Permit SEWER CONNECTION
a PERMIT
Ty
PERMIT # • SWR96 -0018
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 1/18/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 25104BC -HW056
SITE ADDRESS...: 14293 SW LUKAR CT
SUBDIVISION • HILLSHIRE WOODS ZONING: R -7 PD
BLOCK • LOT • 56
TENANT NAME :DAN & KELLY HOWIE
USA NO FIXTURE UNITS...: 16
CLASS OF WORK...:NEW DWELLING UNITS..: 1
TYPE OF USE •SF NO. OF BUILDINGS: 1
INSTALL TYPE •LTPSWR IMPERV SURFACE: 0 sf
Remarks: Septic tank must be pumped, filled and inspected. (Existing house)
Owner: -- -- FEES
SIERRA PACIFIC DEVELOPMENT type amount by date recpt
PO BOX 1754 PRMT $ 2200.00 JSD 01/18/96 96- 275055
INSP $ 35.00 JSD 01/18/96 96- 275055
LAKE OSWEGO OR 97035
Phone #: 503- 780 -1785
Contractor: --
S & N ESCAVAT ION
LAKE OSWEGO OR 97035 - - - --
Phone #r. $ 2235.00 TOTAL
Rep #.. .
REQUIRED INSPECTIONS
This Applicant aorees to comply with all the rules and regulations Sewer Inspection _
of the Unified Sewage Aoency. The permit expires 180 days from Septic Tank F i 1 1
the date issued. The total amount paid will be forfeited if the
permit expires. The Aoency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement _
given. the installer shall orosoect 3 feet in all directions from - -- _____-
the distance given. If not so located. the installer shall purchase __—
a °Tao and Side Sewer° Permit and the Aoency will install a lateral.
--------- - - - - -- -- - - - - - - -- - -- - --
Permittee Sinn- _ -e: /_' / l � __ — -- - — -- —._—
Issued B, • .010Pr'
Call for inspection -. 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
131.25 SW Hall Blvd. P ermit # - Sft//C�i
Tigard, OR 97223 ?amp F��L ll�s�� /_
(503) 639 -4171 OLD G . 76
10 4 Be- aog a) TA 03 MINIMUM $25.00 PERMI FEE + ST. SURCHARG&W
' '` V t � New Single Family Residences Only
't l 1 l)ti 1 lA i e 14...As •
Aid... ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job 14 2_9 z3 5 &D. L,,c..k14rx= Ct . ❑ 3 BATH HOUSE $225.00
Address crosor. m Fee includes all plumbing fixtures in the dwelling and the first 100 feet v
1-1 CA A<?.._ ,(7.- 9-122_ of water service, sanitary sewer and storm sewer. See fees below.
"'""° mono aa.n.) _ 7`- / L FIXTURES QTY PRICE AMT IN 1
4 l gr EA l / .. Sink 9.00
°"'0 Atlases ` "9 Lavatory 9.00 ( �
Owner ?') . --),( 17 ---- 750 Tub or Tub/Shower Comb. 9.00 _
ao Shower Only 9.00
/�4.& vIr-c r°� / OlZ q 7 3S Water Closet 9.00
r
4.
Nam (at maw d bumming) U Dishwasher 9.00
n! V--f-uv 4t,,,_). , Garbage Disposal 9.00
Occupant wog Add . J
Washing Machine 9.00
42.-9 3 S G■. 1 ,w 1Z C-- Floor Drain 9.00
apse.b. a. Water Heater 9.00 2
T C� 4r_D OR. . '11 2:2- Laundry Room Tray 9.00
AR-e2 Urinal 9.00
ex,C ,) .6.4-, T„� Other Fixtures (Specify) 9.00
�+�+a Aaa.o wwu
Contractor (ch.lio _ 5e..3 9
! 10113 ‘. 9.00
�°� � 9.00
44-k6 n , r , ) _ ° T 703S Sewer 1st 100' l 30.00 't
ca a'°. Tax "° Sewer - ea. AddiL 100' • 25.00 `
1
Water Service 1st 100' 30.00 *�
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of t
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00 E
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
► f' /," _4_..- • - / /-- 6 Device or Anti - Pollution Device 9.00
/ °�°' Any Trap or Waste Not
/ Connected to a Fixture 9.00
Descn•e work new 0 addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential '$. non - residential 0 Insp. of Exist. Plumbing 40.00/hr V
Specially Requested Inspections 40.00/hr
Existing use of n /
building or property / IBS /Ql ei ... Rain Drain, single family dwelling 30.00 1 n
Residential backflow prevention `,
devices 15.00 It
Proposed use of /
building or property r" /G e Pi 15-e_ -
'(Except residential baclxflow
prevention devices)
NOTICE - Minimum Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5°/. SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED r
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Special Conditions ,$A -n , 7 5. e..->e( efr,1 ^ec. f+as1 iI1C i S T , 1 *4.4A -- 6.t i5G Date issued � (6 by // v ������i'�' L
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
Gas Line Appr /Sdwlk Reins.
Other: G
Date: ' / / / <p A.M. P. . Entry:
Address: / 2.-9 3
Tenant: �7 Ste: MST:
Con /Own: � / � U o MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
a,otS 5(0 0 0/if
•
r /
Inspector: / Date: wr
APP'OV D _DISAPPROVED /CALL FOR REINSP. CF CO