Permit cJ1YOFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
•
PLUMBING PERMIT
PERMIT # • PLM95--iZuLl42
639 -4171 DATE ISSUED: 03/07/95
PARCEL: 281 1 1 CA- 0020200
SITE ADDRESS...: 09650 SW SATTLER ST
buki)IVISION • ALDERBROOK FARM ZONING: R-7
BLOCK LOT..... ........ :12
CLASS OF WORK..: ALT GARBAGE DISPOSALS": MOBILE HOME SPACES.:
TYPE OF USE -SF WASHING MACH ..... ..:1 BACKFLOW PREVNTRS..:
OCCUPANCY GRP..:R3 FLOOR DRAINS....... : 1 TRAPS
STUDIES........: WATER HEATERS • CATCH BASINS •
•
.= I X TURES - - - -- LAUNDRY TRAYS '1 SF RAIN DRAINS
SINKS URINALS • GREASE TRAPS •
LAVATORIES ^1 OTHER FIXTURES .
TUB /SHOWERS • 1 SEWER LINE (ft) • 1110
WATER CLOSETS.. :1 WATER LINE (ft) •100
DISHWASHERS RAIN DRAIN (ft) •100
Remarks:
Uwner: ------ FEES —•--
MARK FAHAY type amount by date recpt
9650 SW BATTLER STREET PRMT $ 144.00 JF 03/07/95 —
5PCT $ 7.20 JF 03/07/95 —
TIGARD OR
Phone #:
Contractor: —
RESCUE ROOTER
7717 SW NIMBUS
BEAVER - TON OR 97006 •— — • - - - -- -- - - --
Phone #: 243 -1172 $ 151.20 IOTAL
Keg #..: 44677
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection - _
Tigard Municipal Code, State of Ore. Specialty Codes and al1 other Water Line Insp
applicable laws. All work will be done in accordance with Top—out Insp
approved plans. This persit will expire if work is not started Rain Drain Insp •`_
witnin 1ba days of issuance or if work is suspended for wore Final Inspection _
than 180 days. „_
Permittee Sign /tie, __ /,���� _
Issued By: � r
I Call for inspection — 639 -4175
•
-- - -�
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
131256W Hall Blvd. Permit # IS - 0
Tigard, OR 97223
(503) 639 -4171
c
1 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of ,/ / J New Single Family Residences Only
. Patrons /4ix d A4 r
❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job q 6 5ti So2J S.511-lie S r ❑ 3 BATH HOUSE $225.00
Address aMaeste zro Fee includes all plumbing fixtures in the dwelling and the first 100 feet
- 779.49 ee._,, of water service, sanitary sewer and storm sewer. See fees below.
Name name of Bupi10p) FIXTURES QTY PRICE AMT
Sink 9.00
Many Address drat Lavatory / 9.00 qe
Owner Tub or Tub/Shower Comb. 4101... 9.00 I
City S'"' DP Shower Only / 9.00 r 07)
Water Closet 1 9.00 / , (at)
Name (s ' mune of n1°^°") Dishwasher 9.00
Garbage Disposal 9.00
Occupant MaAn Aadres, Slone Washing Machine / 9.00 / L/
Floor Drain / 9.00 q, p-t)
r
C°x"Sta Water Heater 9.00
Laundry Room Tray / 9.00 Ci 0
Urinal 9.00
'p Eft , t Other Fixtures (Specify) 9.00
Mabry Address ansm 9.00
Contractor
L 9.00
n om• 9.00
I` 3 1 c q p Sewer 1st 100' � 30.00 _30, oO
State R°�etra"°" "° CS S'"• Tax "a. Sewer - ea. Addit. 100' 25.00
Li l 1 1 Water Service 1st 100'
1 30.00 3 U , OC.>
I hereby acknowledge that I have read this application, that a Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' I 30.00 30, 00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti - Pollution Device 9.00
Signature (arm of cyan) Due Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new 0 addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of
building or property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed use of
building or property
'(Except residential backtlow
prevention devices)
NOTICE `Minimum Fee $25.00 SUBTOTAL 111f ��
PERMITS BECOME VOID IF WORK OR CONSTRUCTION / /
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE '- ;U
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL /6 1
Special Conditions
Date issued by
87v ia.
CITY OF TIGARD BUILDING INSPECTION NOT
(
Inspection Line: 639 -4175 Business Phone: 639 -
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling .
Post/Beam Mech. Shear /Sheath Framing -Mechi
PIbg.Und /FIr /Slab Plbg. Top Out Insulation ! lec
Post/Beam Struct. Mech. Rough -in Gyp. Bd. "11.
San. Sewer Gas Line Appr /Sdwlk � ' ^' '
Other:
Date: _ _ A.M. P.M. Entry:
Address: i-Sa Sum
Tenant: Ste: -
Con /Own:
4031 ,,
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
, , Ilf.f/ 4i �, d r/57/A4 � , 3v 4 sf /
.//D S9 t< o 7/96-15 /9,O,10.0 .
fAN/Y4le 6(//11, /i,cr— Fix'J26S Ate. ' E 2
Insp tor: 4 40 2 Date: 5 7-7— ?E,
APPROVED DISAPPROVED /CALL FOR REINSP. CF CO
� � T COPY TO:
LI- CATION - STREET IMPROVEMENT /EXCAVATION
ORDINANCE NO. 74 -14 e ® (WHITE) -FILE
® (YELLOW) - INSP.
(INSTRUCTIONS ON SEPARATE SHEET) ® (BLUE) - PPL APPLICANT
APPROVED T] APPLICATION NO.: 7/ I l
NOT APPROVED ❑ CITY OF TIGARD, OREGON FEE AMT.: $ IL -
PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.• 95---Z(oZ551:
hp
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMENT BY kW.; DATE / 1 / "1 C
- _. _ +L,.
PENDING AGENCY "OK" ❑ Application and Progress Record MAINTENANCE BOND #
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT /EXCAVATION AS REQUIRED C
ANNUAL ❑
PENDING VARIANCE ❑ EXPIRATION DATE:( / ,
PERMIT NO.: 4+6 4S , DATE ISSUED: 3 / - 1 / IS - , BY: I = ���
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND P V CONNECT I F DRA TO EXISTING
AREA DRAIN AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT Rescue Rooter P.O. Box 1728 Wilsonville OR 97070 685
NAME ADDRESS CITY PHONE
CONTRACTOR (Same)
NAME ADDRESS CITY PHONE
PLANS BY - per City Standards & Specifications
NAME ADDRESS CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ 200
DOLLARS liffibtfila
FOR
(2) EXCAVATION DATA: 00 8.00
4 xSi 4 _$ ❑MIN.
STREET DESCRIPTION PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS /TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY _
STREET
OPENED
Sattler Street - see attached - INSPEC -
R TION
E
Q
U
ESTIMATED STREET OPENING DATE: / / 8
ESTIMATED STREET CLOSING DATE: / / E
D
(3) SECURITY NO. SECURITY AMT.: 200 : $ ' STREET
CLOSED -
SURETY CO.: _ FINAL
, CHECK CASH ❑ B OND 0 INSPEC.,
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS / CONDITIONS:
FEATURES; EXCAVATION LOCATION AND EXTENT.
N
- see attached -
I BITE: 9650 SW Settler .- -tt I
4' -
I I I �'
I work area I I
��,+ t --
CtRB - ' It \� — -- - — .a
r *V S. W. LAKESIDE DRIVE -
-CURB - - - - - - -- - - - - -- y .- - , .
7 ` � I ♦ N
i
I I I I ______
I I I 1
_____ ___ (5) NOTE: THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT -OF -WAY JURISDICTION IS THAT OF' WASHINGTON COUNTY OR THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES. TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK. AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
v i
APPLICANTS SIGNATURE: ��L !7✓ DATE 7 1 7 / s