12015 SW ROSE VISTA DRIVE 12015 SW Rase Vista Drive
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00302
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/13/02
SITE ADDRESS; 12015 SW ROSE VISTA DR PARCEL: 2S103CC-01200
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING IINITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect existing house to nevily installed sewer lateral.
Owner: (�!
FEES
SMITH, GENE F MARY E I
12015 SW ROSE VISTA DR Description Date Amount
_
TIGARD, OR 97223 1SWUSAJ Swr Connect 11/13/02 $2,300.00
(SWINSPI SNNr Inspect 11/13/02 $35.00
Phone: _
Total $2,335.00
Contractor:
Phone:
Reg#:
Required Inspections
Sewer Inspection
t3G TT 1C- TANK F t t-u=P
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
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" Perm
r/ nature:
Issued by: Permittee Si� t `L <.�'�� � ---_ g L �t
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next busln4ss day
/ \ CITY OF TIGARD __ PLUMBING PERMIT
(DEVELOPMENT SERVICES PERM!T 4: PLM2002-00434
•
DATE ISSUED: 11/13!02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103CC-01200
SI1 E ADDRESS: 12015 SW ROSE VISTA DR
SUBDIVISION: ZONING:
BLOCK: LOT: – —_—_-__A_-JI RISDICTION:
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:
LAVATORIES: OTHER FIXTURES:
SUB/SHOWERS: SEWER LINE 100 ft
WATER CLOSETS: WATER LINE. ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 100 or less of sewer line and reversal of plumbing under the house to connect to newly installed
sewer lateral. Septic tank is to be pumped, ;,,ad and inspected. Reimbursement District#20 fee paid. Recpt
#2002-4307
FEES
Owner: Description , Date Amount
SMITH, GENE F MARY E [TAX] K'!'o State Tax 11/13/02 $9.40
12015 SW ROSE VISTA DR ITAX] 9%State Ta-. 11/13/02 $0.00
TIGARD, OR 97223
1 I'I.l iMB] Permit Fee 11/13/02 $117.50
�111,11M111 Permit I-ce 11/13/02 $0.00
Phone 1: `--� Total $126.90
Contractor: _
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPEC71ONS
Sewer Inspection
Phone 1: 939-5246 Misc. Inspection
Reg#: LIC 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
Issued By: _s_�. ! r Permittee Signature: A/t,�:�. �r !- 2 ---
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures - ,� r�� _003L��-
Plumbing Permit Application olls
[)atc receivcd. /�- /� l,, ,t Permit no.:
City Of .I igsird Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of7Ygard Pho•le: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: ( ►` Receipt no.:
Land use approval - Case file no.: Payment type:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-Gamily U Tenant improvement
U New construction U Addition/alteration/replacement U Food service U Other:
INFOIRMATION
Job address: Ci Description Qt Y. -'ee(ea.) Total
Bldg. no.: �'Ste oo.c New 1-an . -frmlly dwellings only:
(includes 100 ft.for each utility connection)
Tax map/tax lot/account no._: SFR(1)bath _
Lot: Block: Subdivision: SFR(2)bath
Project name: _ SFR(3)bath
Cit /county: - 'L N ZIP: Each ad('litional ath/kitchen
Qescription andfocation of work n premises: r' kol irK Sileutilities:
'r it 1 - Catch basin/area drain
Est.date of completion/inspection Drywells/leach line/trench drain
I owing drain(no.lin. fl.)
s ! Manufactured home utilities
Business name: e('Imy 1111anF.oles
Address:// ` r Gn drain connector
City: r _ State:�� ZIP: f?9,9 aC) Sanitary set,.,cr(t+o. lin. (t.) —
Phone6p , c ,r c I Fax• A E•-mail: Storm sewer(no. lin. fl.)
CCB no.: j Plumb.bus•reg.no: Water service(no.lin, ft.) r,
City/metro lic.no.: Fixture or item:
Abso tion valve
Contractor's representative signature _ Back flow preventer _
Print name: 't' a-,-, Date: K2 Backwater valve
! ! Basins/lavatory
Name: Clothes washer_
- --- — Dishwasher
Address: _ — Drinking fountain(s) —
City: - State: ZIP_ _ Cjectors/sump _
Phone: F;,, F.-mail: l xpansion tank _
!To Mki Fixture/sewer ca _
Name(print): Floor drains.ifloor sinks/hub
---- — Uprbage disposal
Mailing address_ — I lose bibb —
_City: —�-- -- State: ZII' Ice maker
Phone: Fax: E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be mat by me or the maintenance and repair made by my regular Roof drain(commercial) ^_
employee c the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _
Owner's si mature: Date: Sump
Tubs/shower/shower pan
Urinal _
Name: Water closet
Address: _ _ Water heater
City: State: ZIP: Other:
Phone: Fax:�� E-mail: Total
—• — Minimum fee................ S _.1l
Not all jurisdictiot t accept credit cards,please cell jurisdiction for more information Notice: This permit application
sa O MlasterCud Plan review(al�_ %) $
❑vi
expires if a pemmit is not obtained State surcharge(8%)....$
Credit card number — --•.4 011. within IAO days afler it has been spry accepted as complete. TOTA1.....................
-- oime of catafiolder a m shovone it a
Cardholder signature Amount 440-4616(6/00ICOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and'2•family dwellings only:
FIXTURES (individual) QTY ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
16.60 for each utility connection)
Lavatory One(1)bath $249.20
Tub or Tub/Shower Comb. 16.60 _ Two(2)bath $350.00
Shower Only 16.60 Thre1j)bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
---__ -__... _- ---TOTAL
Garbage Disposal 16.60 --- -
Laundry Tray 16.60
Washing Machine 16.60 _
Floor Drain/Floor Sink 2" 16.80 PLEASE COMPLETE:
3" 16.60
q" 16.60
Quantity b f Work Performed
Water Heater O conversion O like kind 16.60
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
aspCa ed
jermit
MFG Home New Water Service 46.40 Sink
MFG Homo New San/Storm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal -
Other Fixtures(Specify) 16.60 Dishwasher
Garbaa Dis osal _
Laundry Room Tray
Washing Machina _
_ 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
Other Fixtures
Water Service-each additional 200' 46.40 (Specify)
_
Storm&Rain Drain-1st 100' 55.00 _
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 Specially 62.50
Requested Ins actionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 6525
�3rease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram Is required If
Quantit Total is >9 _
'SUBTOTAL - -
8%STATE_SURCHARGE
"PLAN REVIEW 25°/a OF SUBTOTAL _
Required only II fixturetr1Y loyal Is?9 _
TOTAL 5
'Minimum permit lee Is$12 50•a%stale surcharge,except Residential Backflow
Prevention novice,which 18$36 25+B%state surcharge
"All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
I:\dsts\forms\plm-fees.doc 12/26101
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PL 200
14/02 00437
DATE ISSUED: 11/14/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103CC•01200
SITE ADDRESS: 12.015 SW ROSE VISTA DR
ZONING:
SUBDIVISION:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: C TCH BASINS:
_ FIXTURES LAUNDRY TRAYS: 31' AIN DRAINS:
SINKS: URINALS: G 4SE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS- WATER LINE-•: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Reversal _ ------- --
FEES
Owner, Description Date Amount
SMITH, GENE F MARY E [PLUMB] Permit Fee 11/14/02 $72.50
12015 SW ROSE VISTA DR IPLUMH) Permit Fee 11114/02 $0.00
TIGARD, OR 97223 ITAX1 8"i,State Tux 11/14/02 $5.80
1 ,TNI S State fax 11/14/02 $0.00
Phone 1: Total $78.30
Contractor:
LARRY CAMERON PLUMBING
1812 SE '158TH AVE
PORTLAND,OR 97233 REQUIRED INSPECTIONS
Final Inspection
Phone 1: 503-256-2705
Reg#: 11(' 41)7-')2
11I.N1 26-3661113
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 952-0001-0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246-6699.
Issued By: �, -Yr: Permittee Signature: '4 L-7
Call (503) 63 4175 by 7:00 P.M. for an inspection needed the next b t the day
Building Fixtures
Plumbing Permit Application
Date received: 7,77 o� Permit n6.4m�� .c q3
City of Tigard Scwcr permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,'rigard,OR 97223 —
c'in of Tigard Phone: (503) 639-4171 Projccdappl. no.. Expire date:
Fax: (503) 599-1960 Date issued: By: Receipt no.:
Land use approval:_ Case file no.: Payment type:
TYPE OF PERMIT
;da &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
Lj New construction ddition/alteration/replacement U Food service U Other:
JOB SITE INFQRMA'II t
Job address: U lv L(J� S Ueptiun Qt .I Fee( Total
Bldg. no.: Suite no.: -- New I-and 2-family dwelling%only:
Tax map/tax lot/account no,: `— —J (includes 100 ft,for each utility connection)
SFR(1)bath _
Lot: Block: Subdivision: SFR(2)bath
Project name: SFR(3)bath _
City/county: ZIP: Each additional bath/kitchen
Desniption and location of work on premises: _- Siteutllities:
_V&U133'15 it L _ Catch basin/area drain
Est,date of completion/inspection: � OZ•— Drywalls/leach line/trench drain
Footing drain(no.lin. ft.)
Manufactured home utilities
Business name: mA v2VLA- a� t�(rtrL J Lytf t Manholes
Address: _ s r Rain drain connector
state: 1,11 (e Sanitary sewer(no.lin. fl.)
Phoneg-o - >>y - Fax: _ E-mail: Storm sewer(no. lin. 11.)
CCB no.: J`4 Plumb.bus.reg.no• _ 2�, G6 Water service lin. R.
City/metro tic.no.: Fixture or itemm::
Contractor's representative signal `_ BackAbsotion vale
Back flow preventer
Print name: '��, / ,�7_1�-��-,_-� ate' Y Backwater valve _
CONTACTe $asinsllavatory _
Name:
Clothes washer
_
�' �.�"�_- ._�
Address: — Dishwasher
Drinking fountains)
State: LIP: Ejectors/sump _
Phone: Fax: E-mail: Expansion tank
Fi,.ture/sewer cap
Name(print): Floor drains/floor sinks/hub
Mailing address: — --- 0arbage disposal—
.___..__. Hose bibb
City: =State: ZIP: _ Ice maker _
Phone: Fax: E-mail Interceptor/grease trap
Owner insudlation/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 mature:_________._—__ Date: Sump _
Tubs/shower/shower pan
Urinal
Name.
-- Water closet
Address: Water heater
City: --� State: ZIP: Other _eve�5/a L_ _—
Phone: Fax: E-mail otal _
Not all jurisdictions accept credit cards,please call jurisdiction for mote information. Notice: 'this permit application Minimum fee................ S
Plan review(at` %) S
U Visa U MasterCard expires if a permit is not obtained c
Credit card number: ^�_—__ _.___ —__ State surcharge(8%).... S —
•a irea within I l30 days a4cr it has been T
P
Name of csr ho der is shown on credit ural
-- accepted as complete. TOTAL........................ S
_ S
holder N�nature _� Amount "046I6(61001COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (Individual) QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 – for each utility connectioq__
One(1)bath _ $249.20
Tub or Tr.0/Shower Comb. 16.60 Two_(4bath $350.00
Shower Only 1660 Three 3Zbath _ $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 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" - 1660 PLEASE COMPLETE:
4" 16.60 _
Water Heater O conversion O like kind 16.60 uantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Rem wed/
permit Ca,-,ped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 4640 Lavato
-- Tub or Tub/Shower
Hose Bibs 1660 Combu atun
Roof Drains 16.60 Shower Onh/
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 16.60 !–^ Urinal
_ Dishwasher _
Garbage Disposal
Laund Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer-1st 100' 55.00 3„
Sewer-each additional 100' 46.40 4"
Water Service-1st 10r' 55.00 Water Heater _
Water Service-each additional 200' 46.40 Other Fixtures
S 9cii
Storm&Rain Drain-1st 100' 5500
Storm 8 Rain Drain-each additional 100' 46.40 _
Commercial Hack Flow Prevention Device 46.40
Residential Backflow Prevention Device' 2-.35
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 6250
Requested Inspections per1hr 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
'SUBTOTAL — –
8%STATE SURCHARGE -----
"PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qty total is>9
TOTAL $
*Minimum permit In Is$72,50+5%state surcharge,except Residential Backflow
Prevention Device,which Is:30.25+B%state surcharge
"All New Commercial Buildings require 2 sett of plant with Isometric or riser
diagram for plan review,
1:\dsts\forms\plm-fees.doc 12/26/01
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503) F.,9-4171
BLIP - _
Received Date Requested - -
AM PM �__~ BLIP -_..
Location __._ �U1 S �_ - �11. 5.�-kr-4-r- � Suite_ ___ ME
Contact Person --_- ---- Ph(—) 9 P. e 0�3
Contractor Ph(----) -- - sW' ;2va-
BUILDING Tonant/Owner - _ ELG
Footing ELC
Foundation
Access: � E R
Ftg Drain 9 e7 -_ -
Crawl Drain - SIT
Slab Inspecti otes: �� 'r --
Post&Beam
Shear Anchors - -
Ext Sheath/Shear
Int Sheath/Shear
Framing -- — --
Insulation
Drywall Nailing -- —
Firewall
Fire Sprinkler --
Fire Alarm
Susp'd Ceiling ---
Roof
Other:
Final --- - - - - — -
PASS RT FAIL
i'
MEFSlab -- -- -
Hough-In
Water Service — -
nTta�Y
Rain Drains - - - — -- ' —
Catch Basis i/Manhole
Storm Drain _
Shower PaLl -
Other: . -
F'
naL
PAS PART FAIL ----- �`---`-_ -.— ------------_._-�_____
VEI
HANICAL- _ ---- -_s-- — -----.____-__------
Post&Beam —
r Rough-In --
Gas Line
Smoke Dampers - - -
Final
PASS PART FAIL -- -- -- - --
ELECTRICAL
Service
Rough-In ------ ---- --__- -..
UG/Slab
Low Voltage _ -_— _ ----------____� --- --
Fire Alarm
Final F] Reinspection fee of$__-____ __required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ '- Please call for reinspection RE'_— ______._-_._6_._ E] Unable to inspect-no access
Fire Supply Line
ADA I1i
Approach/Sidewalk DAftj !� - Inspector --__—_Ext-_
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BLIP
Received _�_— ate Requested � –AM .-_ PNI", --- BUP _
Location __�__LS��{ _�__,� _�__.Suite._. _ MEC _
Contact Person . ._._ Ph(—.-..---) ___ PLM O GL(3�
Contractor s^� Ph(_.._,._) _.__ SWR
BUILDING Tenant/Owncjr ^ __ ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Dain -- - --
SIAh Inspection Notes: SIT
Post&Beam
Shear Anchors -a---�-�
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - -- --
Firewall
Fire Sprinkler - - - -- - --- -
Fire Alarm
Susp'd Ceiling -- - ----
Rc f
Other:
Final
00PstW&S!!q8P S FAIL - -
Under Slab -
Rough-in
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
FZ�SS ----------------
PART FAIL
MECHANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers - —- - -- -- --- - -
Final
PASS PART FAIL -- - -- ----
ELECTRICAL
Service -
Rough-In _ - -
UG/Slab
Low Voltage
Fire Alarm
Final ElReinspection fee of$-_ required before next Inspection. Pay at City Hall, 12125 SW Hall Blvd.
_PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk n�_UA 4� RnflNolOr--- --—
Other:
Final DO NOT (REMOVE this Inspection record from the Job site.
PASS PART FAIL
invoice.
Date
Address 1. I6 S-("') ?'0Se_U'(!5TA r Phone_ 7� 'P�('
tz
city—.
Initial On Acct.
State _Zip Code
Price Amount
NOT RESPONSIBLE FOR DAMAGES PAST CURB LINE OR LANDSCAPING
• A service charge of 1.5%will be levied on all past due accounts. Total:
• Returned check fee is$20.00.
• In case suit, ction or arbitration is instituted by either party for breach or to enforce any
provisions h n,the court shall award reasonable attorney's fees and actual costs to the
prevailing pa ht trial or arbitration, or upon any appeal taken therefrom.
AApro I to
-AS-z
cust&ner Signature
P.O. BOX 1136 • Canby, OR 97011 DEQ#37464