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11090 SW Fonner Street
CITYO F T I GAR D SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00090
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2112/02
PARCEL: 2S 103AD-00801
SITE ADDRESS; 110530 SW FONNER ST
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE' SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit. Septic tank to be removed, or pumped, filled and instection.
)wner: FEES _
MICHAEL B, MERRIUAN Type By Date Amount Receil-t
11090 SW FONNER
TIGARD, OR 97223 PRMT CTR 1112102 $2,300.00 27200200000
INSP CTR 2112102 $35.00 27200200000
Phone: Total $2,335.00
Contractor:
Phone:
Reg #:
Regi.1red Inspections
newer 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 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Perm
Issued by:/IA ,f ���:{ ./: Y Permittee Sic nature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needel tare text business day i
CITYOF TI GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00042
"
13125 SW Hall Blvd., l igard, OR 97223 (503) 639-4171 DATE ISSUED: 2/12/02
SITE ADDRESS: 11()1-1 S1,N 177ONNER ST PARCEL: 2S103AD-00801
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: At_ V GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: `)F WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: P3 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: f5 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 65ft. sewer line. Plumbing will be reversed.
Owner: _W_ -FEES --
Type By Date Amount Receipt
MICHAEL B. MERRIGAN 97223 PRr�T CTR 2/12/02 $117.50 :7200200000
TIGARD, OR 97223
11090 SW F 5PCT CTR 2/12/02 $9.40 27200200000
Total $126.90
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone 1: Sewer Inspection
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION; Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: , ti0l, Z _ Permittee Signature: : G�L
Cai: (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day
Plumbing Permit Application
Date received: j U Permit no.:
City Of Tigard ,ewer permit no.: Building permit no.:
An1111 MAL Addrem; 13125 SW I lall Blvd, I iy,m],OR 923
Phone. (503) 639-4171 / I ( - ) Project/appl.no.: Expire date:
Fax: (503) 598-1960 ' / Date issued: By: Receipt no,:
Land use approval: � Case file no.: Payment type:
U I &2 family dwelling or accessory U Commercial/indusvial U Multi-family 711fcnanl impr venlenl
U New construction U Ad,lilinn/alteralion/replacement U Food service l r illu t j
Il 1
5/v �,v.�>�� >f //llyi�D LcstripNutt (ltc. FCe(s'9.) I War
Jub ad.Iress: //D 9C — New 1-and 2-family dwellings only:
Bldg.ne.: Suite no.:
(includes lOOft.for each utllityconnection)
Tax map/tax lot/account no.: �-3OZ SFR(1)bath
Lot: 'Z Block: Subdivision: SFR(2)hath —
Project
_ name: A, � _ SFR(3)bath
City/county: /te,*W ZIP: C7 7ZZ :r Each additional hath/kitchen
Description and location of work un premises: 46&,e uo& 7V _ Siteutllities:
72(e"0 S__"e7t _ Catch basin/area drain
list.date of completion/inspection: Z /$—D 7— Drywells/leach line/trench drain
1 Footing drain(no.lin. ft.)
Manufactured home utilities
Business name: 0 JIUB. Manholes
AddreFs: Rain dr&n connector _
City: State: ZIP: Sanitary sewer(no,lin,ft.)
Phone: I Fax: I E-mail: Storm sewerr(no.lin.ft.)
CCB no.: I Plumb.bus.reg.no: Water service(no. in.ft.)
City/metro lic.no.: - Fixture or Item:
Contractor's representative signature: Absorption valve
Bac flow prcvcnter
Print name: Date: as, Backwater valve
Basins/lavatory
Name: Clothes washer _
Address: (J D (,C) Dishwasher ---
Drinkin fountain(s)
City: state:O ' 7.fP: 7ZZ
_� Ljectors/sump
Phone: (e Fax: I 1i-mail: x ansion tank
Fixturc/sewer cap
Name(pdnt):/y/G,s/,�¢r<� /GqI� Floor drains floor sinks/hub —
Mailing address: //U 9y 54C.., �✓iv� T HoseGarbage bili sal
Nose Bibb
City: T/G,gf2/� Statcz'yie ZIP: 9 zt 3 Ice maker
Phone: G -979,e Fax: E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the mnintenance mid repair made by my regular Roof drain(commercial)
employee on the property I ow ns ler ORS Chapter 447. Sin (s), asin(s),lays(s)
Owner's si nature: Date: Z'1Z0z Sump
Tubs/shower/shower pan
r Irinal
Name: Water closet _
Address: State: ZIP: Water heaterCity —
Add
Phone: Fax: E-mail:
Not all Jurisdictions accept credit cards,please cell jurisdictinn for mune information. Notice:This pertnit application Minimum fee.... ...........$ / 7. !i V
O Visa p MasterCardexiPlan review(at ! %) $ .
Credit card number: _-_.-- -- — _L--- within
if a permit is not obtained
18o days atter it has been Slate surcharge(896)....$ ----�,=tie•
accepted as complete. TOTAL .......................$
Narne of cardholdet u shown on credit card
_ s _
-- Crud;tolder sl f"ture Amouni 4404616(61000MM)
PLUMBING PERMIT FEES:
PRICE 70T�L New 1 and 2-family dwellings only:
FIXTURES Individual r QTY eaq AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sint,
-5----�-► 1660 the dwelling a mu the ti.�t100 ft. QTY (ea) AMOUNT
for b
Lavatory utility,connection
16.60 One(1 --. -- $249.20
Tub or Tub/Shower Comb. 16.60 Two(2)bath _ $350.00
�.
Shower Only 16.60 Three 3 bath $399.00
-
Water Closet 4 16.60 - SUBTOTAL
Urinal 16.60 F 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL _
TOTAL
Garbage Disposal 16.60 ---
Laundry I ray 16.60
t Dashing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3^- 16.60
4" 1660
Water Heater O conversion O like kind 16.60 Quantity b f Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit.
-_ Ca ed
MFG Home New Water Service 46.40 Sink
Mi G Home New San Slnrm Sewer 46.40 Lavatory -
_ Tub or Tub/Shower
Hose Bibs 16.60 Combination
Hoof Drains 16.60 Shower Only
Drinking Fountain 16,60 Water Closet
Urinal
Other Fixtures(Specify) 16.60 Dishwasher-
Garbage
ishwasherGarbs a Disposal
Laundry Room Tray -
Washing Machine
Floor Drain/Sink: 2"
Sewer-1 st 100' S 55.00 .S S�,_ 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 6 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 (L`, 62.50 5e
Requested Inspoctions ((� 1l1 or/hr BIZ COMMENTS REGARDIN(�ABOVE:
Rain Drain,single family dwelling 65.25 - -
Grease Traps 18.60 i --
QUANTITY TOTAL
Isometric or riser dlagrem Is required It
Quantity Total is >e
SUBTOTAL S
d%STATE SURCHARGE 9 40
"PLAN REVIEW 5%OF SUBTOTAL
Require, 11If fixture qty.total Is>9 _
TOTAL a�zG q0
"Minimum permit fee Is$72 50 4 8%state surcharge,r■cept Rnsidential Bacl,fiow
Prevention Device,whlrh Is$3625+e%state surchnrge
"All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for pian review.
I:\dsts\forms\plm fees.doc 12/26/01
_ENGINEERING PERMIT
/ CITY OF TIGARD PERMIT #: ENG2002-00007
DEVELOPMENT SERVICES PRIM. PERMIT#: ENG2002-00007
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 2/13/2002
SITE ADDRESS: 1 1090 SW FONNE_R S1 PARCEL: 2S103AD-00801
ZONING: R-4.5
SUBDIVISION:BLOCK: LOT: JURISDICTION: TIG
PERMIT TYPE: SOP PUBLIC IMPRV QUANTITY LIN FT VALUE
AGREEMENT DATE: GRA/EROS:
ASSURANCE EXPIRATION _ STREET:
-- - SAN SEW:
PERFORMANCE: STM SEW:
MAINTENANCE: PATHWAYS: "
ALL OTHER: "" $800.00
TOTAL: $800.00
Remarks: STREET OPENING, TO TAP AN EXISTING PUBLIC MAINLINE AND INSTALL ASIDE SANITARY-SEWER
SERVICE LATERAL.
FEES
Owner:
MICHAEL B. MERRIGAN Type By Date Amount _Receipt
11090 SW FONNER OPEN CTR 2111/2002 $150.00 272002000C
TIGARD, OR 97223 BOND CTR 2/1312002 $800.00 272002000C
Total $950.00
Phone:
Engineer:
Phone: REQUIRED INSPECTIONS
STM/SAN SEWER STREET_
Permittee I Applicant: MH/CB/CO CRB LINE & GRADE
PIPE LN & GRr SUBGRADE
BCKFLL & Ch BASE ROCK
AIR & TV TEST LEVEL COURSE
WEARING COURSE
TRAFF & PED CONT
Phone: GRADING
MONUMENTAI'ION
CONTOURS STREETLIGHTING
DRAINAGE WALK/APRON/RAMP
Permittee/ EROSION CNTL.
Applicant
Signature
� REPR'SIADJ'S __PATHWAYS
Issued y i/ _
C J�
FOR INSPECTIONS, CONTACT THE CITY OF TIGARD,
SPECIAL CONDITIONS. (SEE ATTACHED) ENGINEERING DEPARTMENT, AT: (503) 639-4171
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171 /f
(/ /y 3i1P _
Received - --Date Requested _-�� AM.�_. PM �--/ BUP -.---
Location z 6)21) /F D,v Suite MEC _
Contact Person --_ Ph( ) lyePL _
Contractor —_ _ Ph( _) _ SW 'D 00�}
BUILDING Tenant/Owner _ — ELC
Footing _
Foundation Access: ELC
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SIT _
Post&Beam
Shear Anchors -------- -_ �------ -- -
Ext Sheath/Shear
Int Sheath/Shear -
Framing
Insulation 1
Drywall Nailing
Firewall
Fire Sprinkler - ---- - - -
Fire Alarm
Susp'd Ceiling ------ -- - -- - -
Root
--
Final -- -
PASS PART FAIL -- ---``- --'-
PLUMBING
----- -----
Post& Beam --
Under Slab _-
Rough-in
Water Service - ----- - -- -
�a a �ew�
airti'TDP�T s --- -___--- ----.- -
Catch Basin/Manhole
Storm Drain ----- -------
Shower Pan
Othor: --- -
Fina --------- -
SS - ART FAIL
MECHANICAL--
Post&Beam -------------_- -
Rough-In
Gas Line
Smoke Dampers ---- - - - -- - - - -
Final _-_...- -- --_ ---- -
PASS PART FAIL --- - -__ -_--- - - ---------
ELECTRICAL—
Service
Rough-In
UG/Slab -
Lnw Voltage
Fire Alarm
Final Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE -- [] Please call for reinspection HE: Unable to inspect-no access
Fire Supply Line
ADA �^ 1
p�t�
Approach/Sidewalk �--� I L Inapeotor _ EXI� `
Other:
Final — �- 00 NOT REMOVE this Inspootlon r000rd from the job,alto.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Lina: (503)639-4176 MST
INSPECTION DIVISION Business Line: (503)639-4171 BUP
Received
_ __ Cate Rested__ ��._ AM __-- PM BLIP — - _-- _----
Location ._l�__- -,� '' Suite MEC —
7�Yi-tl -�-�-.P 111 Q>1U.ckc Ph I �L =r�cc yZ
Contact Person — - ( ) vv) L-� -
Contractor _—. __ -_ _ Ph( ) - -
SWR
BUILDING TenantlOwner —_ ._ _ ___. ELC
Footing ELC
Foundation Access:
Ftg Drain ELF!
Crawl Drain SIT _
Slab Inspection Notes.
Post&Beam -
Shear Anchors
Ext Shoath/Shear _ ---
Int Sheath/Shear
Framing -
Insulation —_
Drywall Nailing -- —
Firewall ---
Fire Sprinkler --
Fire Alarm
Susp'd Ceiling
Roof __ ---
Other:
Final -
PASS PART FAIL
Post&Eeam -_--
Under Slab — — --
Rough-In _
Wator Service - —
trrDrefrf�"��-- _ _ —
Catch Basin/Manhole
Storm Drain
Shower Pa
PART FAIL
MFCHANICAL -- --
Post&Beam
Rough-In --- ---
Gas Line
Smoke Dampers --
Final
PASS PART FAIL -
ELECTRIGAL -- -- ---- —__
Service
Rough-In -
UG/Slab
Lov:Voltage --------
Fire Alarm
Final u Reinspection fee of$ --required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
F]SITE Please call for reinspection RE:— ___� Unable to inspect-no access
Fi-e Supply Line /')// /fir,i
ADA Dst / �� Ilnspector _ `'_ --'"�`--- - - ---- �
Approach/Sidewalk
Other: _ _
Final DO NOT ItEMOVE this Inspection record from the Job site.
PASS PART FAIL