14040 SW 117TH AVENUE i
v�
larecordslmlcrotlmktargetsltiuilding.dor
CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
13125 SW Hall Blvd., T�qard,OR 97223(503)639-4171 PE RM I T
PERMIT #. . . . . . . : SWR98-0331C.,
DATE ISSLri):
PARCEL. 2S110BA-140300
SITE ADDRES5. _ : 140/40 SW 117TH AVE
SUPDIVIS)ION. . . . : ZONING. R--4. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . JURISDICTION: TIG
TENANT !NAME.. . . . . : RENAISSANCE DEVELOPMENT
LISA NO. . . . . . . . _ : F I X TORE UN I TS. . . : 171
CLASS OF WORK. . . :ALT DWELLING UNITS. . : 1
TYPE OF USE. . . . . :SF 1\10. OF 13HIL.DJNGS: 0
INSTALL 7YPE. . . . :LJPSWR IMPERV SURFACE: 0 Sf
Remarks : Fewer- connection. Septic tank mi-tst be pt_impFd, filled, and inspected.
Owner-: FEES
RENAISSANCE DEVELOPMENT type amount by ate recpt
1.6-72' SW WILLAMETTE FALLS DR PRMT $ 2300. 00 B 11/12:/98 98-310758
WEST LINN OR 97068 ThISP $ 35. 00 B 11/12/98 1.38--310758
Phone #:
Contractor-
OWNER
PI-)one $ 213135. 00 TOTAL
Reg #. . :
REOUIRED INSP; (�JTONS
This Applicant agrees to comply with all the rules and regulations Sevier Inspection
of the Unified Sewage Agency. The permit expires 180 days from Septic Tank Fill
the date issued. The total amount paid will be forfeited if the
permit expires, The Agency does not guarantee the accuracy of the
side sewe- laterals, If the sewer is not located at %hp lFa5111-potnt
given, +'e 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 foilow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR
952-MI-0010 through OAR 952-000I-0080. You say obtain copies of
these rules or direct questions to OLV, by calling (503)246-1987.
cc -7
Issitted hy:8M_ _6'V Permittee Signatttv-e:
-C
1-++++++-4•f...........4•.........4...............++4.++++++++•++++4-+++++.+++++++++•+•+-+++4
Call 039-4175 by 7:00 p. m. for an ingper-tion needed tl')p next bi.isiness day
+++++'4++'4•t.................4,4-+4-+4-+4+4--4-+4-4-++'4-++++'4.+++++++.+++'f'++.4.. -....+++.'++++++
CIT` OF TIGARD PLUMBING PER1yIT
DEVELOPMENT SERVICES PERMIT #. . . . . . : PLM98-0419
13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171 DATE ISStJED: 11/12-/98
PARCEL: 2S110BA00300
SITE ADDRESS. . . : 1401+0 SW It7TH AVE 5
SIJBDIVISTON. . . . : ZONING- R--4. I
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . JLjRISDICTION: TIG
----------------------------------
CLASS OF WORK. . :AL1' GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. 0
TYPE OF !JSE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . 0
OCCUPANCY GRP. . : R3 FLOOR DRAINS. . . . . . : 0 TRAVIS. . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . 0
FIXTURES LA1_JNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
5 1 NIKS. . . . . . . . . 0 LJR I NALS. . . . . . . . . . . : 0 GREASE -i"RAPS. . . . . . . .. 0
LAVATORIES. . . . .- 0 OTHER F I XTURES. . . - - 0
T1_1B/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 100
WATER CLOSETS. : 0 WATER LINE ( ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remar-ks : 'sewer line.
Owner-: FEES
RENAISSANCE DEVEI—OPMENT type amot-int by date I.-ecpt
1.672 SW WILLAMETTE FALLS DR PRMT $ 30. 00 B 11/12/98 98--31-0758
WEST LINN OR 97068 5PCT N1.. 50 B I 1 98 98 -31.0758
Phone #:
I C Ont t-art Or---'
CRAFTWOR11k PLUMBING INC
7736 SW NIMBUS AVE
BEAVEPTON OR 97000
Phone #: 512`4-5420 S 31. 50 'TOTAL
Reg #. . : 000796REDUIRFD INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer- Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within IN days of issuance, or if work is suspended for more
`han 180 days. ATTENTION: Oregon law requires you to follow rules
adapted by the Oregon Utility Notification Center. Those rules are
sot forth in DAR 952-0001-0010 through DAR 952-000I 0080. You may
attain copies of these rules or direct questions to OUNC b,,, calling
SL
CJ rte/
I S S tt P d By : Pet-mittee Si gnat 1.tv,e
-1-+++-+,+4-+4-4-++++4+++-#-+-f 4-{++++++•}+++++++++4•++++++i.+++++++++++++ -++++++++++++-+-++++
Call 639--4175 by 7:00 p. m. for an inspection needed the next bl-Isiness day
+++4...........4-++4....................................4.........................
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SAN HAIL BLVD. Commercial and Residential Recd By�_�
TIGARD, OR 97223 Date Recd (I (
(503) 639-4171 Date to P.E.
Print or Type Date to DST
Nief
Incomplete or illegible applications will not be accepted Permit# R ►�#
Related SWR#
Called__ _
Name of Developme_nUProject FIXTURES (individual) _ QTY PRICE AMT
Job �v-. �.� _s��,� Sink 9.00
Address Street Address Sulte / Lavatory 9.00
St✓ 1 1 7 Tub or Tub/Shower Comb. 9.00
Bldg# City/State Zip Shower Only 9,00
a og
Name IWater Clor.et 9.00
P t I e ��'v[�� �+r��t Dishwashei 9.00
Owner Mailing Address �./.. Suite Garbage Disposal 9.00
147ZS(n/ L/.,,e- ?Fz 6 _._ _ Washing Machine 9.00
City/Stale Zip Phone —
v7- LX,' g79G g SS7-6�1 C Floor Drain/Floor Sink 2" 9.00
Name/ 3" 9.00
r04d sus�n S�. J 4" goo
Occupant Mailing AddressSuite Water Heater O conversion O like kind 9.00
Qi4./ ../17'r" Gas pipi 9 requires a separate mechanicalpermit._ _
City/State Zip Phone Laundry Room Tray 9.00
7,A�n, " 9P _ 57,1- y a Urinal 9.00
N me // n
a tl�gt h 1"�N rr ►4 _ Other Fixtures(Specify)_ 9.00
Contractor Milling Address Suite 9.00
7739 S(,/ A/;�.' itrs 9.00
Prior to permit City/Stale Zip Phone Sewer-1st 101' ( 30.00 3�
issuance,a copy � � Qj 97,0108 5Z i y Z� Sewer-each additional 100' 25.00
of all licenses are Oregon Const.Cont, Board Lic.# Exp.Date
required if 7 b 6( Water Service-1st 100' 30.00
expired in COT Plumbing Lic.# Exp.Dale Water Service-each additional 200' 25.00
database Z,V_.- ! y f"3', _A 1
1 fs Storm&Rain Drain-1 s 100' 30.00
Name Storm 8 Rain Drain-edch ad(litional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City/Slate Zip Phone Residential Backflow Prevention Device' 1500
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New O Repair O Replace with like kind Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 't&' (-,om_mercial O Catch Basin 9.00
Adddiliona,descriplirin of work Insp.of Existing Plumbing 40.00
,lA.ii fuey Sawa/ 14e,a l' _ erRtr
/ 1Specially Requested Inspections 40.00
AiJt•nrrKT ; P:tr� . Ad ><�� J't�p�rG _! per/hr
Are you capping, moving or relacing any fixtures? Rain Drain,single family dwelling 30.00
LL Yes O No Grease Traps 9.00
If yes,see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAII URE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram Is required A Ouant ly Total is 9 _
WORK COULD RESULT IN INCREASED SEWER FEES. -- *SUBTOTAL
1 hereby acknowledge that 1 have read this application,that the information
given Is correct,that I am the owner or authorized agent of the owner,and 5%SURCHARGE 90
J
that !ins submitted are ,I compliance with Oregon Stale Laws f 7
Signature of Ownor/Agent Date **PLAN REVIEW 25%OF SUBTOTAL
Requlret only it fixture qty total Is>9
J i— 0 3 Iil� TOTAL y�
Contact Person Name Phone SV
/ Ss 7 O�� 'Minimum permit fee is 325* 5%t urcharge,except Residential P--flow
7 ✓s i o�`r _ Prevention Device,which is$15 4 5%surcharge
"A!I New Commercial Buildings require plans with isometric or riser diagram
and plan review
I%dstslplumapp doc 72/99
PLEASE COMPLETE:
Fixture Type Quantity by Work rerformed
New Moved Replaced Removed/Capped
Sink
Lavatory ---
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal _
Washing Machine
Floor Drain/Floor Sink 2"
_Water Heater
Laundry_ Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
w _ - - - --
I lA^i 9('um alm dux?lIl'
TIGARD .
SANT? & GRAVEL, INC. , �0
IONQUIN AND STAF'7RD QUARRIES
P.O.BOX 413•TUALATIN,ORECON 97062
PRONE 692,1600
i 0':'1 ItH3
f�lYl.l�i�! t.L.I16' 1 UN }:.t,L,FaVW f TI�iCi TICKEI NO.: I 1 /24/713 �5
(r
SOLD TO: Prl VIOX '0/19 DATE: 1 /4.R 04 i
WIl,:il:]NVII l.V. 1R `3%V1% '' TIME: CLO�'iZO ? �"
I...
JOB NO.: i;l_01.fel'1 �
u.
JOB: TRUCK NO.:
DELIVER TO: ORDER NO.: •
J
�D
D. W
C1
L.
NWEIGHt QUANTIr, AMOUNTS IIIN
> •
�— rHO5S TARE �Ngt iQN0._.CL'13I0YAWp9 MATERIAL DESCRIPTION )NIT PRICE i TOTAL
J 1. 1 . 58 Nei; Iltbtric: LonA
i
RECFiVED 13Y
ISE MAKI?DELIVERIES INSIDE THE CURB LINE AND ON THE LOT AT THE CUSTOMER'S RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR DAMAGE •
P ULTIN0 FROM SUCH DELIVFRIES.ALL CLAIMS FOR SHORTAGES MUST BE MADE IN WRITING WI HIN 5 DAYS FROM DATE OF DELIVERY FREE UNLOADIWO TIME
OF t0 MINUTES FOP A SINGLE TRUCK AND.0 MINUTES FOR A TRUCK AND TRAILER IS ALLOWED.Ek'FSS TIME WILL BE CHARGED AT EXISTING RATES
OFFICE COPY
AL0,HASANITARY SERVICE
P.O. BOX 309, BANKS, OREGON 97106
644-2797 648-6254 639-5188
NAME: —�---r
ot
ADDRESS:
CITY: / STATE:f,r� , zip:
HOME: _d( � WORK: _ _ CELL:
JOB SITE: /�'aCZ _� �Z_ �~ ,� - P.O.#.
PAID BY CHARG _ CHECK n / CASH rI CREDIT CARD rI
BATE /- Z — RIVER �,--_�L/ _ j��rct aul AMOUNT
PUMP SEPTIC TANK
❑ LINE OPENING
O INSPECTION FEE
CI SERVICE CALL
LABOR, LOCATING, DIGGING & BACKFILL__ _
I MATERIAL —
-THIS IS NOT ASEPTIC SYSTEM INSPECTION REPORT--- TOTAL $
- - REMARKS - -
TY► OF TANK: STEEL '-I CONCRETE , PLASTIC -1 HOMEMADE
HORIZONTAL ❑ \ VFR I ICAL. -1 RECTANGLE -1 OTHER
SIZE OF TANK: 350 -1 500 f 1 �50
00 C) 1250 -1 1500 -1 2000 71 3000 q
LID LOCATION: INLET ^1 OIITMIDDLE I ENTIRE TOP '�
TANK CONDITION: GOOD O Ff 1FITTINGS: BAFFLES n CASTIRON , PLASTICNEEDS NEW LID? , YES S --_ s_-
�' GROUND COVER OVER TANK
COMMENT ON CONDITION OF DRAINFIELD ETC.
SIGNED BY % y/ DATE