Permit CITY OF TIGARD
F 14 a , : 9 ��� ;,,, DEVELOPMENT SERVICES PLUMBING PERMIT
I l i ` PERMIT # • PLM96 -0348
%6• 13125 SW HaII Blvd., Tigard, OR 97223 (503) 6394171 DATE ISSUED: 11/19/96
PARCEL: 2S102CB -06801
SITE ADDRESS...: 10475 SW PARK ST #NEW
SUBDIVISION • ZONING: R -4.5
BLOCK • LOT -
CLASS OF WORK.. :NEW 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)...: 65
WATER CLOSETS..: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Run sanitary line for SWR96 -0523
Owner: FEES
KRISTIN SMITH type amount by date recpt
10475 SW PARK PRMT $ 30.00 JSD 11/19/96 96- 286696
SPCT $ 1.50 JSD 11/19/96 96- 286696
TIGARD OR 97223
Phone #:
Contractor:
MR ROOTER WASHINGTON COUNTY
PO BOX 1897
HILLSBORO OR 97123
Phone #: 693 -2458 $ 31.50 TOTAL
Reg #..: 009370
REG?UIRED 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 Final I n s p e c t i o n
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.
1
Permittee Signature:
Is sued By —7 ,..-' %p„:„:
i
Call for inspection — 639 -4175
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,sp.;�•. �� Z.S� � �:;J' - . n � "1F9w. lw.A• _ :�5c r . �h3�'Y� 7
NAME C i\ NO I 11) (V\ e DATE 1/ 2 2
MAILING ADDRESS t -`f% 1A - l' 1?
'h! A N
`(t CITY DATE NEXT MPIG
•. i ' + JOB ADDRESS \ .041 5 i `\) . r Pealk-
Phone: (503) 648 -8246 V i \a`h
(/oY7.5w M .
SEPTIC PUMP: u ti k l / &V c:11
DIG & LOCATE:
TANK & DRAINFIELD INSTALLED:
MISC: - " --- - - - -- _ - - -
TOTAL $ 1 e (r
PUMPING CHART
Household Size 1 2 3 4 5 6 7 8 9 10 .
(Number of People)
500 5.8 - 2.6 1.5 1.0 0.7 0.4 0.3 0.2 0.1 -- '
750 9.1 4.2 2.6 1.8 1.3 1.0 0.7 0.6 0.4 0.3
1000 12.4 5.9 3.7 2.6 2.0 1.5 1.2 1.0 0.8 0.7
Tank 1250 15.6 7.5 4.8 3.4 2.6 2.0 1.7 1.4 1.2 1.0 _
Size 1500 18.9 9.1 5.9 4.2 3.3 2.6 2.1 1.8 1.5 1.3
(gal) .\ 1750 22.1 10.7 6.9 5.0 3.9 3.1 2.6 272 1.9 1.6
2000 25.4 12.4 8.0 5.9 4.5 3:7 3.1 2.6 2.2 2.0 '
- ;2250. 28.6 14.0 9.1 6.7 5.2 4.2 3.5 3.0 2.6 2.3 '
2500 31.9 15.6 10.2 7.5 5.9 4.8 4.0 4.0 3.0 2.6
Note: frequent pumping ,needed If garbage disposal is used.
I
'ITY #OF TIGARD Plumbing Application Rec'd By •
4 .3125 SW HALL BLVD. Commercial and Residential Date Rec'd / / -/ 6 7 -r 7 CP
TIGARD, OR 97223
Data to P E.
Cate to DST
503) 639 -4171 Permit a ( } 6r 1 5'(0 -0 S
Print or Type . Related SWR s C i 6-05
Incomplete or illegible applications will not be accepted Called ( TZ
(6.
Name of OevelopmentlProlect FIXTURES (Individual) QTY PRICE AMT
Job 1& pit) 5M 1 7-1-1 Sink 9.00
Address Street Address Suite Lavatory 9.00
/Q _ ? 5,- P, A C " e Tub or Tub/Shower Comb. 9.00
Bldg s City /State Zip Shower Only 9.00
` c f) owe ? 7u3 Water Closet 9.00
Name
14<( CO SM ( n-1- Dishwasher I 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
MC Washing Machine 9.00
City/State Zip Phone Floor Drain 2' 9.00
Name 3" 9.00
_ 4' 9.00
Occupant M ea n 0 Address Suite Water Heater 9
Laundry Room Tray 9.00
• City/State Zip Phone Urinal 9.00
Name
Other Fixtures (Specify) 9.00
' Mg, / / 4V VC- LJr4)/4 W 9.00
I Contractor Mailing Adaess Suite 9
pl2 �C iq a, ? 9.00
ty to Zip Phone 9.00
l 3 �' C ' i (1-3 6 Z73
den
on Const. Cont. Board Lic.A Exp. Date 9.00
A Copy of 705- 9.00
Cent Plumbing Lic, a Exp. Date Sewer - 1st 100' 5
Licensee 3 - z_ 'p ch G 25.00 --3/1 Sewer - ea additional 100' � 25.00
COT Business Tax or Metro 9 Exp. Date Water Service - 1st 100' 30.00
�A�O 5 Water Service - each additional 200' 25.00
Name
Architect Storm & Rain Drain - 1st 100' 30.00 •
•
Or Mailing Address Si.. ;e Storm &Rauh Drain - each additional 100' 25.00
Mobile Home Space Y5.00
Engineer C.tyiState Zip Phone . Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Cevice
*scribe work New 'Addition 0 Alteration 0 Repair O Residential Backflow Prevention Device' 15.00
1 be done: ResicentialuO "Non- residential 0 Any Trap or Waste Not Connected to a Fixture I 9.00
.ddRlonal descripuon of work ,
Catch Basin I 9.00
insp. of Existing Plumping 40.00
, per /hr
Specially Requested Inspections 40.00
using use of
wilding or property oerrhr
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps I 9.00
wilding or property
QUANTITY TOTAL
i Are you capping , moving or replacing any fixtures? Yes ❑ No i Isometric or riser diagram is reouireo if Auanity Total is > 9
(if yes see back of form) 'SUBTOTAL ----51)
I hereby acknowledge that I have read this application, that the information „\
given ■s correct. rat I am the owner or authorized agent of the owner. and 5% SURCHARGE / U
/hat clans submitted are 'n compliance with Oregon State Laws.
Signature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
Recuired only if fixture city. total is >• 9
TOTAL ./S
Contact Person Name Phone
'Minimum permit fee is 525 • 5% surcharge. except Residential Backflow
Prevention Device. which is S15. 5% surcharge
iadstslplmapp.doc 8/96
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
c eta it
CITY OF TIGARD B ILDING 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 /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: �.
Date: 1 �ZZ1 M. P.M. Entry
Address: !D L/7 S
Tenant: Ste: MST:
3 -- MEC:
Con /Own: l
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
1 . / / IA / jil
4111
air
I Spector: ` !/ Date:
APPROVED _DISAPPROVED /CA F diP CO