Permit 1
CITY OF TIGARD
1 DEVELOPMENT SERVICES PLUMBING PERMIT
�� ° '�t PERMIT #.......: PLM98 -0294
� 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08! 26! 98
PARCEL: 25111CB -01716
SITE ADDRESS...: 10040 SW KABLE ST
SUBDIVISION....: HOOD VIEW ZONING: R -3.5
BLOCK • LOT :015 JURISDICTION: TIG
CLASS OF WORK..:OTR GARBAGE DISPOSALS.:. 0 MOBILE HOME SPACES.: 0
TYPE OF USE °SF WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS......: 0 TRAPS.......... .... 0
STORIES ° 0 WATER HEATERS 0 CATCH BASINS.......: 0
FIXTURES LAUNDRY TRAYS ° 0 SF RAIN DRAINS.,...: 0
SINKS ° 0 URINALS ° 0 GREASE TRAPS.......: 0
LAVATORIES 0 OTHER FIXTURES....: 0
TUB /SHOWERS...: 0 SEWER LINE (ft)....: 80
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: Installation of 80' feet of sewer line, to connect house to sewer.
. Owner: -- FEES --
KEN DOHERTY type amount by date recpt
10040 SW KABLE LN PRMT $ 30.00 DEB 08/26/98 98- 308604
TIGARD OR 97224 SPCT $ 1.50 DEB 08/26/98 98- 308604
Phone #:
Contractor------ .
ANCHOR CONSTRUCTION CO
27748 S HWY 170
CANBY OR 97013
Phone #: 263 -7575 $ 31.50 TOTAL
Reg #..: 99939
REQUIRED 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 Misc. I n s p e ct i o n
applicable laws. All work will be done in accordance with Final Inspection
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-Y01-10 through OAR 952 -0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issue. By: / Permittee Signature: /
+ ++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+ ++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Ch #
13125 SW HALL BLVD. Commercial and Residential Rec'd y
TIGARD, OR 97223 Date Rec'd 8 2- 4 - 4
(503) 639 -4171 Date to P.E.
Print or Type Date to DST -----
Incomplete or illegible applications will not be accepted Permit# -oa� / Related SWR # o�P'< q k '.a ey
Called
Name of Development/Project IXTURESf intlividiialD D_ "'j `'PRIC
� .�. >�,�..�,�� .... . ;� -, Yip ` ..R.. ''�,`:' °;` AM , AMn
Job Ta.c .)t -.--e_r___ Sink 9.00
Address Street Address Suite Lavatory 9.00
/00 l .4 Ci L Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
T d °Z
Name Water Closet 9.00
j'ZG /'✓ <(- $q-,vn Do14- 1"'('2 -- Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
M' Washing Machine 9.00
City /State Zip Phone
Floor Drain /Floor Sink 2" 9.00
Name 3" 9.00
S Aes* 7 4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name
Other Fixtures (Specify) 9.00
4.c/Chof' Go-• -St Ca
Contractor Mailing Address Suite 9.00
Z77 S. AI /7G 9.00
Prior to permit City /State • Zip Phone Sewer - 1st 100' 30.00
issuance, a copy C. g/ o2 el 70 /3 Z - 75 /"'S'
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if coq q39 6/r7 Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st 100' 30.00
- " Name Storm & Rain Drain - each additional 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 /State Zip Phone Residential Backflow Prevention Device* 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work: -
Insp. of Existing Plumbing 40.00
SCw en ` p - per /hr
Specially Requested Inspections 40.00
per /hr
Are you capping, moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes 0 No Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL, 'a _.:; ..-
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
NMI 1 '%-; : ° , t;;
Isometric or riser diagram is required if Quantity Total is > 9 ;;r %
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL ' "' °t °e= =E' %; ee
I hereby acknowledge that I have read this application, that the information � �: IC : �:;
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ; 'i ° � °',, l ,.-
that plans submitted are in compliance with Oregon State Laws. - "S IM : i 'c j / • J
Signature of Owner /A SUBTOTAL OF ent Date * *PLAN REVIEW 25% ; �. , ;,'`:_;
/ „ _
I"// ' -- Required only if fixture qty. total is > 9 N. -' " ".,,
• TOTAL '
.. A i
V , yr . ..,
Contact Person Name / Phone ��` , �'= ;'�: =a�'�� '
G Ff x' u. _ ✓ S 3 1 1 7 ' 7C *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
V Z6 3 -75 Prevention Device, which is $15 + 5% surcharge
- * *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:ldststplumapp. doc- 7/7/98
PLEASE COMPLETE:
• Replace .
New Moved Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2"
3 „
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
•
•
I: dsts1plumapp.doc 7/7/98
O9/.rl/98 TUE 07:13 FAX 503 263 1981 ANCHOR CONSTRUCTION U001
r �
ANCHOR CONSTRUCTION CO.
Jeff Edwards
27748 S. Hwy. 170
Canby OR, 97013
Telephone (503) 263 -7575 (Mobile 319 -7575)
FAX COVER SKEET
Date: Aug 31/98
To :'Tom - -- -City of Tigard plumbing Inspector
From: Jeff Edwards /Anchor Construction Phone: 263 -7575
Fax : 263 -1981
RE: copies of pump and gravel receipt
Number of Pages (Including Cover Sheet): 2
Message: Tom: Enclosed for your processing are copies of my pumping
receipt for 10040 SW Kahle I will not have a gravel invoice until I am billed
for materials later this month , I will then forward you a copy of gravel
invoice Thanks Jeff
Z
0911/98 TUE 07:14 FAX 503 263 1981 ANCHOR CONSTRUCTION 002
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ORVALL T CADE JOB INVOICE
13VIR'SSEPTIC TANK SERVICE
• •• 12753 S. New Era Road: . •
OREGOkCITY, OR:•'..:!ON 97045
(503) 656-3326 54 9785
cusromens ORDER N( , DATE ORDERED
•';-
8 --
655-64)2 3 1 - 98
• ORDER TAKEN BY DATE PROMISED c '
•
, Grace
BIU.. TO
• .
&ncher - Cons t • • PHONE
263-7573
ADDRESS
• 27484 Hwy. t70 pnwmc
CITY
Canby, 97013 HELPER
JOS NAME AND LOCATION
10040 . SW Kabie O DAYWORK
DESCRIPTION OF WORK CI CONTRACT
EXTRA
Ord: Jeff 319
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4 •
OUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
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Tank pumpin. --
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HOURS LABOR AMOUNT
1 TOTAL
MECHANICS MATERIALS
HELPERS a TOTAL
LABOR
I hereby acknowledge the satisfactory
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completion of the above described work. I TOTAL LABOR • TAX
SIGNATURE
DATE COMPLETED
. , TOTAL •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST Aar
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
- 3I - • BUD dra
Date Requested Q � / PM BLD wo
Loca ion ' #1 L. AW1 41 Suite MEC
Contact Person 4,', 14 EeterUaA I Ph 3 (q- 7575 Z 7'��"
Contractor I /L .I l�r _� /..i_ : ,� _VL Ph 943 -75 15 - !4 _ J -
BUILDING �-, ' - .i Tenant /Owner Itn: ZQA ...) offC.0 e. ELC
Retaining Wall ELR
Footing Access:.
Foundation 64_ JJ„ L � �' `-'`' . ?� �J 0 2 G_ j� 9 FPS
Ftg Drain G GN
Crawl Drain Inspection Notes: -c -X . 1 /�
Slab ' I
Post & Beam j .
i 4 „ i j a i —4 •
Ext Sheath /Shear '� ..s' or r /I Or IF re, .1 111E701 ' r
Int Sheath /Shear — i /
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling ', L- / -
Roof /
Misc:
Final
PA S PART FAIL
,PLUMBING ' _..--°-
Post & Beam
Under Slab
Top Out
Water Service
unitary Sewer ✓ ` ^ - f J
Rain Dtams Kam Y 5 ' �r C / /
Fj, > J
: , PART FAIL "/1 r /�. ,.
HANICAL , Z r
Post & Beam ;� c l 6,--14--T
Y T- A) / tie � C
Rough In �ei t/ / 3 f 4
Gas Line /
Smoke Dampers
Final
PASS PART FAIL
ELECTRICALt - ,
Service
Rough In _
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE,. , ,
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Payat City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk t�
D I ec tor ns . Ext _ J / i' P
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.