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12035 SW Bull Mountain Road
CITYOF TIGARD SEVVER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00230
13125 SW Hall Bivo.,Tigaru, OR 97223 (503) 639-417'1
DATE ISSUED: 7/2;102
PARCEL: 2S 11OBD-00901
SITE ADDRESS; 12035 SW B::I_L MOUNTAIN RD ZONING: R-2
SUBIIIVISION
BLOCK: LOT- — _ _._ JURISDICTION: .:G _
TENANT NAME:
USA NO: FIXTURE UNITS:
CDWELLING UNITS: 1
LASS OF WORK: ALT
TYPE OF U3E: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect existing house to sewer lateral.
Owner: — _ _ FEES
WHITNEY, PAUL.AND DIA NE Type By Date Amount Receipt
12035 SW BUIL MTN RD —
TIGARD, OR 97224 PRMT CTR 7122102 $2,300.00 27200200000
INSP CTR 7122102 $35.00 27200200000
Phone: Total $2,335.00
Contractor:
Phone:
Reg#:
Required Inspections
Sewer Inspection
Septic Tank FiIIE!d
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
clays from the date issued. The total amount paid will be forfeited if the permit expires. The Agency doe- -,ot guarantee
the accuracy of the side sewer laterals. If the sewer 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" Perm
f 1
X ) Permittee Signature:
Issued by: {a
~" Call (503) 639-4175 by 7:00 P.M. for ai. inspection needed the'ne)Vd
ssday
C1 01,'Y OF TIGAR.D _— PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PL.ML'002-00285
DATE ISSUED: 7/22/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S110BD-00901
SITE ADDRESS: 12035 SW BULL MOUNTAIN RD ZONING: R-2
SUBDIVISION:
BLOCK: LOT: JURISDIt;TION TIG__ —
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE NOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
FLOOR DRAINS: TRAPS:
OCCUPANCY GRP: R3
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURcS LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: 65 ft
WATER CLOSETS: WATER LINE: ft
DIS►iWASHERS: RAIN DRAIN: ft
Remarks: Installation approximately 65 feet sewer line to lateral Septic tank is to be pumped, filled and inspected.
FEES
Owner: Type By Date Amount — Receipt
WHITNEY, PAUL_AND DIA NE PRMT CTR 7/22102 $72.50 27200200000
12035 SW BULL MTN RD 5PCT CTR 7/22/02 $5.80 2.7200200000
TIGARD, OR 97224 —
f otal $78.30
Phone 1:
Cuntractor: — —
REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: Fiiial Inspection
Reg#:
TiIiS permit is issued subject to the re�lulations co,itained in the Tigard Mu,flcipal Code, State of OR.
Specialty Codes and all other applicable laws. AI, work will be done in accordance with approved plans.
I his permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 1J0 days. ATTENTION: Oregon law requires yoij 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 ru!es or direct questions to OUNC by calling (503) 2.46-1987.
r f L4 � Permittee Signature:
Y�
Issued B
Call (503) C'0-4175 by 7:00 P.M. for an inspection needed thetneJkl business day
Building Fixtures
'
Plumbing Permh Application
Date received: d Q 2 Permit no.: (/hXtla
Cit of Tigard
Y g Sewer permit no Building permit no.:
Address: 13125 SW Hall Blvd,Tigard, 97223 — — ---
Ciry If 741d Phone: (503) 6394171
ProjccUappl. no. Expire date:
Fax: (503) 598-1960 I Gt Date issued: B Receipt no.:
Laud use approval:
Case file no.. Payment type:
—._____
1
b 1 &2 family dwelling or accessory U C'ommerci tirindustrial U Multi-family U Tenant improvement
U New construction ld i1.;ldltion,altciation/replacement U Food service U Other:
MOTOR=
Job address: %,r? S�✓ / 1 Description Qty. Fee(ea.) Total
'slew t-and 2-family dwellings only:
Bldg.no.: :uite no.. (includes t00 ft.for each utilit)'connection)
Tax map/tax lot/ac count no.: _ SFR(I)bath --
Lot: Block: I Subdivision-. SFR(2)batt
Project name: SFR(3)bath
City/county- ZIP: Each additional bath/kitchen
Description and I cation of work on premises: Sv 42e/' /,h e !_ S Site utilities:
`, IDA Catch basin/area drain
=_ --- Drywells/leach ineltrenc drain
Psi date of r,nnhletirm/inepccfion
Footing drain(no. inin—�fl.)
Manufactured home utilities
Business name: r Gi!/r�� _ Manholes
Address: d
/ ' / ' h __ Rein rain er onnector
c
City: -- State: ZIP:�O Sanitary sew (no.lin.fl.) 5
Phone:ip 7 Fax: E-mail: Storm sewer(no.lin. fl.)
CCB no.: Plumb.bus.reg. - Water service no.lin.ft,
Fixture or Item:
City/metro lic.no.: - ------ Absorption valve _
Contractor's representative signature: Back flow preventer
Pnnt name: --_�� i1t Backwater valve _
IcONTACT PPRSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: 41 ,�_ Drinking fountain(s) _
city: "Sth,e'
ZIP: 7�� - Ejectors/sump
Phone: A 6' // Fax: il: Expansion tank
IQ Fixture/sewer ca
Name(print): / Floor drains/floor sinksi nil
_� (}ar age disposal
Mailing address: _� _ I lose bibb _
City: State: ZIP:9 Ice maker _
Phone: Fax: I E-mail _ Interceptor/grease t:ap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I uwn as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's signature: _ Date: Sump _
Tubs/shower/shower pan
Urine
Name: _ _ Waters oset
Address: _ _ — Water Crater
City: State: ZIP_ Ot er:
Phone: Fax: FT0taI
Minimum fee................ $ a- S
Not oil'--irdictions orsepi credit tarda,please call iudrdiction tbt more Irfomutian. Nwice: This pen-nit application plan review(at— %) $
O via U MasterCard expires if a permit is not obtained State surcharge(8% `w
Credit card number —�� -- --Exp ra within 180 days after it has been TOTAL.................>..... S �S', 2 0
Name of car o r as-h--n on credit card
accepted as complete.
_ S
G ho n eiptawre `�— Amount 1/04616(NOIVCOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 1-family dwellings only:
FIXTURES (individual)_ QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the firsl100 ft. QT' I (e ) AMOUNT
Lavatory — 16.60 for egc_h_utility connection i-- —
_�_-- One 1 bath $249.20
Tub or TubfShower Comb 16.60 Two 2 bath $350.00
Shower Only — ^� 1.6.60 ThreL th "399.00
Water Closet _ 16.60 — -- -
-_—_. SUBTOTAL _
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 _--_-_--— --.- .--_ --- --
Laundry'fray — — 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 1660 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion O like kind 16.150 — Quantity la t Work Performed
Gas piping requires a separate mechanical FlxtUre Type: New Moved Replaced Removed/
permit. _ Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
— Tub or Tub/Shower
Hose Bibs 16.60_ Combination
Root Drains 1660 Shower Ord _ —
Drinking Fountain 16.60 Water Closet —
Other Fixtures(Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Ronm?rte
----- -- Washing Machine _
Floor Drain/Sink: 2"
Sewer-1 st 100' 55.00
Sewer-each additional 100' 46.40 4"
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
(Specify)
Storm&Rain Drain•17t 100' 55.00 A
Storm&Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or dpeclaRy 62.50
Requested Inspectionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps — — -- —16.60 --
QUANTITY TOTAL —
Isometric or riser diagram is re.luired If
_Quantity Total is>9 __ — ---- -- --
`SUBTOTAL.
^'r
8%STATE SURCHARGE `f` -------
-','L/,N REVIEW 25%OF SUBTOTAL
Re ulred only if fixture iv total is>g
TOTAL
'Minimum permit fee is$72 So•811,state surcharge,except Residential Backflow
Prevenlicn Device,wwr'i is s w 75•8%stale 3ur0arge
`*All New Commercial Buildings require 2 sets of pians with Isontet•Ic or riser
diagram for pian review
\dsts\forms\plm-fees dor 17..126/01
CITY OF TIGARD 6441our
BUILDING Inspection Line: (503) 6;,9-41/5
INSPECTION DIVISION
Business Line: (503)639-4171 MST _
Received
Date Requested_ g I AM --`—
Location —__--- �I M PM ''',UP
Up
BLIP
Contact Person .-2n�7 --Suite MEC
Contractor --___ Ph ( A —) � _ PLM ������
BUILDING _ Tenant/Owner SWR
---
Footing ELC
Foundation - - --- - - _
Ftg Drain Access: '^�- ELC
Crawl Drain -
Slab Inspects N tes: ELR
Past&Beam SIT
Shear Anchors - - ---
Ext Sheath/Shear - _-- -
Int Sheath/Shear - -
Framing -
Insulation - - -
Drywall Nailing -
Firewall - - -
Fire Sprinkler - - -
Fire Alarn -
Susp'd Ceiling - -
Roof - - ----- _— _
Otho,-: -
Final - ------- -
PASS PART FAIL - - - -
-
Post& Beam
Under Slab
Rough-In ----
-
Water Service -
Rain Drains
Catch Basin/Manhole -
Storm Drain - - ----- ___
Shower Pan --
Other:
F• a - --
A PART FAIL ------- - -
HANICAL — —
Post&Bearer `I —
Rough-In --- -
Gas Line
Smoke Dampers _ ----__—_
Final
PASS PART FAIL -
ELECTRICAL - -
Sorvice
Rough-In
UG/Slab —----- -
Low Voltage -
Fire Alarm
Fines —
P.'ASS PART FAII. ❑ Reinspection fee of$ —,required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
ci tE ----^-- ❑ Please call for reinspection RE:_- d.
--
Fire Supply Lino
ADA ❑ Unable to Inspect-no access
C
Approach/Sidewalk Date
Other - ---- Inspector
I
Final --Ext -_ —
PASS PART FAIL DOLOT REMOVE this Inspection record from the job site.
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received _ -_____.___..._—__Date Requested AM PM _ BUP
,,ation !Moa, Am- A!!° ---Suite_. ___--___- _ MEC _—
Contact Person _ fl —__._ _ Ph( —) �� U y�G __ - PLM Z,1 ,62 2-L14 772
Contractor----.—_-__- __--- _-.-_..—_ Ph(--) _ _ SWR
BUILDING Tenant/Owner _—_ _—.A — _--- ELS
Pouting— �-------- EL_C
Foundation Access:
Ftg Drain ELR
Crawl Drain _
Slab Inspection Notes: SIT
Post&Beam — -
Shear Anchors
Ext Sheath/Shear _
IrI Sheath/Shear
Framing - ---- ---- --- — —_
Insulation
Drywall Nailing -- - -- -- --- -
Firewall
Fire Sprinkler ---- ---- -- -- ---
Fire Alarm
Susp'd Ceiling -- --- �_
Roof
Other: - —
Final
PASS PART _FAILQ. - -- --
PLUMB
Post& Beam
Under Slab -- -------------- - —
Rough-In
Water Service - - -- — — -- --
Sanitary Sewer
Rain Drains - - -- -- —
Catch Basin/Manhole
Storm Drain - —
Shower
l�aal
PPA S PART FAIL
L
HANICA
Post&Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIT_ -- ----
ELECTRICAL
Service
Rough-In _
UG/Slab
Low Voltage - --- - --- ---
Fire Alarm - - -
Final I ll
Reinspection fee-,r$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL.
SITE _ P'ease calf fog reinst .otic i RF _ _-__ E] Unable to inspect-no access
Fire Supply Line
- ----- / �)
ADA !�
Approach'Sidewalk Data___ _�__ / w < Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Joh AIte.
PASS PAR F FAIL J
ALOHA SANITARY SERVICEINVOICEl NG I
8600 SW. Hillsboro Hwy., Hillsboro, OR 97123 6421
503-644-2797 503-648-6254 * 503-639-5188
NAME.'_
ADDRESS:
CITY: -_ STATE: ZIP: (�
HOME: -- WORK: CES-,: c (
.1QB SITE'. vim -,z P.O.#: '.. W/J —
PAID BY CHARGE ❑ CHECK ❑ r� CASF6 , CREDIT CARD LJ
IDATE O �. C�C)Z_ - DRIVER AMOUNT
4' PUMP SEPTIC TANK `
❑ LINE OPENING J
L] INSPECTION FEE
- ❑ SERVICE CALL
❑ LABOR, LOCATING, DIGGING, BACKFILL
L] MATERIAL
TOTAL �yr•r'� `-� -
- -
THIS Is NOT A SEPTIC SYSTEM INSPECTION REPORT - - L $
- - REMARKS - -
TYPE
- REMARKS - -TYPE OF TANK: STEEL ❑ \ CONCRETE L7 PLASTIC ❑ j"HOMEMADE ❑
HORIZONTAL ❑ ' VERTICAL LI RECTANGJ.E� L) OTHER
SIZE OF TANK: 350 ❑ 5U0 750 U 1000�d'1250 LJ 1500 U 2000 LJ 3000 U
LID LOCATION: INLET U O�TLET ❑ /1�IDDLE U ENTIRE TOP LJ
TANK CONDITION: GOOD ❑ FAI1L.�%/ POOR ❑
FITTINGS: BAFFLES L] Cq�KRriTE ❑ CAST IRON ❑ PLASTIC U
NEEDS NEW LID'? YES ❑ IZE -
GROUND COVER OVER TANK r _
COMMENTS ON CONDITION 0 RAINFIELD ETC.
---
DATE
--- -------
SIGNED BY -