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CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR1999-00150
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/19/99
SITE ADDRESS; 11945 SW ANN ST PARCEL: 2S103BA-00112
SUBDIVISION: LERON HEIGHTS ZONING: R-4.5
BLOCK: LOT: 012 JURISDICTION: TIG
TENANT NAME: MAYLENDER, CAROLE
USA NO: FIXTURE UNff 5 0
CLASS OF WORK: NEW DWELLING UNITS. 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL.TYPE: LTP IMPERV SURFACE:
Remarks: Sewer connection
Owner` — FEES
MAYLENDER, CAROLE J T B Date Amount Receipt
11945 SW ANN ST Type y - p
TIGARD, OR 97223 PRMT BON 7119/99 $2,300.00 99-316987
INSP BON 7/19199 $35.00 99-316987
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Req aired Inspections
Sewer Inspection
Septic Tank Filled
ORIGINAL
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
180 days from the date issued. The total amount paid wail be forfeited if the permit expires The Agency does not
guarantee the accuracy of the side sewer laterals If the se: is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given If not so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246.1987
Issued by: fj ' L( 1 �0 _ Permittee Signattrf�
Call (503) 639-4175 by 7:00 P.M.for an inspection needed the next business day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP _
Date Requested S _AM_ PM -- BLD
Location_ ( 2 SOS �- Suite _— MEC
Contact Person Ph PLM
Contractor _, Ph SWR
BUILDING Tenant/t�Vune�___ - c�S "Z y�7 _ ELC
EL.R
Retaining Wall
Footing Access: FPS
Foundation
Ftg Drain _ SGN _
Crawl Drain Inspection Notes:
Slab ----- -- 51T -----
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing --
Insulation
Drywall Nailing � � ) $11� -- - ----- ----—
Firewall "� �aL''
Fire Sprinkler z.
Fire Alarm i
Susp'd Ceiling1..��'�"
-��
Roof _—_-----
Misc: _ _ -- ---- - --- -
Final
PASS PART FAIL ------ --
PLUMBING -
Post& Beam
Under Slab - --- ------- -- ---- ------ — ---
Top Out
Water Service -
Sanitary Sewer
Rain Drsins "---- —
Final
P AR FAIL - --- ---- - -- - -
ECHAN G _L-
Post 9 Beam - -- -- - - - -
Ru h In -_---------- ----
as in
Smoke Dampers -
PART FAIL _- - -
ELECTRICAL
Service --� —
tluugh In
UG/Bleb --- --------_ ----
Low Voltage _
Fire Alarm
Final
PASS PART FAIL_ _ - --- ------
81TE —
Backfill/Grading -'-
SanitarySewer
Storm rain [ Re;nspection fee of$ -required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ Pl-ease call for reinspection RE: _-_-_____ L_._--_._ [ ]Unable to inspect- no access
Fire Supply Line
ADA aa
Approach/Sidewalk Date erd _Inspector ---__---- Ext
Other
Final —
p" oe�T FAIL DO NOT REMOVE this inspection record from the job site.
CITYOF TIGARD PLUMBING PERMIT
PERMIT#: PLM1999-00218
DEVELOPMENT SERVICES
DATE ISSUED:
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S10313A-00112
SITE ADDRESS: 11945 SW ANN ST
SUBDIVISION: LERON HEIGHTS ZONING: R-4.5
BLOCK: LOT: 012 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 LAI INDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: 120 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Rema6s: Sanitary sewer line
FEES
Owner: _
---- Type By Date Amount+ Receipt
MAYLENDER, CAROLE J PRMT BOP 7/19/99 $70.00 99-316986
11945 SW ANN ST MISC BOP. 7/1.9/99 $4.90 99-316986
TIGARD, OR 97223 _ _ ---
Total $74.90
Phone 1:
Contractor:
B & B SEPTIC & SEWER
10959 SE 92ND AVE
PORTLAND, OR 97266 REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: 569-8969 Final Inspection
Reg #: PLM 3-227PB
LIC 79653
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 `UNC by calling (503) 246-1987.
Issued By: (L _ W y l.— Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF 1IGARD Plumbing Permit Application Plan Check#
1312!1 SW HALL BLVD. Commercial and Residential Recd By &tJ
TIG KL), OR 97223 Date Recd
(503) 639-1171 Dale to P.E.
Print or Type Date to DST �
Incomplete or illegib;e applications will not be accepted Permit# 0 �
Related SWR#
1�r Called
! l Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address t'eel VI--,
Suite Lavatory -- 11.50
\--, Tub or Tub/Shower Comb. 11.50
Bldg# City/State Zip Shower Only 11.50
> 1 -
___
Nat e Water Closet 11.50
C C ( Dishwasher _— 11.50
Owner Meiling Address Suite Garbage Disposal — 11 50
- Washing Machine 11.50
City/Slate Zip Phone Floor Drain/Floor Sink 2" 11,50
-- Name 3" _ - 11.50
4" 11.50
Occupant TMailing Address Suite Water Healer O conversion O like kind 11.50
Gas piping requires a se agate mechanical permit.
City/State Zip Phone Laundry Room Tray 11.50
Urinal — 11.50
To
C� Other Fixtures(Specify) 15.00
Contractor MailingAddress
�r A Suite17
r� I ',e /�rT1 Ne-
Prior
Prior to permit Elly/St to Zip Phone
issuance,a copy l ��, % G2 `17a([ —
of all licenses are Or n Const.Cont.Bnard Lic.0 Ex .Date "l 7 --- - --
required if _ —
expired In COT PluniI Lic.# Exp.Date
database JJ> - y Sewer-1 st 100' 38.00
Name Sewer-each additional 100' 32.00
Architect Water Service-1st 100' 38,00
or Melling Address Suite Water Service-each additional 200' 32.00
Engineer City/Slate Zip Phone Storm&Rain Drain-1st 100' 38.00
9 Storm&Rain Drain-each additional 100' 32.00
Describe work to be done: Mobile Home Space 32.00
New O Repair O Replace with like kind: Yes O No O Commercial Back Flow Prevention Device 32.00
Residential O Commercial0 Residential Backflow Prevention Devine' 1900.
Adr.itional description of work_ catch Basin 11.50
it;W of Existing Plumbing 5000
Are you capping,moving or replacing any fixtures? per/hr
Yes O No O Specially Requested Inspections 50.00
erihr
If yes, see back of form to indicate work performed by Rain Drain,single family dwelling 4500
fixture. FAILURE TO ACCURATELY REPORT FIXTURE —
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application,that the information - QUANTITY TOTAL
'Y'
given is correct,that I am the owner of authorized agent of the owner,and Isometric or riser diagram is required d Ouanttty Total Is >9
that plans submitted are in co nce Oregon State Laws. "SUBTOTAL
Signature of 00061111 Date
-----� 7%SURCHARGE
Contact Person Name r Phone
i, �__ �, ` ; "PLAN REVIEW 27%OF SUBTOTAL
1 BATH HOUSE$178.00 r Required onl d hxwre qty total is>9 __
2 BATH HOUSE$250.00 TOTAL
3 BATH HOUSE$285.00 — —
(This foo Includes all plumbing fixtures in the dwelling and the first
100 feet of sanitary sewer storm s wor and water sor.Ice) 'Minimum permittee is/,s a 796 surcharge,except Residential Backflow F evenuon
Device,which Is$25+7°,6 surcharge
"All New commercial Buildings require plans with isometric or riser diagram and
plan review
I%dstsvonnstplumapp doc 719199
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed/Capped
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain/Floor Sink 2"
411
_Water Heater
_Laundry Room Tray _
Urinal
Other Fixtures (Specify) —�
13OMMENTS REGARDING ABOVE:
I WstsV0MvP1um8pp dM 719199
CITYOF TIGARD PL.UMBINGPERMIT
DEVELOP` =NT SERVICES PERMIT#: PLM1999-00?.18
DATE ISSUED: ,812!99 � �
13125 SW Hall Bivd.,Tigard, OR 97223 (`03) 639-4171
PARCEL: 2S 103BA- 0112
SITE ADDRESS: 11945 SW ANN ST
SUBDIVISION: LERON HEIGHTS ZONING: IG
_ BLOCK: LOT: 012 JJURISDICTION: TTIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASH!IJG 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: 120 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks. Sanitary sewer line --
FEES
Owner: Ty..e By Date , Amount Receipt
MAYLENDER, CAROLE J PRMT BON 7/19/99 $70.00 99-316986 I
11945 SW ANN ST MISC BON 7/19/99 $4.90 99-31698
TIGARD, OR 97223 -- — —
Total $74.90
Phone 1:
Contractor: �–
B & B SEPTIC & SEWER
10959 SE 92ND AVE
PORTLAND, OR 97266 REQUIRED INSPECTIONS
Sewer Inspectio-i
Phone 1: 569-8969 Final Inspection
Reg #: PLM 3-227PB
LIC 79653
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 B _ �' Permittee Signature: —
Call 03) 639-4175 by 7:00 P.M. for an inspection neaded tie next business day
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection line: 639-4175 Business Line: 639-4171 --�
BUP
_
—Date Requested 7�2�-' AM —PM —_ BLD
Location L I "f� 'lin r Suite �^ MEG _
Contact Person ( _+1 Y �_ Ph 1 Cl b L4 PLM _
Contractor Ph SWR
BUILDING Tenant/Owner —_ ELL
Retaining Wall ELR ___---
Footing Access FPS
Foundation
Ftg Drain _ SGN
Crawl Drain Inspection Notes. _-- --
Slab SIT
Post& Beam
Ext Sheath/Shear ------ -- - ---
Int Sheath/Shear
Framing - -- --— _ -
Insulation
Drywall
Drywall Nailing ---
Firewall
Fire Sprinkler _ --
Fire Alarm
Susp'd Ceiling
Roof Misc �/ �sG�L��Q TIo —_----
Final -_-�-_-
PASS PART FAIL -1-1� 0 �-�------------------ __—_
Post 8 Beam
Under Slab - -_-— - —
To-)Out --- -----
Water Service -------
anita f--
n )rains ---- .. -- - -- -- __
IEEE
PAR i FAIL -._ ----- -- � ��--- — �rt -
1.IECHANICAL
Post& beam
Rough
---- - -- - -_ — --
Rough In --
Gas Line --_- - --
Smoke Dampers -- -_
Final _�-
PASS PART FAIL
ELECTRICAL
Service ---- ._�__----- ---- - �_
Rough In
UG/Slab --------- --- ---- — - ---- ---
Low Voltage
Fire Alarm -- ----------- - �. --
Final
PASS PART FAILS -------
SITE
Backfill/Grading -
Sanitary Sewer
Storm Drain ( ) Reinspection fee of$ required before next inspection Pay at City Hail, 13125 SW Hall Blvd
Catch Basin Unable to inspect _no access
Fire Supply Line [ J Please call for reinspection RF __— _. [ ) p
ADA /
Approach/Sidewalk Date /_ Inspector �— - Ext
Other -_
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.