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12170 SW MARION STREET-1 IS N0lklVW MS 01626 w a �i a rr i pu v i I iI N r� H a z w � N r 12170 SW MARION ST 1 CITY OF TIGARDS � BUILDING DIVISION PERMIT#: PLM200500102 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2W-., Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 13/12/2005 TIME: 7.06AM PAGE: tyt SITE ADDRESS: 1217il Sw K-1 RI ON ST CLASS OF WORK: SUBDIVISION!: WIL_LAMf fTE NO.2 LOT#: 026 TYPE OF USE: PROJECT NAME: DAHL DESCRIPTION: 1(91 line work for sewer connection. Septic system to be pumped and filled or removed. OWNER: DAHL, STEPHEN MARION S, PHONE #: 15B 5W45% CONTRACTOR: OWNER PHONE#: Inspection Request Scheduled For: Date: 8/12/2f)M Pour Time: Code # Inspection Description Confirm # Contact # Message sff, Sanitary c.w er 013404-01 501.8*0921 Y rrCorrections/Comments/Instructions: i . FTP ASS ❑ PARTIAL APPROVAL_ ❑ CANCEL y — ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 710- CITYOF TIGARD _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2005-00102 A L 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 DATE ISSUED: 3/16/2005 PARCEL: 2S103CB-04700 SITE ADDRESS: 12170 SW MARION S'i ZONING: R-4.5 SUBDIVISION: WILLAMETTE NO.2 LOT: 023 JURISDICTION: TIG Project Description: 100ft line work for sewer connection. Septic system to be pumped .,d filled or removed. CLASS OF WORK: NEW 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: SINKc- URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES DAHL, STEPHEN MARION S Description Date mount 12170 SW MARION ----- TIGARD, OR 97223 JPL.UMI3] Permit Fcc 3/16/2005 $72.50 [TAX]8%State Surcharl 1/6/2005 $5.80 Phone: 503-590-4.,56 Total $78.30 Contractor: OWNER REQUIRED ITEMb AND REPORTS Phone : Reg#: C n 0 1 his 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 U not started within 1R0 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 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling503-24 699 r 1-800-332-2 4. Issued By: aar�. �, Permittee Signature: Call 503-639-4175 by 7:00 a.m.for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each Inspection. CITY OF T I GA R D SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2005-00088 13125 SW Hall Blvd.,Tigard, OR 97223 503-639-4171 DATE ISSUED: 3/16/2005 PARCEL.: 2S103C13-04700 SITE ADDRESS; 12170 SW MARION ST ZONING: R-4.5 SUBDIVISION: WILLAMETTE N01.' LOT: 020 JURISDICTION: rIG Project Description: Sewer connection existing house to lateral. TENANT NAME: CWS NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: I_TPSWR IMPERV SURFACE: Owner: --- _ FEES DAHI_, STEPHEN MARION S Description Date Amount 12170 SW MARION TIGARD, OR 97223 (SWIJSAJ Swr Connection Fee 3/16/2005 $2,500.00 ISWINSP]Sewer Inspection Fee .3/16/2005 $35.00 Phone: 503-590-4550 Total $2,535.00 Contractor: REQUIRED ITEMS AND REPORTS Phone: Reg#: n' This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 Ndays 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" —1 Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the m Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You W may obtain copies of these rules or direct questions to OUNC by calling 503-246-6699 or 1-800-332-2344. J 100, — Issued by: Permittee Signature; Call 503-639-4175 by 7:00 a.m.for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project, Approved plans are required on the job site at the time of each Inspection. ti lPlumbing Permit /4uflf�iiFatien Cit of Tigard �� lReceived 3125 SW HalehBlvd,Tigard,OR 97223 e/B : �y / Permit No r► aa�Jt/J �Q l Plan Review r ?hone: 503.639.4171 Fax: 5039.4175 Date/B Other Permit 24-Hour Inspection Line 503,639.4175 1005 rw _ Date Ready/By: 0 See Pe 2 for Internet: www.ci.tigard.orus �O� r�(;!\�,L; Notified/MethodI SupplemenialInformation t r v t'+ JI I1I ftE- SCHEDULE []Newconstaction C1 Demolition — For special!nornrarionuse checklist. — — — Description Qty I Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-famlly dwellings(includes 100 fl for each utility connection) SFR(1)bath 249.20 ❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350.00 ❑Accessory building ❑Multi family SFR(3)bath 399.00 ❑ — Each additional bath/kitchen 45.00 Master builder ❑Other: Fin sprinkler( sq.ft.) Page 2 / MffiSite utilities Job site address: �' { O Catch basin or area drain 16.60 City/State/ZIP: l Drywell,lea h line,or trench drain 16.60 Suite/bldg./apt.no.- Project name: Footing drain(no.linear ft. _—) Page 2 ��- Manufactured home utilities 110.00 Cross street/directions to job site: Manholes i 16.60 Rain drain connector 16.60 Sanitary sewer(no.linear fl.: Page 2 Storm sewer(no linear R.._) Page 2 Subdivision: Lot no.: Water service(no.linear It.: ) Page 2 "— --- Fixture or Item Tax map/parcel no Absorption 6 valve 1 60 A. ak'r,. " ��+t Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 1660 Drinking fountain 16.60 Ejectors/sump 16.60 Name: ,1 It Expansion tank 16.60 Address: ca _ Fixture/sewer cap 16.60 City/State/Z1P: Floor drain/floor sink/hub 16.60 Phone:(r '' ) [) 14 -C� Fax:( ) Garbage disposal 16.60 v Hose bib 16.60 i 1 - Ice maker 16.60 Business name: Interceptor/grease trap 16.50 Contact name: _ _ Medical gas(value:S ) Page 2 IL Address: Primer 16.60 N City/State/ZIP: Roof drain(commercial) 16.60 r t Phone: V ��-- SinUbasin/lavatory 1660( ) Fax: :( ) — Tub/shower/shower pan 16.60 J E-mail: Urinal 16.60 ue t :i' i '!� .9Bt a..i' Mr: t r� j•t d .. .''` Water closet 1660 W Business name: Water heater 16.60 J — Address: Other: City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) Residential backflow minimum permit fee: $36.25 '1 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) -- ,) State surcharge(8%of permit fee) �. Authorized signs - TOTAL PERMIT FEE '7 Print name: ? Date: - This permit application expires If a permit Is not obtalneA within 1-1 _ 180 days after It has been accep:ad as complete. "Fee methodology set by Tri-County Building Industry Service Board. i\Building\Perrniu`PLM-PermOAppdoc IV03 440^4616T([0IO2/COM(WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppressiio{n�{♦S stems: _ 0 Let Footing drain-1" 100' 55 00 0 to 2,000 — $1 1').00 Footing drain-each additional 100' 46.40 2,001 to 3,600 _ S 160.00 Sewer-I st 100' S5 00 .),601 to 7,200 — $220.00 7,201 and greater _ $309.00 Sewer-each additional 100' 46.40 Water Service- Ist 100' 55.00 Medical Gas S Ste Is: Water Service-each additional 100' 46.40 RML1r r a+-" — Storm&Rain Drain-Ist 100' 55.00 Z'" t( .5,�,- _ S L(H)to 55,000.00 J Mt. '*tum fee 572.50 Storm&Rain Drain-each additional 100' 46.40 55,001.00 to 510,000.00 572_1 for the first 55,000.00 and S1.52 for each additional 5100 00 or fraction thereof,to and �* _ including$10,000.00. Commercial Hack Flow Prevention Devier 4640 510,001 00 to 525,000.00 5148.50 for the first 510,000.00 and SI 54 for Residertial Backflow Prevention Device each additional$100,00 or fraction thereof,to minimum Permit fee$36.25 27.55 and rrcludi:,g 525,000.00. Rain Drain,single family dwelling 65.25 $25,00100 to$50,000 00 $379.50 for the first 525,000.00 and$I 45 for each additional$100.00 or fraction thereof,to Inspection of existing plumbing or _ and including$50,000.00. s eciall requested ins ections-pet hour 72.50 550,001.00 and up $742.00 foi the first$50,000.00 and Si.i for Subtotal: each additional$100.00 or fraction they . Fixture Work: Are you capping,moving or replacing existing fixtures? If "Yes",please indicate work performed by fixture. Failure to accurately report fixtures could result In increased sewer fees*. r. Comments regarding fixture work: BaptistryfFont Bath -Tub/Shower -lacuui/Whirl ool — —— Car Wash -Each Stall -Drive'lhru Cuspidor/Water Aspirator -- Dishwasher -Commercial -Domestic — - -- Drinking Fountain — Eye Wash — Floor Drain/sink 2" 3„ -- -- 4„ — - L Car Wash Drain 2 Garbage -Domestic Disposal -Commercial *Note: If the fixture work under this permit results in an -Industrial increase of sewer EDUs,a sewer permit will be issued and ~ Ice Mach./Refs .Drains J oil Separator Gas Station fees assessed for the sewer increase must be paid before the p Rec.vehicle bump Station _ plumbing permit can be issued. Shower -Gang U -Stall J Sink -Bar/Lavatory _ uantit Total -Bradley Isometric or riser diAg--am Is required if fixture quantity -('ommerciel total is>9. -Service Swimming Pool Filter Washer-Clothes Water Extractor Plan Review Water Closet-Toilet Plan review is required if fixture quantity total is>9. Urinal Other Fixtures: i IBuildinalPermiUlPtM-PemdtApp dm 3103 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)6394175 INSPECTION DIVISION Business Lne: (503)639-4171 MST BUP Received _Date Requested -LAI _._ AM PM BUP Location _ _1_ 1-7 a _ '"�' -A&-suite_ MEC Contact Person LA.)a I 4_T Ph( ) _ ��OS PLM Contractor_� _— _ Ph SWR _ BUILDING Tenant/Owner —_ ELC Footing a. Foundation ELCFAcceS3 �'Ftg Drain / '8 r � � ELR Crawl Drain 1Slab on Notes: SIT Post&Beam Shear Anchors — Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall F`.re Sprinkler --- -- ---- - -.—_- Fire Alarm Susp'd Ceiling ----- - ---- ---— Roof Other: _--- `_ — -- - Final PASS PART FAIL PLUMBING Post&Beam Under Slab _ -- Rough-In -- Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain - -- Shower Pan Other. — - - _ZPA'So PART FAIL ANICAL Post&Beam Rough-In - Gas Line Smoke Dampers - Final PASS PART FAIL -- - -- ELECTRICAL i Service Rough-in i UG/Slab j Low Voltage Fire Alarm Final F] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE -_ F1 Please call for reinspection RE:_ _ I_J Unable to inspem-no access Fire Supply Line ADA /7� Approach/Sidewalk �� --- InspwCter_ _ iili>rt Other: — Final DO NOT REMOVE this InspOction record from thly job site. P18191 PART FAIL J