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9090 SV# O'MARA ST
CITY OF TIGARD — PU 4BINGPERMIT
DEVELOPMENT SERVICES PERM,T#: PLM2005-00601
13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 DATE ISSUED: 10/24/2005
PARCEL: 2S 1 C2DC-00511
SITE ADDRESS: 09090 SW O'MARA ST ZONING: R-4.5
SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG
Project Description: Line work for sewer connection.
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
_,.dATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: -100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: - FEES
YEDINAK, MARTIN J +CHRISTINE v Description Date Amount
9090 SW OMARA
TIGARD, OR 67223 [PLUMB] Permit Fee 10/24/200F $72.50
[TAX]8%State Surcharl 10/24/200! "05.80
Phone: 503-684-3573 .� Total $78.30
Contractor:
TCJ CONSTRUCTION
19750 SW PAGE CT. REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97007
Phone: 503-320-7831
Reg*: PLM 674-)9
OC
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This permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Specialty Codes
m and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
C7 not started within 180 days of issuance,or if work is suspended for more than 180 days. ATTENTION: Oregon IFry
J requires you to follow niles adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0001-0010 through OAR 952-0001-0100. You may obtaiii copies of these rules or direct questions to OUNC by
calling 503-246-,66�5$or 1--800-332-234,4. �,s-
Issued By: _7� �.- -- �[ 4�� Permittee Signature: Ale
Call 503-639-4175 by 7:00 a.m.for an Inspection that business day. '
This permit carts shall be kept In a conspicuous pace on 4he job site unHi completion of the project.
Ap^roved plans ane required on the job ske at the time of each Inspection.
CITY OF TI GARD SEWER CONNECTION PERMIT
` DEVELOPMENT aR�,IIt.ES
PERMIT#: SWR2005-0��337
DATE ISSUED: 1
13125 SW Hall Blvd., Tigard.OR 97223 563.6.19-4171 005
PARCEL: 2S SI02 102DC-00511
SillE ADDRESS: 09090 SW O'MARA ST ZONING: R-4.5
SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG
Project Description: Sewer connection. 'jeptic system to be pumped and filled or removed.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TY?E OF USE: SF NO.OF BUILDINGS: 1
INSTALL TYPE: LT?SWR IMPERV(SURFACE:
Owner: _ FEES
YEDINAK, MARTIN J +CHRISTINE G
9090 SW OMARA Description Date Amount
TIGARD, OR 97223 [SWUSA]Sewer Connection Fee 101241200E $2,600.00
[SWINSP]Sewer Inspection Fee 10/24/200E $35.00
Phone: Total $2,635.00
Contractor:
REQUITED ITEMS AND REPORTS
Phone.
Reg it: l
n. This Apr!.cant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
n, days from 'the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not 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"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the
OrQgon Utility Notification Center. Those rules are set forth In OAR 952-001 0010 through OAR 952-001-0100. You
m m: ;/ obtain copies of these rules or direct questions to OUNC by calling 503-246-t C39 or 1-800-332-2344.
h;s unci by: Permittee Permittee Signature:
Call 503-839.4175 by 7:00 a.m.for an Inspection that business day.
This permit card shall be kept In a conspicuous place on the job site un.11 completion of the project.
Approved plats are required on the job ske at the time of each InspwAlon.
Building Fixtures RECEIVED
Plumbing Permit Application
City of Tigard OC l 4 2005 Reom"A pennit
fhte/B N -f� 01
13125 SW Hall Blvd.,Tigard.OR 97222A�1�TY OF TIGARG ManItewe othaPeml N),
Phonc: 503.639.4171 Fax: 303.39gii 4QLUING UIVISI rhte/B _ -.-,---
24-Hour Inspection Line: 503.639.4) I f)rc Reedy/By - 0 cert Fpte 2 rte
Internet wW,v.ei.tigard.or.us NotiReNMcthod3Vr erweetd Irinrteert�w
TYPR of *URK FU* IIA
❑New construction ❑Demolition For y!clat i w watlew was heeAft
--- -- Descri on _� _ Ea. Total
❑Addition/alleration/replacement ❑(hher: New I-2-hmfly dweRbip(includes 100 ft.for arch utility conn_ecdon)
CATSMRY 01'CONlit1'RUCTION SFR(1)bath - 249.20
1-and 2-family a 'ling ❑❑C�ornmercial/industrial SFR(2)bath 330.00
❑Accessory bui!d ,g --�- ' D Multi-family--J SFR(.3)bsth - 399.00
❑Master builderOtdte►: -�-� Each additional bethikitchen 43.00
Fire sprinkles Page 2
JOB 1)t M 1"41)ORMATION AND LOCATION Site W;,ties -�
Job site addrecs: yO�DJ� O Larch Ixtsin or area dni a 16.60
okd4f _L _- --_-
City/Stair.7iP: Drywell_leech line,oc trench drain 16.69
0z � - - Footing Min(no.linear ft.: Page 2
SuiteMldg./apt.no.: roject name: - -
- ---- --- Manufactured home utilities 110.00
Cross street/directions to job site:
-- Manholes 16.60
Rain Min connector 15.60
Sanitary sewer(no.linear A.IMJ Page 2
-- _._
Storm sewer(no linear It.: �) Page 2
Subdivision: Lot no.: Water service(no.linear ft.: ) Page 2
_ - -- ---
Fixture nrWas -- _-
1 ex map/parcel no.. �-
Absorption valve jl&.6]DUCRIPTION OF WwORl11; Backflow prevents
Redo water valve - 16.60 -
Clothrs washer 16.60
-- -� - --- Dishwasher 16.60
❑ PROFMTY OMTIit r E3 7'LNAXT Drinking fountain MAO
Fjectorshump 16.60
Name: Q�,�[� r pJ - --- Expansion tank - 16.60
Address: r7p3a1 a � S} --- -- Fixture/sewer cap 16.60 -
City/State/?.IP: A/ Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone:(��-jr1 _PG�1- Fax-71- (f��) �� - -
C7 APPLICANT C] CONTACT )N Holo bib - ----- 16.60
---._-..--- Ice makes 16.60
Business name:
-- -_. -- --- Int,*rocpta/gratae trap 16.60
Contact name: Medial gas(value:S ) Page 2
Address: - - -- Prima- 16.60
l" City/Slate/71P: Roof drain(commercial) 16.60
Sink/basin/lavatory - 16.60
Phone:( ) - - Fax: : - -_- -
Tub/slKwer/shower pan 16.60
J F-mail: )Join.{ 16.60
k°+ON UCTOR Wa.a close) 16.60
W Business name: -- 7 Wt!a hater 16.60
Address: __ __ _-
City/State/ZIP: __.____-- ser Metal
!-/�- Minimum permit lee: 172.30
Phone:((- )�j� / Fex:( ) - Residential backflow minimum_"mit Poe: x36.23
LCCB L ' aces, /�'� CJ(� Plumb g Lic.no. -- Plan review (25%of pa nit'x)
-'`-►q �� State surdarM(11%of permit fee) d-
Authori*t'signature: TOTAL FEE
_ ,3Q
CP ---int name: ' r' L7ble: tyr Ti let permit apples&%expires Na pervalt r net obtained within
��r 180 days after M ha been accepted as complete.
'Fe•,methodology set by Tri-County Building Industry3avice Board.
i\Rui\ding\Pr mih\PI.MF-Pe irApp dm(W01 MM61671HV02X0M/WFB)
Plumbing i ,-rrm.t ADDlicatign - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Stems: !_
Site Utiiiitiel - on. RK(a) T"ial V_F -a • Pe ee: _
Footing drain-f 100' 55.00 0 to 2,000 _F _ $115.00
Footing drain-each additional 100' 46.40 2.001 to 3,600 $160.00
Sewn-1 at 100' 55.00 3 601 b 7 00 $220.00
7,201 and ter $309.00
Sewer-each additional 100' 46.40
Wata Service-1st 100' 55.00 Medical Gas S;;stems•
Water Service-each additional 100' 46.40
Stotts tfk Rain Drain-151100' 53.00
_ $1.00 b SS 000.00 Minimum Gee 2 50
Storm A Rain Drain-each additional 10040 $5,001.00 to 510,000.00 :72.30 for the first 15,000.00 and S 1.52 for each
Tod additic dS 100.00 err traction thereof,to and
Future or Item _ in.. ,,, !10,000.00. _
Commercial Bade Flow Prevention Device 46.40 SIC,001.90 b 5a.',:i00.00 g.50 fhr the fit at s tU,000.011 and S 1.34 for
Residential Backflow Prevention Device isch additional$100.00 or ruction thereof,to
(minimum permit fie SM.25) 27.55 _ and including 323 000.09.
Rain Dain,single familv dwelling 65.25 1,25,001.00 to S i0, $379.50 for the first$25,000.00 and$1.45 for
Inspection of exining-Aumbing or ych additional 11100.00 or fraction thereof to
s Tally requested insl;ediops_per hour 72.50 ___ M mcludina$50,000.00.
-- - subtotal, 550,001. and up 5742.10 for the first$50,000.00 and$1.20 for
each additional$100.00 or fiaction theroof.
Fixture Work: ld%z�llin
hu Rniew for Complex Strilidarm
Are you capping,adding or replacing fixtures? 1 es", lex stnicture,' is defined as an installation of a plumbing
please indicate work performed by fixture. Fa re to at meets any of the following criteria.
acct:ratel report fixtures could result in i ased sewer fe.�*. eck all that apply.
cull new commercial building.
Marti Type: ne•v exterior plumbing site utilities.
mercial building with installation,alteration or addMon
Ba 'st /Fry ant _ ine(9)or more new or relocated plumbing fixtures.
Bath -Tub/Shower ictal gas and vacuum systems for health care facilities
-Jawr�i/Whirl I ing services to human beings.
Car Wash -Each Sall 'ng installations,alterations or additions to food set vice
-Drive Th lit s where new plumbing fixtures,including Interceptors,
Cuspidor/Water As i et g installed for the food service area.
Dishwasher mrnr:tial _ n residential building containing three(3)or more
-Domestic llin units.
Drinking Fo6nain ❑ Any NF A 13-I)multipurpose fim sprinkler system.
Eye Wash
Floor Drain/sink 2" _ SM mit I sets of plans w�lth any of the shove.
-3"
Car Wash Drain wet Or I� rMM
IL Garbage -Domestic Isometr or riser diagram is required for new txtildings
Disposal -Commercial three 3 or more stories in hei t.
N -Industrial
Icc Mach./Reff-ig,Drains
Cil Separator Gas Station Comment regarding fixture work:
Rec.Vehicle Dump Station _
m Shower -Gang
-Stall _
W Sink -BvMvatory
-a -Bradley
-Commercial P
-Service
Swimming Pool Filter
�h rtm -Ca •Note It the tFxtare work.7"der this permit Insults in in
%'ata Cloud-Toild inerea of sewer .DUs,a sewer permit will be hutted and
,;_,A hes assessed for the sewer iecrease mast be paid behr2 the
I t)tha r'i finw: plumbing permit can be issaed.
i\nuitdena\PemiibNl.M-Pe mi1App dor.MM"S
CITY OF TIGARD
BUILDING -DIVISION PERMIT#: Pt.M2000_5y00601
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1012412005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10128/20f)6 TIME: T 18AM PAGE: 15
SITE ADDRESS: 09M SW 07AARA ST CLASS OF WORK:
SUBDIVISION: EDGEMOD LOT IV 013 TYPE OF USE:
PROJECT NAME: YEDINAK
DESCRIPTION: Line work for sfwrer connedion.
OWNER: YEDINAK, MARTIN J + CHRISTINE G, PHONE N: 5x3684-3573
CONTRACTOR: TCJ CONSTRUCTION PHONE k: 5033:107831
Inspection Request Scheduled For: Date: 10/28%1005 Pour Time:
Code # Inspection Descrintion Confirm # Contact # Messa
b()?i Sandmy sower 019717-01 5033207831
Corr ctions/Comments/Instructions:
L � )
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❑ PASS PARTIAL APPROVAL [:] CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V V - Date: _,— ._____ ____ Phone 1#: (503) 718- _
CITY OF TIGARD PL�'I _
BUILDING DIVISION PERMIT #: Lam►0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: ' h j TIME: PAGE:
SITE ADDRESS: Q 6 1, U P"l CLASS OF WORK:
SUBDIVISION: LOT k: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE N:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Messa.go
Corrections/Commen s/Instructions:
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/T"PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS —
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ __ y' y ��'" _� Date: S� '__ Phone #: (SO3) 718-
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Invoice
(,RIF l S MENUSERVICE
Na
$ /n Phone
Address On Acct.
city _1
�State . zip code _._..
,ATpuM
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e c ..4'60
m NOT RESPONSIBLE FOR DAMAGES PAST CURB LINT,OR LANDSCAPING
. A ssrvlCS charge of 1.5'Yo will be levied on all east dur,•xoun .
• Re2umed check fee Is$20.00.
• Is instituted by either party for broach or to enforce any
In case suit,action or arbitration
award►eaaonabie alto►r�ka therefrom. al eoets the
provisions herein.the Court shall
prevallinp party at trial or arbitration, or upon any appeal
Approval
By:_. DEf�N 374l�1
P.O.BOX 1138 • Canby,OR 87013 DEO 17420
rtultM 2A3-3067 or (503) 632.5139 _
1279
ROCKY IUS
TRUCKING, INC.
715 NE St ST HOME-600 254-9444 FAX-6Q3 254-940
PORTLAND OR 97713 CELL-503 W-3206 NOM BU6LDM NET- 31'7378
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TE ip PER HDUFi/TXXM. DUMP FEE Y PER YD. TOTAL}YDS.
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CITY
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STAF�Y TIME i� LUNCH TIME FINISHED 3 C)
DOWN TIME DRIVERS TIME
MAULCO FROM MAULID TO LAADS TWM
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ORI�/ERS SIGNATURE TOTALS _ _ I
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