InitiallyGood 14825 SW 104'x' Avenue
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2�02-00121
-� 13125 SW Hall Bled., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/1 1/02
SITE ADnRESS• 14925 SW 104TH AVE PARCEL: 2S1—iCB-01310
SUBDIVISION: DEL MONTE SUBDIVISION NO.2 ZONING: R-3.`;
BLOCK: LOT: 019 JURISDICTION: TIG
TENANT NAME-
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: SF NO, OF BUILDINGS:
INSTALL TYPE: LTi':iWR IMPERV SURFACE:
Remarks: Sewer connection. Reimhursement district#16 PAID 11-30-00, Receipt#2000-1425.
Owner: _ FEES _
BAKER, JOHN G y Type By Date Amount Receipt
BRADSHAW-BAITER, LEANNE
14825 SW 104TF AVE PRNIT CTR 3/11/02 $2,300.00 27200200000
11GFRD, OR 97'224 INSP CTR 3/11/02 $35.00 27200200000
Ph w L�-- Total $2,335.00
Cco,rtract,,.,,
Phone:
Reg#:
Required Inspections
Sewer Inspection
Septic Tank Filled
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 fleet In ail directions from the distance given. If not so located, the installer shall purchase a"Tap and
aide Sewer' Permit and the 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: - _ t�� Permittee Signature: �st.µ''^�
Coll (5111,?) 639-4175 by 7:00 P.M. for an Inspection needed the next business day
CITYOF T I G A R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: P 11/02 00085
DATE ISSUED: 3111/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S111CB-01310
SITE ADDRESS: 14825 SW 104TH AVE ZONING: R-3.5
SUBDIVISION: DEL MONTE SUBDIVISION N0.2 JURISDICTION: TIG
BLOCK: LOT: 019 _-- - —
MOBILE HOME SPACES:
CLASS OF WORK: ALT GARBAGE DISPOSALS: BACKFLOW PREVNTRS:
TYPE OF USE: SF WASHING MACH:
FLOOR DRAINS: TRANS:
OCCUPANCY GRP: R3 CATCH BASINS:
STORIES: WATER HEATERS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URIN/SLS: GREASE TRAPS:
L AVATORIES. OTHER FIXTURES.
TUB/SHOWr:RS: SEWER LINE: -100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHE?S: RAIN DRAIN: ft
Remarks: Sewer line work for sewer connection. Less than 13-00 I f.
Septic tank to be removed, or pumped, flied and inspected.
_ FEES
Owner: Type By Date Amount Receipt
BAKER, JOHN G + PRMT CTR 3/11/02 $72.50 27200200000
BRADSHi1W-BAKER, LEANNE ,PCT CTR 3/11/02 $5.80 27200200000
14825 SW 104TH AVE - - Total $78.30
TIGARD, OR 97224
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: Final Inspection
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
o
Specialty Codes and all other applicable laws. All work will be done in accordance with app 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 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: c,, �«
Permittee Signature °
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day
Plumbing Permit Application
Dacereceived!�, r PennitnOR/ —
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City ofTigard phone: (503)6394171 Projec/appl.no.: Expircdate:
Fax: (503)598-1960 Date isr,ued: R Receipt no.:
Land use approval: case file no.: Payment type:
TYPE,6F-PERAI IT
1 &2 family dwelling or accessory J Coniniercial/industnal J Multi-lardy U Tenant improvement
U New construction lJ/1rlr}iiiun/altcrttuji/rclilarrmrnl J Food service U Other:
W11:0 Z 14T MEMO R, IN r
!nb arihess: ( t{ Ucscri�tion _ l)tt�'. heti(ca.) "Tota!
--- - -- NcN 1-ant!2-Minily INellingsorty:
Bldg.no.: _- Suite no.:
- ------ --- (includr�s tUU A.fur each u41i1 y connr•ctinul
Tax map/tax lot/account no,: - SFR(1)bath
Lot: —�QloA: Subdivision: _ _ SFR(2)bath _
Project name: - SFR(3)bath
City/county: ZIP: Each additional bath/kitchen _
Description and location of work on premises:_. _ Sitentilities^
Catch basin/area drain
Est.date of compldion/inspe coon: Drywells/leach line/trench drain
Footing drain(no.lin.ft.)
Manufactured home tdilities
Business name: _ -) I L' Manh(•les
Address: Rain drain connector
City: --� State: ZIP: - Sanitaty sewer(no.lin.ft.)
Phone: - --TFax: I E-mail: Storm sewer(no.lin.ft.)
CCB no.: Plumb,bus.reg.no: Willer service(no. lin.ft.)
City/metro lic.no.: _ Fixture or Item:
Absniption valve
Contractor's representative ,1r1 .0nre_ _ Back flow preventer
Print
a
I1i1" Backwater valve
K1101Basins/lavatory -
Name: Clothes washer
- Dishwasher
mm
Address: Drinkingtountain(s)
City: State: LIP: Ejectom/snn)
Phone: Fax: E-mail: Expansion tank
Fixture/sewer cap
Name(print): ria On le '!ex it c%S hG w-SSa ll P ►' Floordrains/floor sinks/huh
Garbage disposal
Mailingaddress: /yj*zS' St✓ 10'Y + /4 V Hose bibb
City: `j I qa r el k1e:0K_ ZIP: q,72 7_ Ice maker
Phone::.4 s16-48' 7 1 Fax: So I E-mail: Interco tor/ rease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will he 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. Sin (s), asin(s),lays(s)
Ownces si nature:,", w� c3r.r�la� Date: i i� _ Sum
Tubs/showcr/shower an
_Urinal
Name: e—_ _
Water
Address: Water heater
City: State: ZIP: Other: �Jv
Phone: Fax: E-mail: obt
Na oil Juridktla i kept Credit crrL,Piew c111 Jurimdictlon•a mae infannlrtlnn. Minimum fee............ ) $ �,J rjG
Notice:This permit application Plan review(al _ 96) s
U Visa U MutetCard expires if a permit is not obtained l
Credit cmd number._ within 180 days after it has been State surcharge(8%) ....$
None of curia-inkier u shown on credit crd
A fe• accepted as complete. TOTAL .......................$ -24? ?10
_ _S
cardholder signature Amount 4404616(6AWOM)
PLUMBING PERFMIT FEES:
--- PRICE 70TAL f'^.w 1 and 2-famlly dwellings only:
includes all plumbing fixtures Ir PRICE TOTAL
F)XTURES individurl QTY ea AMOUNT 1 p AMOUNT
16.60 the dwelling and the first100 ft. QTY deal
Sink — for each utility connection) - -
16.80 One(1)bath $249.20
Lavatory — _ $350.00
Tub or Tub/Shower Comb. 16.60 Two 2 bath — $399.00
16.60 Three 3)bath —
Shower Only SUBTOTAL
Water Closet 16.60 —
Urinal 16.60 8%STATE SURCHARGE
1660 PLAN REVIEW_25%OF SUBTOTAL
Dishwasher TOTAL
_TOTAL
Garbage Disposal
Laundry Tray
16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60 —
4" 16.60 -- Quantttyb Work Performed _
Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Replaced Removed!
Gas piping requires a separate mechanical -- lapped
ermit. 46.40 Sink
MFG Home New Water Service Lavato
MFG Home New San/Storm Sewer 46.40 Tuh or Tub/Shower
Hose Bibs 16.60 Combination
16.60 Shower Onl
Roof Drains _ Water Closet
Drinking Fountain 16'60 Urinal
Other Fixtures(Specify) 16.60 Dishwasher —
Garba a Dis Osal —
Laund Room Tra
Washin Machine —
Flour Drain/Sink: 2"
5e war•1st 100' 55.00 'Y
40 4"
Sewer-each additional 100' 46. Water Healer
Weler Service•
at 100' 55.00 Other Fixtures
Water Seryice•each additional 200' 46.40 S ed
Storm&Rein Drain•1st 100' 55.00
Slorm d Rein Drain•each additional 100' 4640
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin
16.60
inspectionof ExlsUng Plumbing or Specially 62.50
or/hr COMMENTS REGARDING AB
Re uested Ina ections 65 25
Rein Drain,single famlly dwelling ___----
Grease Traps _ _
QUANTITY TOTAL '
Isometric or riser diaprarn is required II --_
Ouantlty_ �'Is _�
—" "SUBTOTAL
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL O
Re ulred onlyll fl■tura qty total Is 9 ��
TOTAL
3G"Minimum psm+lt fes Is$72 W•8%stale surctrarge,except Residential Backflow
Prevention device,which Is$36 25•6%s1AlA surcharge ---•�—
"Att Now Commoraisl Buildings require 2 sets of plans with Isometric or riser
diagram for Plan rovlow.
I:Idstslfomts\pim-fees doc 12/26/01
CITY OF TIG ARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
BLIP
Received ___ Date Requested 3 _ AtO PM BUp - -
Location -
Lrg as �� qL-z� --- ---
f� Suite MEC
Contact Person — k ,� Ph( ) 29� l> PLM _
Contractor_. — PhSWR / a
BUILDING — Tenant/Owner _— — ELC
Footing
Foundation Access: '---�'— ELC
Ftg Drain FLR
Crawl Drain ----
Slab Inspection Notes: - SIT
Post&Beam _ _ -
Shear Anchors —
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:--- - --
Final
PASS'"PA FAIL - --
KUMBWa
UM
Under Slab
Rough-In -
Water Service ------.
n
t3iDfw w
-am ---� _
Catch Basin/Manhole
Storm Drain
Shower Pan
PASS PART FAIL ` -
-ICAL
Rough-In
Gasline ----- ----------- --------------
Smoke Dampers - _--- .-----..---__-�- _ _
Fina
PASS PART FAIL. - ----- - - -- ---- - -- --------- -- --
ELECTRICAL
Service — --------- — --- ------- -----------
Rough-In
UC/Slab -- --- - -- --- ----- ----..-
Low Voltage -
Fire Alarm --- — - -------._._._ _
Final Reinspection fee of$—_—. _required before next inspection. Psy at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
S_tT_E _ __ ❑ Please call for reinspection RE:— _ _ _ Unable to inspect-no access
Fire Supply Line ADA / 7Approach/Sidewalk Date - / l ' In+speMor 7-ey-74
-- u—
Other:
Final DO NOT REMOVE this Inspection -ecoid from the job site.
PASS PART FAIL