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— QM(OF"MAR i INVOICE NO. 1
8600 SW Hillsboro Hwy., Hillsboro, OR AgUICP :G DIVISI•N2 0350
1 503-6442797 0 503-648-6254 * 503-846-1951 (FAx)
www.alohasanitary.com -0 Email: info@alohasanitayy.com
NAME:
ADDRESS: CITY:
ZIP: HOME: WORK: I CELL:
At 12"— 4-2. - "14 'L? /
Jos SITE: //ife..4 574 / 4•41/ , k. 4fis ' /'," 't P.0.#: 3/24 71 7
,
, PAID By CHARGE CI CHECK 0 CASH 0 CREDIT CARD 0
DATE 3 -36--24/7f‘..) \v.,,,,_ '1.‘
DRIVE,i‘ xIL, ,,etty,,A..Az4, 74.4y4qcof AMOUNT
IIIV PUMP SEPTIC TANK
MillU iNSPECTION FEE I
11
11111 LI SERVICE CALL
11 0 LABOR,LOCATING,DIGGING,BACKFILL IMI
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- - miks,,Is Afar A SEPTIC SYSTEM irlifSPECTIOIREPORT- - TOTAL $ 5 y--5-
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TYPE OF TANK: STEEL LI *CONCRETE,0 PLASTIC LI HOMEMADE LI
RECTANGLE
HORIZONTAL 0 VERTICAL LI LI U OTHER
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SIZE OF TANK: 350 U 500 0 \750 0 1600 0 1250 LI 1500 El 2000 0 3000 0 ,
LID LOCATION: INLET LI OU''' ET 0 / MIDDLE LI ENTIRE To P LI
TANK CONDMON: GOOD 0 FAIR POOR LI
FITTINGS: BAFFLES LI CONC _ E LI CAST IRON LI PLASTIC 0
GROUND COVER OVER TANK 77 \
COMMENTS
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Customer Signature DATE ..",
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,
t CITY OF TIGAR® SITE COPY
iiik r. . BUILDING PERMIT
4 }; COMMUNITY DEVELOPMENT Permit#: BUP2016 00013
-ri it 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2016
.71. F, Parcel: 2S1070001302
Jurisdiction: Tigard
Site address: 16650 SW BULL MOUNTAIN RD
Project: Polygon at South River Terrace Subdivision: None Lot: None
Project Description: Demo existing 2,368 sq ft house&125 sq ft shed. On septic. Upon approved final inspection SDC credits
available for future construction.
Contractor: BULL MOUNTAIN RIDGE LLC Owner: ADLV LAND HOLDINGS LLC
109 E 13TH STREET BY FORSUM, MICHAEL
VANCOUVER, WA 98660 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 360-695-7700 PHONE:
FAX: 360-693-4442
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 03/02/2016 $464.97
Demolition
Occupancy Grp: Occupancy Load: Info Process/Archiving-Sm$0.50(up to 03/02/2016 $1.50
Dwelling Units: 0 11x17)
Stories: 0 Height: 0 ft Erosion Control w/Development 03/02/2016 $107.60
Bedrooms: 0 Bathrooms: 0
Value: $25,526
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $574.07
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done .. _ -.ice with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
da ATTENTION: Ore..n la1-00uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
'52-001-0010 through OAR 9 1 00 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1
Issued By: p /� / / / i Permittee Signature: '-- - -
' Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Inspections Required. for I nit No.:
IVR Code Type Permit Description IVR Code Type Permit Description
01 BUP Building—structural 07 SIT Site Work
02 ELC Electrical 08 SWR Sewer Connection
03 ELR Restricted Energy 09 FPS Fire Protection
04 MEC Mechanical 10 RER Re-Roof
05 MST Master—residential combination 11 CMS Commercial Manufact. Structure
06 PLM Plumbing 12 SFM Single-Family Manufact.Structure
J Req'd Code Inspection Description I Req'd Code Inspection Description
Building(structural)Inspections Electrical Inspections
205 Footing 105 Underground/slab cover
210 Foundation walls 110 Temporary electrical service
215 Footing drain 115 Electrical service
220 Slab 120 Electrical rough-in
225 Post/beam structural 125 Wall cover
230 Underfloor insulation 130 Ceiling cover
240 Exterior shearwall 135 Low voltage rough-in
242 Interior shearwall 140 Sign installation
245 Firewall 145 A/C or heating unit circuit
250 Roof nailing 150 Hot tub/spa/pool
255 Wtr proofmg basement walls 195 Misc.inspection
260 Tilt-up panel 198 Low voltage fmal
265 Masonry 199 Electrical fmal
270 Reinforcing steel(rebar)
275 Framing Mechanical Inspections
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough-in
289 Approach/sidewalk 620 Hydronic piping
295 Misc.inspection 625 Duct work
199 ` Final inspection 630 Fire damper
635 Smoke detector shutdown
Fire Protection System Inspections 640 Exhaust hood
905 Sprinkler underfloor/slab 645 Grease duct test
907 Sprinkler hydro test 695 Misc.inspection
910 Sprinkler rough-in/test 699 Mechanical final
915 Fire alarm rough-in
920 Suppression trip test Plumbing Inspections
995 Misc.inspection 305 Plumbing underslab
998 Alarm final 310 Crawl drain
999 Sprinkler final 312 Backwater valve
315 Post/beam plumbing
Site Work Inspections 320 Plumbing rough-in
405 Excavation 322 Shower pan
410 Fill 330 Water service
415 Grading 335 Rain drain
420 Sprinkler supply lines 340 Storm sewer
495 Misc. inspection 345 Culvert/catch basin
499 Final inspection 350 Septic tank
395 Misc.inspection
F ion Control Inspections 399 Plumbing final
750 ' Initial erosion control
Q 752 LIDA on-site facility inspection Sanity Sewer Inspections
755 Regular erosion control 505 Sanitary sewer
:192 Final LIDA inspection 585 Misc. inspection
79-8 ) Final erosion control 599 Final inspection
Manufactured Structure Inspections
810 MFG-Structure set-up
899 MFG-Structure final
I:\Building\Forms\Inspection Cards\AOP Insp Card By Case\InspCard_All_061814.docx