11405 SW 95TH AVENUE 11405 SW95"' Avenue
CITYOF TIGAR D _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00609
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/16/01
PARCEL: 1 S135CA-02200
SITE ADDRESS: 11405 SW 95TH AVE
SUBDIVISION: BOETCHERS ADDITION ZONING: R-4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR GA.RRAGE 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-
TUB/SHOWERS: SEWER LINE: 130 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN. ft
Remarks: Connect existing residence to sewer lateral.
FEES
Owner:
Type By Date Amount Receipt
RODGERS, TERRY O AWj CHERYL
c/o MURO, DANIEL AND <ELLY — —
11405 SW 95TH Total
TIGARD, OR 97223
Phone 1:
Contractor: _
MOORE EXCAVATION INC
PO BOX 30569
PORTLAND,OR 97294-3569 REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: 503-252-1180 Final Inspection
Reg #: LIC 28397
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 H Ith 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 952-0001-00 10 through OAR 952-0001-0080.
You may btain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Iss d By: l -+`✓QL _ Permittee Signature: SOA i
Call (503) t3, 9-4175 by 7:00 P.M. for an inspection needed the next business day
F0
Plumbing Permit AppliaAion
Date received: Permit no.:/U J;;"w/-
City of Tigard Sewer permit no.: Building permit no.:
Address: 1312.5 SW Hall Blvd,Tigard.OR 97223 Prajccdappl.no.: Expire date:
City4Tigard Phone: (503) 639-4171
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Case file no.: Payment type:
Land use approval: _
t
1 &2 family dwelling or accessory U Commercial;industrial U Multi-family U Tenant improv.ment
New construction U Addilion/alteration/replacenient U Food service U Other:
Descrlptlot. Fee(La.) Total
Joh address: Q S W 5 --- New 1-and 2-family dr,ellings only:
Bldg.no.: Suite no.: (includes 100 ft.foreacautilityconnection)
Tax map/tax lot/account no.: —77_ SFR(1)bath
Lot: Block: Subdivision: SF'I2(2) at _
Project name: Oct,M I')'I ,� Lc,„„e,>�tit'c� SFR(3)bath
City/county�r ��_(�1 ct ZIP: q 72 Z-3 Each additional hath/kitchen
Description and k ation of work on remises: S”k we _ Slteutilities: —
+r. � _GL/ Catch hasin/area drain _
wells/leach line/trench drain
Est.date of completionlinspection: Footing drain(no.lin.11.)
PLUMBING t Manufactured home utilities
Business name: /yJ rx r E c Manholes
Address: '?O O E f C-1 Rain drain connector _
City: State: b(t ZIP: H y Sanitary sewer(no.lin.ft.)
Fax: E-mail: Storm sewer(no.lin.ft.)
Phone:.2 5� - // -D Water service(no.lin.ft.)
CCB no.: 2 s?'3 rt Plur b.bus.reg.no: Fixture or Item:
City/metro tic.no.: Absorption valve
Contractor's representative signature: Back flow reventer
Print name: - Date: Backwater valve
Dasins/lavntory
Clothes washer
Nana•: Dishwasher _. _—..
Address: Drinking fountain(s)
Citv: State: ZIP: E'ectorslsum
Phone: Fax: Email: Expansion lank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name(print): Garba a dis sal
Mailing address: p � Hose hibb
City: -7- 4,,, State: ZIP: 23 Ice m
PI � a er
P � -ax: E-mail: Interco tort nage tra i
Owner instullation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular R(rof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
O5vncr's sir�nattire: Date: Sum
Tubg1shower/shower Pan
Urinal
Nance: Water closet
Address: Water heater
City: State:J_ ZIPi _ Ocher:
Phone: Fax: Email Tots
Minimum fee................$
Not all juricdlctiom accept credit cards.please call jurisdiction for mom Information. Notice:This permit application Plan review(at _ %) $ —.—
U Visa U Mastercard expires if a permit is not obtained State surcharge(8%)....$ .
Credit card numher. _��—_�_.�--- —1—1—— within 190 days alter it has been
t:spires accepted as complete. TOTAL .......................$
.�—
Name of car oder asihowri a+rree it card s
Cardhul r sl`rtature Amount /4041516 eblfx)1('OMI
PLUMBING PERMIT FEES:
T PRICE TOTAL_ New 1 and 2-famil;dwellings anhl:
FIXTURES (individual) - I QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. I QTY (ea) i,MOUNT
Lavatory 16.60 for each utility connection)
_
Tub or 1 ublShower Comb. 16.60 One 1 bath $249,20
Two 2 bath $350.00
Shower Only 16.60 Three 3 bath _ $399.00
Water Closet 16.60 -
Urinal 16.60 SUBTOTAL
8%STATE SURCHARGE
Dishwasher 16.60 _ PLAN REVIEW 25%OF SUBTOTAL_
Garbage Disposal 16.60 __ _ TOTAL
Laundry Tray 16.60 - T
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" - 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater O conversion O like kind 16.60 _ Quantity b Work Performed`
Gas piping requires a separate mechanical Fixture Type: NowTMoved Replaced Removed/
permit.
Capped
MFG Home New Water Service 46.40 Sink
MFG Home Now San/Storm Sewer 46.40 Lavato
1 ub or Tub/Shower
Hose Bibs 16.60 _ Combination _
Roof Drains 16.60 Shower Only _
Drinking Fountain 18.60 Water Closet
Other Fixtures(Sp icify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Sewer- 1st 100' - 55.00 Floor Drain/Sink: 2"- 3„
Sewer-each additional 100' 46.40 4"
Water Service-1st 100' 55.00 Water Heater
Water Service-each additional 200' 46.40 Other Fixtures
StormR Rain Drain-let 100' 55.00 (Specify)
Storm 6 Rain Drain-each additional 100' 46.40
Commercial 3ack Flow Prevention Device 46.40
Residential lackllow Prevention Device" 21.55
Catch Basi 1 16.60 -
Inspection of Existing Plumbing or Specially 72.50
Re nested Inspections perthr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL ------- -
Isometrk or neer diagram Is required If - - --
__ Quantity Total Is >D
'SUBTOTAL
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Required only If nrture qh total is>0
TOTAL $
"Minimum permit too is$72 50+8%state surcharge,e•,cepl Residential Backflow
Prevention Device,which Is$35 25 4 8%stale sunt arge
"AIL Now Cominorcial Bulldhrps require pto,-c with Isometric or riser diagram and
plan review
I:\dsts\formsWm-fees.doc 10/10/00
CITY OF TiGARD BUILDING INSPECTION DIVISION
24-Hour InspectL n Line: 639-4175 Business Line: 639-4171 MSI'
BLIP
Date Requested _ AM PM BLD
Location Suite — MEC
Contact Person s u Ph - ` -G' p 1y'?� PLM Z dO/ 06 (, O ct
Contractor Ph SWR
BUILDING Tenant/Owner _ ELC
Retaining Wall ELR
Footing Access:
Foundat`nn /
Ftg Drain r,,¢yti FPS _
Cra"I Drain Inspe ton Notes: D-o SGN
Slab �L —_ �___ SIT —� —
Post&Beam __
Ext Sheath/Shear
Int Sheath/Shear —
Framing
Insulation —
Drywall Nailing
Firewall ----
Fire Sprinkler _
Fire Alarm '— --
Susp'd Ceiling
Roof � — ---
Final — — — —
PASS PART FAIL
PLUMBING —----- —__
Post&Beam - ------ ____
Under Slab
Top Out --
Water Seww
nits S - — ---—----
ins
ART FAIL
Mft7ANICAL
Post& Beam
Rough
---._-
Rough In —
Gas Line
Smoke Dampers —
Final
PASS PART FAIL
ELECTRICAL - -
Service
Rough In ---_—___--_--- ------ —_ _..
UG/Slab _
Low Voltage
Fire Alarm —�
Final --
PASS PART FAIL
SITE _
Backfill/Grading - —
Sanitary Sewer
Storm Drain ( ) Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ 1 Please call for reinspection RE _ _ _ ( )Unable to inspect-no access
ADA
Approach/Sidewalk �/ T,
Other Datel. --Inspector-y�S'� �1 C Ext
Final
PASS PART FAIL J DO NOT REMOVE this Inspection record from the Job site.
CITYOF TIGARD _ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-00303
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/16/01
SITE ADDRESS; 11405 SW 95TH AVE PARCEL: 1S135CA-02200
SUBDIVISION: BOETCHERS ADDITION
_—_—_BLOCK: LOT: 003 ZONING: R-4.5
_JURISDICTION: TIG
TENANT NAME:
USA NO:
CLASS OF WORK: NEW FIXTURE_ UNIT"-;:
TYPE OF USE: SF DWELLING UNITS: 1
INSTALL TYPE: LTPSWR NO. OF BUILDINGS:
IMPERV SURFACE:
Owner: Remarks: Connection permit for existing residence. Septic is to be pumped, filled and inspected.
RODGERS, TERRY AND CHERYL _FEES _
C/o MURO, DANIEL AND KELLY Type By Date Amount Receipt
11405 SW 95TH
TIGARD, OR 97223
Phone: Total --
Contractor:
Phone,
Racy #:
Required Inspecticns_
ESew:erinspection
nk Filled
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the dale 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
Issed by: /'�` 6�
Permittee ttee Signature: - --
Call(003)039.4170 by 7:00 P.M.for an Inspection needed the next bus
in s day
AALL.PUMP SANITATION SERVICES
Dalko Corp.
191
13023 NE Hwy. 99 v7
Vancouver, WA 98686
(360) 837-2969 Port. (503) 285-5833
CUnTOMER'S ORDER 1,10. PVQNE
R t
-AME
DAZE
ADDRESS
F
StJ
17 -
AAS' A R 101 UE101 ACCP.
1P, P, --i: 7�2,7—� --PAID
—13Y H HAMDSE.RETO rA-16—OU—T
QTY DESCPOPTION
PRIGE AMOUNf
Q
IIi
Ko
03 -X44 - Ftp
this
eJ I ?(),)aes A ft"Ance charge(if I Wk.1*1
rwl annum)will be chAtRod hr,unokiw bdiari—
collecticif I fe"will bA anmod it notmarti, TAX
7TO'
All claims and fettimed U00(ls MOST Im acCOMPAriled by this bill
rA g-j# Trwti.. 'ThankcYou
) � W