10450 SW DEL MONTE DRIVE O
.A�
Cn
0
v
m
r
O
z
m
v
i
1
1 '
I
10450 SW DEL MONTE DR.
r CITY OF 1 IGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2000-00101
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/30/2000
SITE ADDRESS: 10450 SW DEL MONTE DR PARCEL: 2S111CR-01307
SUBDIVISION: DEL MONTI= SUBDIVISION NO.2 ZONING: R-3.5
_BLOCK: LOT: 014_ -_�-� JURISDICTION: TIG
CLASS OF WORK: AI_T GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: '0F 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:
TUB/SHOWERS: SEWER LINE: 105 ft
WATER CLOSETS: WATER LIFE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 105'of sanitary sewer line
Own �--------- —_ FEES ----`
CROMBIE, RICHARD D JR + MICHEL Type By Date Amount Receipt
10450 SW DEL MONTE PRMT BON 03/29/200': $70.00 0001047
TIGARD, OR 972.23 L� BON _ 03/29/2001 _ $2.80 0001047
Total $72.80
Phone 1: — `- ----
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Sewer Incpection --
Reg #: Final Inspection
ORIGINAL
This permit is issued Subject to the regulations contained in the Tigard Municipal Code, Stat of OR.
Specialty Codes and all other applicable laws. All wr ., - 11 be done in accordance with aporoved plans.
This permit will expire if work is not started within 18J .ccs of issuance, or if wo,k is suspended for more
than 180 days. ATTENTION. Oregon law requires you to follow rules adopted by the O egon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001 -0080.
You may obtain copies of these rales or direct questions to OUNC by calling (503) 246-1987.
Issued By: � Permittee Si nature: --, � /i
-�- — gc L
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next usiness day
ITY OF TIGARD Plumbing Permit Application Plan Check 1 _
3126 SW HALL BLVD. Commercial and Residential Recd By ex _
IGARD, OR 97223 Date Recd Zt1^n
503) 639-4.171 Date to P E.
Print of- Type Date to DST
Incornplete or illegible applications will not be accepted Permit# (" r?tom=
Related SWR#._'Z� I
Called_-
.__ -
Name of Devclopmentfl roject FIXTURES (individual) QTY PRICE AMT
Job Sink, �- 11.W
Address Street Address - Suite Lavatory Y 11.50
5 k.' Ck 10 feL_- _ Tub or I jb/Shower Comb - 11.50-
Bldg City/State Zip Shower Only -T !11.50
Name J Water Closet 11.50
j)l 1 C Ft f C q'- d r! ,KCr 14. F Urinal -- - -- 11.50
Owner Mailing Address Suite Dishwasher 11.50 -
/C 1j(/ /1/0: f G Garbage Disposal 11.50
City/State Zip Phone - -
_ 711 6s r� (0���•�i SSS Laundry Tray - 11.50
Nawe Washing Machine/Laundry Tray 11.50
Floor Drain/i-loor Sink 2" 11.50
Occupant Mailing Address Suite 3" �- 11.50
-
City/State lip Phone 4" 11.50
Water Heater O conversion O like kind 11.50
Name Gas p,ping requires a separate mechanical permit.
(A,;A fir i MFG Home New Water Service - 32.00
Contractor Mailing Address Site MFG Home New San/Storm Sewer 32.00
Hose Bibs 11.50
Prior to permit City/Slate Zip Phone Roof Drains 11.50
Issuance,a copy )j C -
Drinking Fountain 11.50
of all licenses are Oregon Const.Cont.Board LIc.# Exp.Date _ _ _
required if Other Fixtures(Specify) 15.00
exp!red'i COT Plumbing Lic 0 Exp.Date
database ---- - �`
Pame
Architect Sewer-1st 100' 38.00 '
or Mailing Address ulte Sewer-each additional 100' 32,-.n
Cil (Stale Zip Phone Water Service-1 sl 100' 38.00-
Engineer y p Ser --
Water vice-each additional 200' 3200,
Describe work to be done: Storm&Rain Drain-1st 100' 38.00
New U Repair O Replace with like kind Yes O No O Storni&Rain Drain-each additional 100' 32.00
Res!dential O Commercial O --
Additional description of worker - Commercial Back Flow Prevention Device - 32.00
Residential Backfiow Prevention Device' 19.00
( itch Basin 11.50
Are you capping,moving or replacing any fixtures? Insp of Existing Plumbing or Specialty Requested 50.00
Yes O No J Ins eraions prrtv
If yes, see back of form to Indicate work performed by Rain Drain,single family dwelling 4500
ti:fs-re. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps - 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. _ - _- QUANTITY TOTAL
Thereby acknowledge that I have read this application,that the information
given Is correct,that I am the owner or authorized agent of flip owner,and Isometric o.riser diagram is required n Quantity Total is >9
that l submitted are in compliancp with Or State Laws "SUBTOTAL. 3,
Slghature of Owner/Agent Date -- -- -
�'- ? 8% SURCHARGE
r°1)
Contact Person Name Phone `
"PLAN REVIEW 25% OF SUBTOTAL
1 TH HOUSE$178.00 r r t 1' nutred only X fixture qty total is>9 _-To
;SQA OUSE, 50 00 s ' s f TOT
)2AL.
PYA OVSSOs285
ti ncludeaF i u Mb{gig ureE In to III *Minimum Permit fee Is W+8%surcharge.except Residential Backflow prevenlon
seWe1Rtorirl s rid YVatera Device vmKh Is$25.6%surcharge
-All New Commercial Buildings require plans with ma rietric or nser diagram and
ptan review
1 Ustsv,xmstpkxnapp doc t t 11 W
PLEASE COMPLETE:
Fixture Type Quantity by Work !�Ierformed -New Moved Replaced Removed/Capped
Sink _.. ------ -----_ -- _--
Lavatory —— -- -- -- -- -- - ---- — — - -
Tub or Tub/Shower Combination
Shower Only _--
Water Closet.
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray __--
Washing Machine
Floor Drain/Floor Sink_ 2"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
dl,wtlfmf(1A,'-i9(KdX,InfNM
CITYSOF TIGARD► ^SEWER CONNECTION PERMIT
UEVELCPMENT SERVICESPERMIT#: SWR2000-00059
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/30/2000
SITE ADDRESS; 10450 SW DLL MONTF DR PARCEL: 2S111C13-01307
SUBDiVISION: DE! NlONTE "'UBDIVISION NO2 ZONING: R-3.5
BLOCK: — LOT: 014 JURISD,CTION: TIG
TENANT NAME: CROMBIE, MICHELE & DOUGLAS
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF NO. OF 9UILDINGS: 1
INSTALL TYPE: I_TPSWR IMPERV SURFACE:
Remarks: Connecting to sanitary sewer. Reimbursement District#16 fee paid. Septic tank must be pumped,
filled, and inspected.
Owner: T � FEES _
CROMBIE, RICHARD D JR + MICHEL Type By Date Amount Receipt
10450 SW DEL MONTE — —
TIGARD, OR 97223 FRMT BON 03/29/200C $2,300.00 0001047
INSP BON 03/29/200C $35.00 0001047
Phone: ! Total $2,335.00
i --
Contractor:
Phone:
Reg #:
Required 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 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 A;ractions from the distance given. If not so located, the installer shall purchase a"Tap and
Side Sewer' Permit and t,, 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: Permittee Signature:� d —
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next bUlsiness day