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11015 SW Errol Street
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00488
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/18/02
SITE ADDRESS: 11015 SW ERROL S-f PARCEL: 2S103AA-00802
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CAT•C1- BA�36,C:
FIXTURES LAUNDRY TRAYS: SF RikIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/ShOWERS: SEWER LINE: 130 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 130'of sanitary !,ewer line to connect existing house to newly installed sewer lateral. Septic tank
is to he pumped, filled and inspected.
'_ FEES
Owner: - --'
Description Date Amount
OLSON, PANDY S+ NANCY v-
1 1015 SW ERROL ST I I AX] 8',`0 State Tax 12/18/02 $8.12
TIGARD, OR 97223 11'1.I1M131 f'crniit FCC 12/18/02 $100.40
V —!� Total � $148.52
Phone
Contractor:
TED MCBEE EXCAVAT' ;G INC
1 1428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 939-524G fnsp existing/capped fixtures
Reg #: I IC 110314 Final Inspection
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 OAP 952-0001-on 'Li throl'gh OAR 952-0001-0100.
You may obtain copies of these rules or direct questions to OUNC b, calling (503) 246-6699.
Issued By: -� < < i ll ' �' , Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application OFFII�E USE ONLY
Date received '.• l Permit '�p
City of Tigard Sewer permit no.: t- Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 —
City of Tigard Phone: (503) 639-4171 Projecdoppl.no.: Expire date
Fax: (503) 598-1960 Date issued: ByY ' Receipt no.:
Land use approval;
Case file no.: Payment type
1 k 2 family dwelling or accessory U Commercial/industrial ❑Multi-family U l cn,nu 1111pl o%rmt•nt
New construction U Addition/alteration/replacement 0 Food service J(WILT
JQNSITF,INFORNIA11
Job address: Description (jt}. Fee(ea-) Intal
Bldg. no.: Suite no.: New -an -family dwellings on1}:
Tax map/tax lot/account no.: (SFR includes 100 l bath for each utility connectitttt)
O _
Lot: Block: I Subdivision: _ SFR(2)bath —
Project name: _ _ SFR(3)bath _
City/county: ZIP: Each additional bath/kitchen
Des ription and loc tion of wo k on remise S{teulilities:
!b YL0,Q _ IS1 2a Catch basin/area drain
Est.dat ofe' completion/insttection: Drywells/leach line/trench drain
CONTRACTORPLUMBING Footing drain(no.lin, ft.) _
Manufactured home utilities
Business name. tx� KK
Add_r s )q' g NA C _ Rain drain connector
City: I State:E- 'LIP. Sanitary sewer(no,lin.ft.) _
Phone: Fax• rnail: Storm sewer(no,lin. ft.)
CCB no.: Plumb.bus.reg.no:
Water service no.lin.R,
City/metro lic,no.: —^ Fixture or item:
Contractor's representative signature: Abso tion valve _
"Back flow preventer _
Print name: ` C Date: Backwater valve _
CONTACT ! Basins/lavatory
Name: �S ' Clothes washer _—
Address: Dishwasher
Drinkin ountain(s)
City: _ State: ZIP: Ejectors/sump _
Phe:;e: Fax: I E-mail: Expansion tank
Fixture/sewer cap
Name(print): Floor drains/floor sinks/hub
Mailing address: — — Garbage disposni
-- Hose bihb
City: r
i ate: ZIP: _ Ice maker — —_—
Phone: Fax: E-mail: Interceptor/grease trap
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 own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si nature: _ _ Date: Sump _
Tubs/shower/shower pan
Urinal _
Name: __. Water closet
Address: Water heater
City: State: jilw _ Other: _
Phone Fax E-mail: ota
Not all jurisdictions&ccelrl credit cards,please call jurisdiction for more information. Minimum fee................ S Q
Notice: This permit application plan review(al � %) S
Ll Vise U MasterCard expires if a permit is not obtained o
Credit card number, _� —. __. � � State surcharge(8/o)....S _
s�pire`e-- within ISO days after it has been
Name of nyder u shown on credit card
-- accepted as complete. TOTAL........................ $ _
Cardholdet si`nsture Amount 4404616(6/00'COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (Individual)___ _ QTY 1eaL _AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 1660 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.(10 for each utility connectiong)_—
—_ One 1 bath $249.20
Tub or Tub/Shower Comb, 1660 Two(2)b� ath $350.00
Shower Only �— 1660 Three(3)bath _ _ $399.00 `
Water Closet 16.60 —__ -- — SUBTOTAL
Urinal 16 6G _ 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL _
Garbage Disposal 16.60 _ _ TOTAL J—
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain,Floor Sink 2- 16.60
- PLEASE COMPLETE:
3• 16.60
4" 16.60
Water Hoaler O conversion O like kind 18.60 —Quantity by Work Perfor-ned
Gas piping requires a separate mechanical Fixture Type: New Moved ReplacedRemoved/
ermit. !� Capped
MFG Home Now Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower ON
Drinking Fountain 16.60 Water Closet _.
flitter Fixtures(Specify) 16.60 Urinal
_ _
Dishwasher
__garbage Disposal
"—
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer-1 st 100' 55.00 3-
Sewer-each additional 100' 46.40 4-
Water Service-1st 100' 55.00 Water Heater
Water Service-each a aditional 200' 46.40 Other Fixtures
(specify)
_
Storm 8 Rain Drain-1st 100' 55.00 _
Storm 8 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 Specially 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 required If —_
Quantity Total is >9 ' d
*SUBTOTAL - -
8%STATE SURCHARGE ------ —--
"PLAN REVIEW 25%OF SUBTOTAL
Required only It fixture qty total is>9
— TOTAL
"Minimum permit tee is$72 50+8%state surcharge,except Residential BacFBow
Prevention Device,which Is$36 25 4 8%state surcharge
"All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
i:tdsts\formslpim-fees.doc 12/26/01