Permit . i
CITY TIGARD PLUMBING PERMIT
1I DEVELOPMENT SERVICES PERMIT #: PLM2000 -00038
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/14/2000
SITE ADDRESS: 10055 SW INEZ ST PARCEL: 2S111 BC -00500
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 019 ' 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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 40' of sewer line. Sewer must be pumped, filled and inspected.
FEES
Owner:
Type By Date Amount Receipt
MARSHALL, JAMES H + ANNETTE L • PRMT KJP 02/14/200C $50.00 000 - 321688
10055 SW INEZ ST
TIGARD, OR 97223 5PCT KJP 02/14/200C $4.00 000 - 321688
Total $54.00
Phone 1:
Contractor:
DUKE CONSTRUCTION
17860 SE FOSTER RD
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Phone 1: 503-492-0530 Sewer Inspection
Reg #: LIC 127933 Final Inspection
ORIGINAL
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: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n business day
CITY OF TIGARD Plumbing Permit Application Plan Check
131Z53W•HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd 2 - I - ZOOe
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # +P_M2cz12 -Gb4
Related SWR #
•
Called
Name of Development/Project FIXTURES ) e : " : °" ° °" '';QTYe PRICE `•" 7
Job Sink 11.50
Address Street Address Suite Lavatory 11.50
f 0655 SW 2 ME Z Tub or Tub /Shower Comb. 11.50
Bldg # Fay/State (�j Zip G� Shower Only 11.50
Name
i 0` 1 't / /0/ ' ` 9 7" 2 ` J Water Closet 11.50
,„ 1 - 0mg.6 t4, r Q I •t/
/_, N�, , // Urinal 11.50
Owner Mailing Address Suite zK/ �'� Dishwasher 11.50
Nac - J - Garbage Disposal 11.50
City /State Zip Phone
173 FrRD DA f ia,2y 6024-4,10P- Laundry Tray 11.50
Name Washing Machine 11.50
Ng 14, 4- AnI11a G Li A // Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Address Suite. 3" 11.50 •
(f00,55 Sid .SYI e z 4" 11.50 '
City /State Zip Phone
T /G FR A ei4 q7' � y .0� Water Heater O conversion O like kind 11.50
a Gas piping requires a separate mechanical permit.
Name
D Duke e}� .S r ij C� MFG Home New Water Service 32.00
uke l /' /OIl MFG Home New San /Storm Sewer 32.00
Contractor Maili, g Address Suite _ -
��('oo f '',(( Hose Bibs 11.50
Prior to_permit City /S � Zip � P Roof Drains 11.50
issuance, a copy P l frV�d'1 � 7 q t " f M
Drinking Fountain 11 -50
of all licenses are Oregon C Cont. Board Lic.# Exp. Date -
required if i _7 y , 3 Z - 2-2 , Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database NA .
Name
Architect Sewer - 1st 100' I 38.00 1
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
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential • Commercial 0
Additional description of work: Commercial" Back Flow Prevention Device 32.00
Residential Backflow Prevention Device* 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 Inspections per /hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE • Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES.
QUANTITY TOTAL -: !''.: ?
I hereby acknowledge that I have read this application, that the information ' ? T
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9 . T ' "
that plans submitted * ,• ��
tted are in compliance with Oregon State Laws. • -�':> ��`�- -:; " ":" ,�
Signature of Owner /Agent Date -` ",
9 n� 8% SURCHARGE 4'0
G �2_ / 41 'O� < ;v .. ":z
C ct erson Name - Phone `"
4,14Z Le �4a rs4a ce * *PLAN REVIEW 25% OF SUBTOTAL :MVP ; 'S`:` " ;:>
6,24.- ��� Re only if fixture qty. t otal' is > 9 v " r
'l B HW)5E 'l78 00 " "._>-° : v IN
a = . ON TOTAL .. a 1
3 t3A�'1�1 C3tJSlEF$285 40 g � , •
h fee;ti afl pltl btn actu�tn ttte a an the rst :> * Minimum perm f ee is $50 + 8% surcharge, except Residential Backflow Prevention
00 4, of San 1r00 0 80015 nd 1N mo t' CB� Z • Device, which is $25 + 8% surcharge
,
**All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
1: \dsts \ forms \plumapp.doc 12/17/99
•
• PLEASE COMPLETE:
Wo,r
es
ani
,
' = 'la Rem Ye' /Ca ed
e c'ed. - o. d
��" Moved °R
�a =Ne
.
�,.
Sink •
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
lAdstsVorms\plumapp.doc 12/17/99
. ALOHA SERVICE
P.O. Box 309, .BANKS, OREGON 97106
644 -2797 648 -6254 * 639 -5188 r
.,' 03563
NAME: 2 r' `' �
I
DDRES$. < / CITY: ,,` , J STATE: ZIP:
HOME: V- (52_ WORK: CELL:
JOB SITE: P.O. #:
PAID BY CHARGE ❑ CHECK a CASH ❑ CREDIT CARD ❑
DATE .,2 - /6- Z I DRIVER 7 AMOUNT
4a) PUMP SEPTIC TANK 3c oo
❑ LINE OPENING
❑ INSPECTION FEE i
❑ SERVICE CALL
❑ LABOR, LOCATING, DIGGING & BACKFILL r
❑ MATERIAL
:
/
-- -THIS IS NOT A g EPTIC SYSTEM N PECTION REPORT TOTAL _ _ $ 3 d OD /
if / r\, REiM S
TYPE OF TANK: STEED ❑ . \\ CONCRETE ❑ PLASTIC ❑ HOMEMADE
i HORIZONTAL ❑\ VERTIC L ❑ RECTANGLE ❑ OTHER
SIZE OF TANK: 350 ❑ 500 0\750 0/1000 ❑ 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑
LID LOCATION: INLET ❑ OUTl\ET MIDDLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD ❑ FAIRI5 POOR ❑
FITTINGS: BAFFLES ❑ CO NCRETE ❑ CAST IRON ❑ PLASTIC ❑
NEEDS NEW LID? ❑ YES S IZE \\
GROUND COVER OVER TANK \
COMMENT ON CONDITION OF DRAINFIELD ETC.
9 71 /
F
SIGNED BY DATE
3/8/00 Activities for Case #: PLM2000 -00038
12:47:07 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMA003 Application received 2/14/00 KJP RECD No Hold BON 2/14/00
PLMA005 Create Permit 2/14/00 BON DONE No Hold BON 2/14/00
PLMA705 Sewer Inspection 2114/00 2/14/00 No Hold BON 2/14/00
PLMA799 Final Inspection 2/14/00 2/14/00 2/17/00 MS PASS No Hold JMT 2/22/00 turn around sewer & tied into
building drain. okay
PLMA050 (F) Issue permit 2/14/00 KJP DONE No Hold KJP 2/14/00
PLMA800 Case Fineled • 2/22/00 JMT DONE No Hold JMT 2/22/00
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