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13305 SW HOWARD DRIVE I w w 0 v, x O W R. O rD r' P 1 I 13305 SW Howard Drive CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT*#: SWR2003-00017 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/13/03 SITE ADDRESS; 13305 SW HOWARD DR PARCEL: 2S103C;A-00900 SUBDIVISION: WOODCREST ZONING: R-4.5 BLOCK: LOT: ()lJURISDICTION: 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 ConnF,tion. Reimbursement dist. #22 paid. Owner: _ FEES — JACK OTTERSON D 38177 S. DESERT STAR DR escription Date Amount TUSCON, AZ 85739 [SWUSA]Swr Connect 1/13/03 $2,300.00 [SWUSA]Swr Connect 1/13/03 $0.00 Phone: 503-520-6098 [SWINSP] Swr Inspect 1/13/03 $35.00 [SWINSP]Swr Inspect 1/13/03 $0.00 Contractor: -- ---- - Total $2,335.00 Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. 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 givesi. 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 ara set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699. Issued by: _ ,s /a.( L �(.!_� ,` Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures 00Ak) &'T a ► 1�_ �/ Plumbing Pei' yt plication 'NLY ki Date received: Permit no.:�t(� City of Tigard y � Sewer permit no.: Building permit no.: Address: 13125 SW Hall 1313080,180f0 223 City u,7 of Tigard Phone: (503) 639-4171 LLuuProject/appl, no.: Expire date: Fax: (503) 598-1960 CITY OF TIGARD Date issued: BjyM Receipt no.: Land use approval:BUILDING DIVISION Case rile no.: Payment type: I &2 family dwelling or accessory U Conuncrcialiindustrial U Multi-Ianniy U Tenant improvement U New construction U Addition/alteration/replacement U Food service U Other: SCHEDULEJOB WE INF611IMATION FEE Job address: Description 11Qty. Tc,(ea. I 'l o(,i Bldg. no.: Suite no.: _ New 1-and 2-family dwellings only: —___ --- — (includes too ft.for each utility connection) Tax map/tax lot/account no.: SFR(1)bath Lot: jfflock. Subdivision: SFP.(2)bath Project name: SF (3)bath City/county: ZIP: EacNAdditional bath/kitchen Desgription and location of work on premises: 06a 2t,L c,0,;&'710 Siteu sties: t_,Ni-y! - !,X �_t N` 0_r�� Catch b in/area drain Est.date of completion inspection Drywells/ ach line/trench drain Footing drai (no. lin. ft.) PLUMBING CONTRUTOR Manufactured ome utilities Busines' le _ Manholes Address: Rain drain connec r City: State: 'LIP: _ Sanitary sewer(no.hp. ft.) Phone: j F!j> E-mail: Storm sewer(no.lin. CCB no.: ,/ Plumb. u . no: Water service no.lin. fN City/metro tic,n — Ilxture or item: Contracto ' signature. BackAbsepresentative signattion valve _ Back flow preventer Print-rfatne: Backwater valve COON Basins/lavatory Name: Clothes washer — - - - - -- Dishwasher _ Address: Drinking fountain(s) City: Cit -- —— - -Ttate: ZIP:--_— - Ejectors/sump Phone: I ;+ E-mail: Expansion tank t Fixture/sewer cap _. Name(print): `fAt✓, U7 i r-72I0 h� Floot drains/floor sink. ub _ address: <330 S w NoC 4nzi &Z - Garbage disposal Mailin g Hose bibb _ Cit ! -fru) State:,0-,L I ZIP:972_z j Ice maker Phone: Fax: E-mail: �T.�,a�., ptor/grass trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(co mercial) employee on the prop I own as PfiWORS Chapter 447. Sink(s),basin(A),lays(s) 0%%ner's signature: �_ _�--Elate: �-G -i Sump I Tubs/show /s ower pan Urinal Name: W41eAddress: WCity: e: 'ZIP: OtPhone: FE- ail: o Not all jurisdictions accept credit cards,pleau cell jurisdiction for more information. Notice: This permit application Plan re view(at fee..............) — pl — %) S U Viae ❑Mastercard expires if a permit is not obtained a Credit card number _ _L�_ State surcharge(8%)....$ Expires within 180 days rifler it has been Name of cord older as shown accepted as complete. TOTAL........................ $ on cr it cue aid _ S CardToldcr aiFm;rc Amount 440-4616(6xx1/COMi r PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 24;amily dwellings only: FIXTURES Individual) QTY (Be) AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwellinf,and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connectionj_ One bath $249.20 _ � _ Tub or Tub/Shower Comb. 16.80 Two 2 bath $350.00 Shower Only 16.60 Three 3 bath $399.00 Water Closet 16.60 - SUBTOTAL Urinal 16.60 - v 8%STATE SURCHARGE _ Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL - Garbage Disposal 16.60 __________ TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 1660 3" 16,60 PLEASE COMPLETE: 4" 16.60 _ Walur I iadier O runvG�ai,jn O Ill,c kind 16.50 r _ Quantityb Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Ca ped MFG Home New Water Service 46.40 SS MFG Home New San/Storm Sewer 45 40 Lavatory Tub or Tub/Shower Hose Bibs 16.60 Combination Roof 18.60 Shower Only _ Drink g F: ntain 16.60 Water Closet Other Fixtures(Specify) 16.60 Urinal _ Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" Sewer-1st 100' 55.00 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 (Specify) Storm&Rain Drain-let 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 - -- ~Residential Bnckflow Prevention Device' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 Ra uealed Ins ections _ per/hr COMMFNTS REGARDING ABOVE: Rain Uiain,sing a(drtlily Jwelliny 65.25 Grease Traps 16.60 QUANTITY TOTAL -- -� - - Isometric or riser diagram Is required If Quantity Total Is >9 ------- "SUBTOTAL - ---"SUBTOTAL -- ------ - - --- 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL- _ Required only If fixture qly total is>9 _ TOTAL S "Minimum permit fee is$72 50•8%slate surcharge,except Residential Backflow Prevention Device,which is 530.25•9%state surcharge "All New commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. IAdsts\formslplm-fees.doc 12/26/01 CITYOF TIIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00210 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/20/03 SITE ADDRESS: 13305 SW HOWARD DR PARCEL: 2S103CA-00900 SUBDIVISION: WOODCREST ZONING: R-4.5 BLOCK: LOT: 012 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: TORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUBISHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install approx. 100 If of line work to connect house to sewer lateral. Septic tank to be pumped, filled and inspected. Reimbursement district#22 paid. Owner: _ _ FEES _ - - Description Date Amount OTTFRSON, JACK W/ESTHER til - --- 13305 SW HOWARD Dr: I I'I_I INIRI 11CI.11111 I rr 5/20/03 $72.50 TIGARD, OR 97223 11;\X I X Slow f,i5/20/03 $5.80 Total $78.30 Phone : 503-520-6098 Contractor: --� - —�i— Contractor: A-AFFORDABLE SEPTIC SERVICE PO BOX 1130 WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone : 503-969-9548 Sewer InspectionMisc. Inspection Reg#: LIC 151481 Final Inspection This hermit is issued subject to the regulations container 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 r l Issued By: t ! f , Permittee Signature: Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next busin .ss day nuncing r fixtures Ck Plumbing Permit Application ' ' ' NLY �Rcceived n 1 umbing _ annte/rt � �-03�iY Permit No.: fid/O ing Approval Scwer City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Da 13 : Permit No.: Post-RevPhone: 503-639-4171 Fax: 503-598-1960 Date/ate/11 y: land Use °+^• DCase No.: Internet: www.ci.tigard.or.us Contact luns.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: 1 supplemental information. TYPE OF WORK FEE*SCHEDULE(for special information use checklist New construction Demolition D) scription Qqt Fee(ca•) Total Addition/alteration/r lacement Other: New 1•& of eac ly dwellings �_— (includes 100 fl.for_each utilil�connection) CATEGORY OF CONSTRUCTION SFR. 1 bath 249.20 t Family dwelling Commercial/Industrial SFR 2 bath 350.00 o Building [ Multi-Family SFR 3 bath 3`9 00 r Builder _ ❑Other: Each additional bath/kitchen 45.00 Firc sprinkler- ft.- _ _ Pa'e 2 *OB SITE INFORMATION and LOCATION tel• — _. --�--�-- �_,Jldg./Aptfi: -- r Site I4ilities Job site address: / ,l�'� •d - 16.00 — Suite#: Catch basin/area drain D► ell/leach line/trench drain 16.60 Project Name: Footing drain no.linear ft. _ Pae 2 Cross street/Directions t?Job site: `` Manufactwed home utilities 110.00 l " l �� l '04� Manholes 16.60 Rain drain connector 16.60 Sanitary sewer no.linear n.) Pe e 2 Lot#: Storm sewer(no, linear fl.) _ Pae 2 Subdivision: _ Water service no. linear n.t Page 2 Tax map/parcel#: _ — _ Fixture or Item DESCRIPTION OF WORK Absorption valve _ 16.60 Lackflow pteventcr Pae 2 _ Backwater valve 16.60 Clothes washer 16.60 _ ---- --- Dishwasher 16.60 Drinking fountain 16.60 PROP'RTY OWNER TENANT ^ Ejectors/sump 16.60 Name: S, __ Expansion tank 16.60 Address: ,3 �C�.� (,JCI Fixture/sewer ca 10.60 Floor drain/floor sink/hub 16.60 _ City/State/Zip: Garbage disposal 16.60 Phone: -- Fax:_ Hose bib 16.60 _ APPLICANT s CONTACT PERSON [cc maker 10.60 _ Nivaw: - Interco tor/ ease trap16.60 Medical as-value: $ Pae 2 Address: / G 16.60 _ � ,��1C��Tn �n Primer Cit /State/Zi . Roof drain(commercial 16.60 Phon ax: 7Q J 79 Sink/basin/lavatory16.60 E-mail: Tub/shower/shower an 16.60 CONTRACTOR Urinal 10.60 _ Water closet 16.60 Business Name: ' !� —__ Water heater 16.60 Address: / Q Other: �_ Cit /Slate/Zi : Vf7_0other: PubinPer Phon axi 7 mmFees* Subtotal $ CCB C. Plumb. Lic.#: Minimum Permit Fee$72.50 $ At,thorized Residential Backflow Minimum Fee$36.25 Signaturg: _ Date: Ztr 3 Plan Review 25%of Permit Fee $ _ �j W — State Surcharge 8°6 of Permit Fee $ ry (Please print name) TOTAL PERMIT FEE $ Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of plaus with Isometric or 180 days aaer It has been accepted an complete. riser disgram for plan review. 'Fee methodology set by Trl-County Building Industry Service Board. is\Dsts\Permit Fomu\PlmPennrtApp d(w 01/03 tsin ing r fixtures Plumbir+P, Permit Application Receiveduu nn Plumbing }� Date/By: �� 'e22 Permit No.: 4A Planning Approval Sewer City of T igard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review other Tigard,Oregon 97223 Da B : Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use Date/By: Case No.. Internet: www.ci.tigard.or.us Contact Juris.: 0 See Page 2 for 24-hour Inspection Request: 503-639-4175 1 Name/Method: 1 Supplemental Information. TYPE OF WORK FEE*SCHEDULE(for special Information use checklist New construction_ I Lj Demolition -Lacrl�ttion OIv. Fec(ca.l Mural r- Addition/alteration/re lacement _ Other: -� New 1-&2r each u dwellings neludes 1001't.for each utllit vroncctfon CATEGORY OF CONSTRUCTION SFR I bath 249.20 _ 1 &2-Family dwellinE C'olr,mercial/Industrial SFR z bath _Accessory Building_ _ Multi-Family SFR 3 bath 399.00 Master Builder _ ❑Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCA'T'ION Firc sprinkler-sq.ft. Pa c 2 Job site address: >` �� ori Site Utilitics _ $ld ./Apt.#: Catch basin/area drain 16.60 Suite#: _ D ell/leach line/trench drain 16.60 Project Name: Footing drain(no.linear ft.) Page 2 Cross street/Directions to job site: `- ',, Manufactured home utilities 110.00 `3 r4 "�,.)e',-r�/ �� / /r"'�'� Manholes 16.60 Rain drain connector 16.60 Sanitary sewer no. linear fi. Pae 2 Subdivision: Lot#; _ Storm sewer no.linear fi. _ _ :=[== - Water service no. linear ft. Page 2 Tax map/parcel#: Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 _ Backflow reventer Pae 2 Backwater valve _ 16.60 Clothes washer 16.60 --- Dishwasher 16.60 _ [� nking fountain 16.60 - M$O! 1"Y OW�t TENANT E c-„)rs/sum - 16.60 _ Name: Expansion tank 16.60 Address: Fixture/sewer ca 16.60 Floor drain/floor sirtk/hub _ 16.60 City/State/Z_i . , 441 ?_ Garba a disposal 16.60 Phone: Fax: Hose bib 16.60 APPLICANT CONTACT PERSON Ice maker 16.60 Name: ' , lnterce tor/ ease trap16.60 '�� "- Medical as-value: S Pae 2 Address: E-- , (/3 G Primer 16.60 Cit /State/Zi 1 16.60 Itoof drain commercial Phan : e' ax 70- C 7 79 Sink/basin/lavatory 16.60 E-ttlal i* _! Tub/shower/shower pan 16.60 CONTRACTOR Urinal _ _ IG.GO Water closet 16.60 Business Name:- � )/Fri__T'.�� Water heater 16.60 _ Address: ��'S,.�ek //S -_ other: _ Cit /State/Zi g n ei 70 Other: -� Phan : Fax. 7� 77 J Plumbin peritllt Fees Subtotal $ _`-- CC$ e. / / lumb. L1c.#: -'- Minimum Permit Fee 572.50 s �N Authorized - ,, l Backflow Minimum Fee$36.25 _ Signatur : ___ Datc: l �0 3 ResidentialPlan Review 259%of Permit Fee $ KAv -_ State Surcharge 8%of Permit Fee $ (Please print name) TOTAL PERMIT FEE S 7 Notice: This permit application expires If a permlt Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or 180 days after It has been accepted as complete. riser diagram for plan review. *F"wribndology qct by'rrl-('ounty Building Industry Service Hoard. i\Dsts\permit Forms\PimPermitApp.doc 01/03 Plumbing Permit Application - Cih' of Tigard , Page 2 - Supplemental Information Fee Schedule: Residential Ffire Suppression Systems: Site Utilities — Qty. Fee(ea) Total _ Square Foo►:.ge: Permit Fee: Footing drain- I" 100' ---- --- -- 55,()0 0 to 2:000 $115 00 Footing drain-each additional 100 — 46.40 2,001 to 3,600 $160.00 v 3,601 to 7,200 $220.00 Sewer-1st 100' _ 55.00 3,601 and greateru $309.00 Sewer-each additional 100' 46.40 Water Service-Ist 100' 5500 Medical Gas S stems' Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain- Ist 100' 55.00 $1.00 to$5,000,00 Minimum fee$72.50 Storm&Rain Drain-cacti additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each Fixture or Item Fee(ea) Total additional$100.00 or fraction thercol,to and Qty. Commercial Back Plow Prevention( including$10000.00. vice 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow FKevention Device, each additional$100.00 or fraction thereof,to minimum permit fee$36.25 27.55 and including$25,000,00. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 5379.`1 for the first$25,000.00 and$1.45 for Inspection of existing plumbing or each additional$100.00 or fraction thereof,to specialty requested ins ctious•PCr hour _ 72.50 and including$50,000.00. Suhtotai: $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for each additional$100.00 or fraction thereof. Fixture Work: Are you capping,nroi ing or replacing existing fixtures? If "yes",please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity by Fixltre Work Performed Comments regarding fixture work: Fixture Type: Replace New ved ExIsting Capped Bu list /Font Bath -Tub/Shower -Jacuzzi/Whirl pool ('or Wash -Each Stall -Drive Tbru -- — Cuspidor/Water Aspirator — — Dishwasher -Commercial -Domestic — ---- Drinking Fountain ----Eye Wash _ Floor Drain/sink - 4., -- Car Wash Drar i — Garbage -Domestic —" *Note: If the fixture work under this permit results in an Disposal -commercial - Increase of sewer EDUs,a sewer permit will be Issued and -Industrial fees assessed for the sewer increase must be paid before file Ice Mach./Refri .Drains _ plumbing permit can be issued. Oil Separator Gas Station Rcc Vehicle Dump Station Shower -Gang _ -Stall Sink -Bar/Lavatory, -Bradley -Commercial - -Service Swimming Pool Filter Washer-Clothes Water Extractor _ Water Closet-Toilet _ Urinal Other Fixtures: i,\Dsts\Permit Forms\PlmPermitAppPg2.doc 01103 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION P.usiness Line: (503)639-4171 _ BUP -- Received ___.Date Requested_ _— 5 �'�' SAM— PM _.__— _ BUP Location —T_L .__ ��-_Suite____—_____ _-_ MEC PLM 6 F /D Contact Person - _— __-- Ph d------ Contractor_ --____ Ph(___ ) _ ---_- - --- - SWR -----------___..__.._—i BUILDING Tenant/Owner -_ - -_. ELC Footing ELC �� Foundation --- Ftg Drain A �sy' �I 1.70 LQ ELRCrawl Drain Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors ---� Ext Sheath/Shear Int Sheath/Shear Framing - - - -- - --_- - Insulation Drywall Nailing 01 __- 05, - Firewall Fire Sprinkler - - .01 Fire Alarm Susp'd Ceiling - - -- Roof Other: Final PASS PART FAIL — PLUMBING Post&Beam Under Slab --- -- - -- Rough-In Water Service — — - — Rain r -- -- - ---- ----- — - — Catch Basin/Manhole Storm Drain -- Shower Pan Other: - - - -------- - FinaL A_SS PART FAIL - E ANICAL &Beam Rough-in Gas Line Smoke Dampers -- Final PASS PART FAIL --- _- - -- - - - -- - ELECTRICAL Service Rough-In UG/Slab _- -_ __-- _-------___--- --------- ---- Low Voltage Fire Alarm Final Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE __ n Please call for reinspection RE: Unable to inspect-no access Fire Supply Line _�� ADA Approach/Sidewalk Date Inspector - Ext Other: __ r Final DO NOT REMOVE this Inspection record from the job sato. PASS PART FAIT_ I