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CITYOF T I GA R D PLUMBING_PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2000-00123
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 04/14/2000
SITE ADDRESS: 14504 SW FERN ST PARCEL: 2S104BC-01200
SUBDIVISION: HANDY ACRES ZONING: R-7
BLOCK: LOT: 016 JURISDICTION: URB
CLASS OF WORK: ALT 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:
TUB/SHOWERS: SEWER LINE: 150 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Sanit;3ry sewer line to connect to sewer. Septic tank must be pumped, filled, and inspected. Re-routing of
plumbing unneccessary.
Owner: -- — --� ——
-- Type By Date FEESAmount Receipt
CROSS, SUSAN GAIL + PRM4 BON 04/14/200C $70.00 0001442
JAMES MICHAEL 5PC2 BON 04/14/2000 $5.60 0001442
14504 SVV FERN ST
TIGARD, OR 97223 Total $75.60
Phone 1:
Contractor:
CARL DESHRILIA
19290 SE SEMPLE RD
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone 1: 503-658-7946 Sewer Inspecticn
Reg #: LIC 69884
ORIGINIAI-
This
permit is issued subject to the regulations contained in the ;"igard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be donF in accordance with approved plans.
This perm',will expire if work is not started within 180 days of iss ,e, 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 O JNC by calling (503) 246-1987.
P
issued By: / ( (� �i _ Permittee Signature-
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Recd By A
TIGARD, OR 97223 Date Recd
(503) 639-4171 Date to P E —_-
Print or Type Dale to DST
Incomplete or illegible applications will not be accepted Permit#>,M,rn,- 1z3
p g Related SWR#_'V'— "i
Called,—.---._--
— Name of Development/Project FIXTURES (individual) _ QTY PRICE All
Job Sink _ -- -- 11.5(i
Address Street AddreFs Suite Lavatory 11.50
' 7 S. /. FZ7Tub or Tub-Shower Comb 11.50
Bldg# ty/State ZIP ;Hower Only M 11.50
-- ---- t l4421) :7-) .2- — ---
Name Water Closer 11 eU
-TOMS Ml C/lur_>> Urinal -- — -- 1 50
Owner Mailing Address Suite Dishwasher 11.50
1--4 S 5 Fk,,'14 Garbage Disposal 11.50
C*it(y/State Zip Phone Laundry bray 11.50
Washing Machine/Laundry Tray 11 50
Name
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City/Slate Zip Phone — 11 5(1
Water Heater O conversion O like kind
Gas piping requires a separate mechanical permit —
Name _ MFr3 Home New Water Service i 3200.
—
Contractor Mailing Address Suite MFG Home New SanlSlorm Sewer_ 32 00
�L:. / 1 ,1 Hose Bibs 11.50
Prior to permit City/State Zip PhoneRool Drains 11.50
I
issuance,a copy 1 � r
Drinking Fountain
of all licenses are Oregon Const Cont Board Lic.# Exp.Date15.00
required If
2/7 Other Fixtures(Specify)
expired In COT Plumbing LIc.# Exp.Date _—
database
Name
Architect Sewer-1st 100' — — 38.00
Or Mailing Audres.; Suite Sewer-each additional 100' 32.00
Water Service-1st 100' 38 00
Engineer City/State Zip Phone 32 A0
9 Water Service-each additional 200'
Describe work to he done — Slorm&Rain Drain-1st 100' 38.00
New O Repair O Replace with like kind. Yes O No O Stonn 6 Rain Drain-each additional 100' 32.00
Residential O commercial O Commercial Bac' Flow Prevention Device 3200.
Additional der.criplion of work
Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures' Insp of Existing Plumbing or Specially Requested 50 00
Yes O I!o O Inspections —Y per/hr
If yes, see back of form to indicate work performed by Rain Drain,single family dwelling _ 4500
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 1t 50
WORK COULD RESULT IN INCREASED SEWER FEES. -- QUANTITY TOTAL
I hereby acknowledge that I have read this application,that the information Isometric or riser diagram is required d Ouanuty Totals >9 ��)
given is correct,that I am the owner or authorized agent of the owner,and —-- --_ *SUBTOTAL
that plans submitted are in compliance with_Oragon State Laws, ((-
lnature of Owner/ ent Date ----— 8% SURCHARGE
Crli Person Name Phone -
-�Vl "PLAN REVIEW 25%OF SUBTOTAL
Fe weed onlyit fre
ixtu
1 BATH HOUSE$178.00 �-— --q y
TOTAL
2 BATH HOUSE$250.00
BATTI HOUSE$285.00
(This fee Includes all plumbing fixtures In the dwelling and the first 'Minimum permit fee is$50+8%surcharge,except Residential Backflow Prevention
i 100 feet of sanftery sewer storm sewer and water service) Device.which is$25.8%surctiarge
"Alt New Commercial Buildings require plans with isometric or riser diagram and
plan review
I�d stsdonn slplum nrr y, n,
PLEASE COMPLETE:
Fixture Type QuantRy by Work Performed
New Moved Repiaced 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" —
_Water Heater _ _
Other Fixtures (Specify) —
COMMENTS REGARDING ABOVE:
I Wsts\loan s\{,lum anh dat tIIP/9r,
ALOHA SANITARY SERVICE
RO. Box 309, BANKS, OREGON 97106 �
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§44-2797 648-6254 * 639-5188
AME: rz�6-- -
A ESS. �� cd ltcf �c)O`1 r /w
CITY: f 1 G/) S TAT E: C1 ZIP: �
�JOWORK: CELL:
r;l�-•1/��_._ - - - __ P.O* =_
PAID BY CHARGE 0 CHECK T CASH r) T CREDIT CARD Cl
DATE c - ,1 C, '£' DRIVER ,� t- ^I�a.u� 'lfe�cl AMOUNT
— — T
IAL
PUMP SEPTIC TANK
Li1:1: OPENING --
INSPE TION FEE –
r--
1 SERVICE CALL
1 LABOR, L.ovi1TiNG, DIGGING & BACKFILL
' MATERIAL
---TNfS IS NOT A SEPnC SYSTEM INSPFCTION REPORT--- TOTAL
- - REMARKS - -
TYPE
- REMARKS - -TYPE OF TANK: STEEL 1 CONCRETE 71 PLASTIC 1 HOMEMADE
HORIZONTAL rI VERTICAL Cl RECTANGLE 1 OTHER__
SIZE OF TANK: 350 Cl 501; rl 75Q 1 1000 71 12501 1500 n 20001 30001
LID LOCATION: INLET 71 Ou-rLET rI MIDDLE rI ENTIRE TOP rl
TANK CONDITION: GOOD 71'- FAIR 1 POOR i1
FITTINGS: BAFFLES 1 CONCRETE 1 CAST IRON 1 PLASTIC �
NEEDS NEW LID?/1 YES SIZE
GROUND COVEII OVER TANK
COMMENT ON CONDITION OF DRAINFIELD ETC.
SIGNED BY DATE
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PACIFIC
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8"0 N.E. 111th AVEMA a VAN OWER, WA&iWGGTCN 9tkP8.
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CITYOF TIGAR® __SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: S1^JR200n-00078
13125 SW Hall B!vd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 04/14/2000
SITE ADDRESS; 14504 SW FERN ST PARCEL: 2S104BC-01200
SUBDIVISION: HANDY ACRES ZONING: R-7
BLOCK: LOT: 016 JURISDICTION: URI:
TENANT NAME: CROSS JAM.FS M
USA NO: FIXTURE UNITS:
CLASS OF WORK: /,DD D1/ELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit. Septic tank must be pumped, filled, and inspected.
Owner:
FEES _
CROSS, SUSAN GAIL
JAMES MICHAEL Type By Date _ Amount Receipt
14504 SW FERN ST PRMT BON 04/14/200C $2,300.00 0001442
TIGARD OR 97223 INSP BON 04/14/2000 $35.00 0001442
Phone: Total $2,335.00
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. Th,� 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 ;he distance given. If not so located, the installer shall purchase a"Tap and
Side 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 pies of these rules or direct questions to OUNC by calling (503) 246-1987
Issued by: i't 1L � �" Permittee Si, lature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed tho ext business day
SCAL IN FEE-
\ 50 0 50
4D�8�. MH�8SSA8 . 64-55.19
XTT MH SSA 5+30.19 _
00 = 'SSA-4' 0+00 (11+15.16, 8'RT)
(9+90.16, 8'RT
61 62 63 64
7+41 84.91
I 67 7 4' PVC 8+16 4" F,
5+91 6' 40 LF 11* PVC 40 LF
4" PVC 4' PVC 0 06.0, 40 LF D=G-D" 0=6
jet 40 LF 40 LF S.W. DRI'
LN few
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CD
102.01 LF -
5+71 C +14fis.3F E-WOG09_STA 14+00
4' PVC C WIND". G STA 10+00 = 7+97
I„_336 LF CA FERN STA 3+98 36 PVC
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