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12540 SW SUMMER CREST DRIVE a i ii i�. i 1,,h��� �•����d, d "� �, •'.�. + ',. ;: ,lt• , I�. i I a + r c y,,. •��.,'�, ,, . .w•e ^,«-n.r ,r..,.qo^°. .e„5 wy.,r.+» T r�r . w ,. .. ,e.y�i.. ,.TM,y.,�....n A. .yRp+r..ay, i — PERMIT #. . . . . . . . SWR96-0399 1 CITY OF TIGARD DATE ISSUED: 08/14/96 COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 1 S 134CB-0 '206 4'72 W)103"TIST DR SUBDIVISION. . . . : ZONING: R-4. 5 BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : ------_----------------- TE NANi ------_---------TENANI NAME . . . . :LANG Ir USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0 to CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1 TYPE OF' USE. , . . . :SF NO. OF BUILDINGS: 0 INSTALL TYPE. . . . :LTPSWR IMPERV SURFACE: 0 sf kemearks: Sewer, connection to a USA Line - USA instr^k_tc•ted Briar, Reager^ to have applicant obtain sewer- permit throi.tgh i-ts ars this is an emergency. Owner: ___._____---.___.__.___.______.___________.__________._.___.. FEES - -- -------- KENNETH LANG type amount by date r-ecpt 12540 SW SUMMERCREST DFS ORMT $ 2--,00. 00 JSD 08/14/96 96--219290,3 INSP $ .3 00 JSD 08/14/96 96--2829113 T IGARD OR 97223 Phone it 50.5-5,90 7193 ,..actor•: �-__ -- --...... ?ACTOR NOT ON FILE I Irorre #: f 2235. 00 TOTAL flet' tt, . - --- -- - REOUIRED IMSPELTIUNS This Applicant agrees to cneply with all the rules and requlaLions Sewer Inspection of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the oermit 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 to all directions from the distanct given. I'` not so locatrd, the installer shall purchase a `Tap and Side Sewer," perct and the Agency wili install a later 1. Irermittee 5ignacr_tre : G -..... t/L I s s 1_t e d B y: Cali for inspection - 639-•4175 i R i e r 1 I r• yri. r� I � Plan Check# 'TY OF TIGAkLo Residential Building Permit Application Recd By 3125 SW SW HALL L -VD New Construction Additions or Alterations Date Recd• (1 iGARD, OR 97223 Single Family Detached or Attached Date to P E. _ ;03) 639-4171 Date to DST Print or Type Permit# 9G-619 i •- Incomplete or illegible applications will not be accepted Called L< � s Name of Subdivision 1.011 rt Name Job Address Site Address ss Architect Mallin Address 0 S ''� , City/State Zip Phone N e Owner Mahng Address --—�— Name ]LScC� En ineer Mailing Address //,Sllottee Zip Phone g rh Q Na e City/State Zip TP-hone I - i General Describe work new O addition O alteration O repair O Contractor Mailing Address _ to be done: Additional Description of Work City/State Zip Phone Oregon Const. Cont. Board Lic# Exp Date Attach Cory of _ protect Current 71,Business Tax or Metro# Exp Date Valuation - Licenses Name NEW CONSTRUCTION Y:ONL rMechanical Sq.Ft. House: Sq.Ft.Garage: Sub- Mailing Address _ Corner Lot Yes No Flag Lot =Yes �—o - Contractor City/State -zlp -- Phone _ (check one) (check one) _ Restricted Audio/Stereo Burglar Attach Copy of Oregon Const. Cont. Board Lic# Exp.Date Energy System Alarm Curren.; :"T Busine,s Tax or Metro# Exp.Date Installation Garage Door HVAC Licenses Opener i Systems Name (check all that Other Plumbing apply) Sub- Meiling Address - Will the electrical subcontractor wire for all Yes No Contractor restricted energy installations? City/State zip Phor a �— Has the Subdivision Plat recorded? NIA Yes No Oregon Const Cont Board Lic# Exp Oate Reissue of MST# Solar Compliance Attach Copy or (C:alculation Attached) Currant Plumbing Lic.# Exp Date — I hereby acknowledge that I have read this application, that the Licenses information given is correct. that I am the owner or authorized agent of COT Business Tax or�M-Iro# Exp Date the owner, and that plans submitted are in compliance with Oregon State laws. _ Name S1 re of Owntrr/Agent Date y1 Electrical _ _ �on ct Person Name -� Sub_ Mailing Address _ hone Contractor FOR OFFICE USE ONLY: C'.ty/State Zip Phone Plat# Map/TL# -�-�— Jregon Const Cont. Board Lic# Exp Date Attach Cary of Setbacks Zone Current I Electrical l.ir, s Exp DateSolar. Licenses COT Business Tax or Metro# txp Date Engineering Approval: Planning Approval: TIF �dstsvnstal p doc —' s Pfrmij Account Description_ Amout Amt. Pd. l M MST. Permit (BUILD) Plumb. Permit (PLUMB) _ _^ Mech. Permit (MECH) ELC/ELR Permit (ELPRMT) State Tax (TAX) Bldg: Plumb: Mech: ELC/ELR: Plan Check MST: (BUPPLN) i Plumb: (PLMPLN) i Mech.- (MECPLN) 1 CDC Review (L.ANDIJS) 1 Sewer Connection (SWUSA) < -v' Sewer Inspection (SWINSP;, Parks Dev Charge (PKSDC) Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) Water Quality (WQUAL) Water Quantity (WQUANT) Erosion Control Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) Fire Life Safety (FLS) TOTAL:z: `G'% 35 G'�' 35• _may Odsts\mstopp doc Rev.7/96 i Ise a , F. 1 CARR HISTORY FOk ^.ABU NO.: SWR96-0299 KRNNRTH IA M t2540 SW SUMMER CRUST DP OS/17/!8 Attica Deacriptien Req/ Schd/ RndActicn Notes Di9p By DpdMte npd code Seat Dane Done _ Date By ( ----- ------—------ -------- ------ "---. - __ __. 1 SWRA007 Application received / / / / 09/14/96 PASS JSD 08/14/96 JD SWRA080 (F) Iatue permit / / 09/14/96 PADA JSD 08/1J/96 JD SWRA705 Sewer Inspection Ob/15/95 SRPTIC 2ANR F.LMD WITH RCM, PUMP PASS MS 05/17/96 JT RBCRIPT, ALOHA SANITKRY DATED 8/13/96 05/17/98 JT SWRA720 case Finaled / / / / 05/27/98 i i k i t t 1 i now b soft C1 , OF T CARD PT #. . . . F'EFtMIT � PLRM PERMIT #. . . . . . . : F'l_M96-023E3 l COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/14/96 13125 SW Hall Blvd.Tigard,Orogon 97223• 199 (5031 830.4171 PARCEL: 1 S 134CB--00 '06 SITE ADDRESS. . . : 12540 SW SUMMI R CREST DR SUBD I V I S!ON. . . . : ZONING: R-4. 5 BLOCK. . . . . . . . . . : LOT. . . . . . . . . CLA'S'S OF 1• nRK. . :NEW GARBAGE= D I SPOjALS. : 0 MOBILE HOME SPACES. 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 l_"'� OCCUPANCY GRP. R3 FLOOR DRAINS. . . . . . . 0 TRAM'S. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEA'T'ERS. . . . . .. 0 CATCH BASINS. . . . . . . : 0 FIXTURES------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 j SINKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . , , 0 GREASE TRAPS. . . . . . . . 0 LAVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . 200 WATER CL.OSLTF3. . : 0 WATER LINE (ft- ) . . . 0 DISHWASHERS. . . . : N RAIN DRAIN (ft ) . . . : 0 Remarks : Sewer connection to a USA line - USA instrttc-ted Brian Rager to have applicant obtain sewer permit throLigh us as this; is an emergency. Owner: ----____.__.__..____._.. .__._._.._.__._.___. ___.___.____._._.--_•----_..___..._..__ FEES KENNETH LANG type amoL1nt by date rer_pt 12540 SW SUMMERCREST DR F'RMT $ 39. 00 JSD 08/14/96 96-28290-; 5PCT $ 1. 95 JSD 08/14/96 96-282903 TIGARD OR 97223 Phone #: 503-590-7193 Contractor: J & R PLUMBING 3430 c,-)W 2091-H AVE ALOHA OR 97007 Phone #: 642-7/76 t 40. 95 TOTAL I Reg #. . : 72680 " i -- - ---- REQUIRED INSPECTIONS ------- This persit :s issued subject to the regulations contained in the Final Inspection Tigard Muni,,ipal Coot, State of Ore. Specialty Codes and all other applicable lays. All work will be done in accordance with approved laps. -'wit Mit pp p T`i: ,._. 1 expire if work is not started - within 198 days of issuance, or i1 work is suspended for sore than IEIN days. E'er mit: tee Signature: I s s It e d Bye X �` � Call for inspection - 629-4175 AI ._,._... ..., �....�....«.nw�wsa�Nt�a�'+7MR?rM?leis+,kM+rnlx'�rlbn�rt�r,romww�wew,•r...r.......•..�..,...,..,.v,w«:w..,..�._ .....,... .,-_..-..... ,:_:-..._w.,..Mw /00 Recd By CITY OF TIGARD Plumbing Application Cj Date Recd fj 13125 SW HALL BLVD. Commercial and ResidentialI Z Date to P.E. TIGARD, OR 97223 ��tF Date to DST (503j 639-4171 Permitill 0i >(c Print or Type Rolated SWR;117L—LI-911- Incomplete 1L- GI9'1Incomplete or illegible applications will not be accepted called Name of Deviopment/project i . f Job Address Street AddressSuite Bldg 0 City/State Zip !x {tt�l txund a" b Nam FIXTURRS(individual) QTY PRICE AMT Sink 9.00 Owner Mailing Address Suite Lavatory 9,00 Tub or Tub/Shower Comb.h 9,00 city/state Zip Phone _ — V-- - — Shower Only — 9.00 I Name Water Closet_ 9.00 Dishwater 9.00 Occupant Mailing Address Suits Garbdge Disposal 900 Washing Machine 9.00 City/State Zip Phone Floor Drain — 2" 9.00 --- ---- 3" 9.00 Name _ •_ 4" 9.00 Contractor iii dre Suite Water Heater 900 Laundry Room Tray 9.00 It (State Zip Phone —--- Urinal 9.00 Oregon 1.Cont.Board Lic/ Exp.Dat Other Fixtures(Specify) 900 �- Attach Copy of 0 toj 7 9.00 Current Plumbing LIC.a Exp Date 9.00 1 License s O Business r Sewer-1st 100' 9.00 Tax Metro 0 Exp. OLS f[ O Q V O _ Sewer-Hach additional 100' 30.00 Date 7� --- Name Water Service-1st 100' 25,00 Water Service-each additionbl 200' 30.00 Architect Mailing Address Suite Storrs Q Rain Drain-1st 100' 25.00 Of Storm&Rain Drain-each additional 100' 30.00 _ - i Engineer City/Slate Zip Phase - Mobile Home Space 25.00 9 I Commercial Back Flow Prevention Device or Anti- 2j.00 Describe work New O Addition O Alteration O Repair O Poliutlon Device to be done: Residential O Non-residential O Residential Backflow Prw entlon Device* 15.00 Additional desrnption of work Any Tr9p or Waste Not Connected to a Fixture 9.00 Catch Basin 9.00 Insp.of Eyisting Plumbing 40.00 -- --- --- per hr Existing use of Specially Requested Inspections 40.00 building cr property ___^—` _ser hr Rain Drain,single family dwelling 31.00 Proposed use of building or property--_ — Grease Traps — 9.00 Are you caping any fixtures? Yes p_ No p 0JANTi T'TOTAL -- Isometric or neer diagram is requlsu If 9uanity Total la >0 !y I hereby acknowledge that I have read Gds application,that the information 'SUBTOTAL given Is correct,that I am the ownar or authorized agent of the owner,and 'hat plans submitted are in compliance with Oregon State 464. --- --- Signstu OwnerlAgent to 6%s SURCHARGE �JL` f� 9�, PLAN REVIEW 25%OF SUBTOTAL onto Person.Nams s Required on K fixture qty total is>9 -- TOTAL irrl8t : r� L 1l, 'Minimum permit fee Is$25+5%surcharge,except Resldentigl.Backflew 1:ldstslplmapp doc Prevention Device,which Is$15+5%surcharge {,�Af � � � i wa a34 A=. r " ►�i ilk A! CIr 5 µ A ALOHA SANITARY SERVICE P.O. Box 309 BANKS OREGON 97106 644-2797 648-6254 639-5188 NAME: ADDRESS: CITY: �,� �+ STATE: 6 ,2e_ zip: PHONE: HOME:�y - ��/�� HOME: WORK:-- - JOB SITE: , P.O.#: PAID BY CHARGE ❑ e CHECK Z�3a CASH ❑ CREDIT CARD ❑ DATE e-5 � DRIVER �A Cie, AMOUNT _ 0 PUMP SEPTIC TANK Cl MATERIAL _— ❑ INSPECTION FEE ❑ SERVICE CALL ❑ LABOR, LOCATING, DIGGING & BACKFILL ---THiS Is Nor A SEPTIC SYSTEM INSPECTION REPORT--- TOTAL - - REMARKS - - TYPE - REMARKS - -TYPE OF TANK: STEEL rl CONCRETE 0 PLASTIC ❑ OTHER HORIZONTAL ❑ VERTICAL ❑ RECTANGLE 0 OTHER_ SIZE OF TANK: 350 ❑ 5nn n 750 ❑ 1000 M 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑ LID LOCATION: INLET ❑ E'' ® MIDDLE ❑ OTHER _ TANK CONDITION: GOOr, l v POOR rl FITTINGS: BAF "": ONCRFTE ® CAST IRON ❑ PLASTIC ❑ NEEDS NEW LID" 1 *. .:E ` GROUND COVER OVER TANK COMMENT ON CONDITION OF DRAINFIELD ETC. SIGNED BY DATE . ,.