
PASS PART FAIL_ lTa _ -
MECHANICAL
Post& Bean; - - - -- --
Rough
Gas Line � � cjC1 0 2-Lem Q ,-
Smoke Dampers
Final - -
PASS PART FAIL
ELECTRICAL - -"--�-- --
Service
i Rough In
UG/Slab
` Low Voltage _ -- ------- --- -�
Fire Alarm
Final
PASS PART FAIL
SITE -_ -- —_ ---_�—
Backfill/Grading ------
Sanitary
--Sanitary Sewer
Storm Drain ( j rteinsper_tion fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( j Please call for reinsr Pction RE: _ _ [ j Unable to inspect-no access
ADA
Approach/Sidewalk _
Other Date Inspector_— � Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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invoice
N_ame _-� /� /V (6€F A-) C Date
Addiess W Oz 6 c��_�_r� .Phon r
City Initial On Acct.
State-—G.���.—_—Zip Code.___ _.
Price Amount
I
A
NOT RESPONSIBLE FOR LANDSCAPING
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A service charge of 1.50/o per month will be charged on all past due accounts. Total:LU
„2 3fJ
J Not responsible for attorney's fees.
A fee of$25.00 will be charged on all returned checks.
Approval
nv.
Customer Signature
Thankft u P.O. BOX 1244. - Canby, OR 97013
(503) 263-2087 or (503) 632-6138 CCB# 70548
CITYOF TIGARD► SEWER CONVECTION PERMIT
DEVELOPMENT SERVICE PERMIT#: S /10/99 -00262
DATE ISSUED: 12/10/99
13125 SW Hall Blvd.,Tigard, OR 97223 (5
PARCEL: 2S103AA-01910
SITE ADDRESS; 12330 SW 106TH DR A
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: 019 JURISDICTION: TIG
TENANT NAME: PEARSON
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection to sewer lateral installed as part of Reimbursement District#12. Reimbursement fee of
$5,597.82 paid on 12/10/99. Septic tank to be pumped, filled or removed and inspected.
Owner: — FEES
PEARSON, RICHARD E + MARY 4NN Type By Data Amount Receipt
12330 SW 106TH DR —
TIGARD, OR 97223 PRMT DEB 12/10/99 $2,300.00 99-320325
INSP DEB 12/10/99 $35.00 99-320325
Phone: Total $2,335.00
Contractor:
Phone:
Reg M
Required Inspections
Sewer Inspection
Septic Tank Filled
N
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This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
LL
180 days from the date issued. The total amount 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 `nom 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 Oregon-Utility Notification Center. Those rules are set forth in OAR 952-001-00 10 through OAR 952001-0080.
You 'ay obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
1
Iss ed b : � �1� ,'/ Permittee Signature:
\_ Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day
CITYOF T'IGARD PLUMBING PERMIT
17 DEVELOPMENT SERVICES PERMIT#: PLM1999-00421
DATE ISSUED:
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-417,1
PARCEL: 2S 103AA-01310
31TE ADDRESS: 12330 SW 106TH DR
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: 019 JUR'SDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOSILE HOME SPACES:
TYPE OF USE: SF WASHING MAC,i: 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: '100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Rema,ks: SEWER LINE TO CONNECT
FOES
Owner:
-- — - Type By Date V Amount Receipt
PEARSON, 'RICHARD E + MARY ANN PRMT BON 12/10/199 $50.00 99-320339
12330 SW 106TH DR 5PCT BON 12/10/1995 $4.00 99320339
TIGARD, OR 97223 — - -
Total $54.00
Phone 1:
Contractor: _
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECT IONS
Phone 1: 939-5246 Sewer Inspection
Reg #: LIC 110314 Final Inspection
ORIGINAL
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
LL 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.
Isnued ay: �Pr/VZ y� Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Pl imbing Permit Application Plan Chec
13125 SW HALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Cate Recd
(503) 639-4171 0,e to P.E.
Print or Type Date to DS
Incomplete or illegible applications will not be accepted Permit#
Related SWR#_
Called
Name of Develop men UProject FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Street Address -/ T Suite Lavatory 11.50
S Ip DI'I Tub or Tub/Shower Comb. 11.50
Bldg# City/State Zip Shower Only 11.50
ame p r Water Closet/Urinal (Specify) 11.50
' Dishwasher _ 11.50
Owner Mailing Address Suite Urinal 11.50
Garbage Disposal 11.50
City/Stale Zip Phone
Laundry Tray 11.50
Name Washing Machine/Laundry Tray (Specify) 11 50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City/State Zip Phone —
Water Heater O conversion O like kind 11.50
- Gas piping requires a separate mechanical permit.
Name MFG Home New Water Service 3200.
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
\ C �V�/�c Huse Bibs 11.50
Prior to permit City/Slate Zip *—" Phone Roof Drains 11.50
issuance,a copy 9
Drinking Fountain 11.50
of all licenses are Oregon C nst.Cont Board Lic,# Exp.Dale
required if 1 l O-s 1 Other Fixtures(Specify) 1500
expired In COT Plumbing Lic.# Exp.Date
database
Name -- - -
Architect _ _ Sewer-1st 100' 38.00
Or Mailing Address Suite Sewer-each additional 100' 32.00
Water Service- 1st 100' 38.00
Engineer City/State Zip Phone
Water Service-each additional 200' 32.00
based e work to be done: Storm 8 Rain Drain-1 st 100' 38.00
New Re air O Replace with like kind: Yes O No O Storm&Rain Drain-each additional 100' 32.00
Resi ential Commercial O _
Additional escr tion of work: Commercial Hack Flow Prevention Device 32.00 —
a Residential Backflow Prevention Device' 1900.
W 4 }c _ C Catch Basin 11.50
Are yotf capping, moving or replacing any xtures? Insp.of Existing Plumbing or Specially Requested 50.00
Yes O No O Inspectionsper/hr
�- If yes, see back of°orm to indicate work performed by Rain Drain,single family dwelling 45 00
U
Fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. ---
I hereby acknowledge that I have read this application,that the information QUANTITY TOTAL
Isometric or riser diagram Is required H quantity Total Is >9
given is correct,that I am the owner or authorized agent of the owner,and
L that plans submitted are in compliance with Oregon State Laws. 'SUBTOTA
Signature of Owner/Agent Date ° ,�
J 81°SURCHAR2c
I
Con arson Name Phone
**PLAN REVIEW 25%OF SUBTOTAL
_
1 BH HOUSE$178.00 Required only H fixture qty total Is>9
TOTAL
2 BATH HOUSE$250.00
3 BATH HOUSE$285.00 —
(This fee Includes all plumbing fixtures In the dwelling and the first *Minimum permit fee Is$50+8%surcharge,except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device,which Is$75+8%surcharge
-All New Commercial Buildings require plans with Isometric or riser diagram and
plan review
ldsls\for,,rdumapp d-10/8/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink
Lavatory _ _
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher-----
Urinal
Garbage Disposal _
Laundry Room Tray_
Washing Machine__,--_ _
Floor Drain/Floor Sink 2
411
—�
Water Heater_' _ !�
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I Wstjgf s\pl.m Gpp do 10tP/97