Permit ,
- � CITY OF TIGARD PLUMBING PERMIT
r� DEVELOPMENT SERVICES PERMIT #: PLM2001 -00017
`" „��! 13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/24/01
SITE ADDRESS: 13585 SW WALNUT LN PARCEL: 2S104BD -09700
SUBDIVISION: SULLIVAN MLP2000 -00004 ZONING: R -7
BLOCK: LOT: 001 JURISDICTION: TIG
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: 134 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of sewer line for connection to USA sewer system. Septic tank must be pumped, filled and
inspected, or removed and inspected.
FEES
Owner:
Type By Date Amount Receipt
ED SULLIVAN PRMT CTR 1/24/01 $101.40 27200100000
13585 SW WALNUT LN 5PCT CTR 1/24/01 $8.11 27200100000
TIGARD, OR 97223
Total $109.51
Phone 1: 503 - 699 -0238
Contractor:
OWNER
REQUIRED INSPECTIONS
1: Sewer Inspection
Phone Reg 1: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -00: e.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 - 19:7./
Issued By: P ermittee Signatur: _,��1�.1�%�1
Call (503) 639 -4175 by 7:00 P.M. for an inspection nee. ed the next bu ' es ry
•w
Alio Plumbing Permit Application
a °� " `J Date received: /2 v/, Permit no.: And f -000/.7
C l of Tigard Building permit no.:
Sewer permit no.: .
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 - Date issued: By:eceipt no.: •
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
1! 1 & 2 family dwelling or accessory D Commercial/industrial D Multi- family D Tenant improvement
D New construction , D Addition/alteration /replacement D Food service D Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 1 - 5 5-65 . 5 L3 (P a - , t t i 14.S2 Description t . Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: ' -LU,, ,96Li.--- SFR (3) bath
City /county: 0.5l , 'T 1`^'j' I ZIP: 7)-2 Each additional bath/kitchen
Des ption and l9cat)• of work on PWemises:. .QCotx,t�t 155 t — Site utilities:
5 _ k e4 I O %.c.$.t LI j-s - ick., "_`w' I ..c4szr.1 U34 Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: c,Q,I I 5-0- 14A---e Manholes
Address: Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft.) / /
Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lib. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer •
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Address: Dishwasher
State: ZIP: Drinking fountain(s)
City: I I Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
/ 1,.961/`-- _Floor drains /floor sinks/hub
Name (print):
Mailing address: L/ /otA.C.k5Y�w2 '* rf Hose disposal
bibb
City: Lot kg- 05 U.)4?-30 I Stater-; I ZIP: 1'7035 _Ice maker
Phone: to %/j -0� Fax: Sea is I E -mail: Interceptor /grease trap .
Owner installation/residential maintenance o //: The actual installation Primer(s)
will be made by me or th maintenance : , d • pai made by my regular Roof drain (commercial)
employee on the p ,'own as / ". C •,.:', ter 44 Sink(s), basin(s), lays(s)-
Owner's signatu //�,.i, /iiLL► Date: � o� D Sump •
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ /0/, %O' Notice: This permit application Plan review (at _ %) $
D Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $ a- • //
Expires within 180 days after it has been TOTAL $ /6/ 9. S/
Name of cardholder as shown on credit card accepted as complete.
$ ,23.3 5.0
Cardholder signature Amount 440-4616 (6A0/COM) .
1ayyy /°C--/
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavato 16.60 for each utility connection)
ry One (1) bath $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 16.60 SUBTOTAL
Urinal 16.60 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" 16.60
3" 166.660 0 PLEASE COMPLETE:
4" 16 60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
16.60 Urinal
Other Fixtures (Specify) Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' / 55.00 55 3"
Sewer - each additional 100' / 46.40 L/ 9/ 4"
Water Service - 1st 100' 55.00 Water Heater
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & 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 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL 10/, yt7
8% STATE SURCHARGE P,//
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty total is > 9
TOTAL $/9, S/
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36 25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or nser diagram and
plan review
i:\dsts\forms\plm- fees.doc 10/10/00
111116. 1N(. CoP`
TIGARD C T� OF ENGINEERING PERMIT
PERMIT #: ENG2000-00047
AFA0 DEVELOPMENT SERVICES PRIM. PERMIT #: MLP2000 -00004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/01/2000
SITE ADDRESS: 13585 SW WALNUT LN PARCEL: 2S104BD -00200
SUBDIVISION: OBRS HEIGHTS ZONING: R -7
BLOCK: LOT: 005 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: " " "* $3,500.00
TOTAL: $3,500.00
Remarks: STREET OPENING; TO INSTALL A SIDE SANITARY SEWER SERVICE LATERAL & (PVT.) STM DRAIN,
AND, TO 'CUT' THE ROAD TO INSTALL A WATER SERVICE.
FEES
F - - Owner:
Type By Date Amount Receipt
OPEN JSH 07/31/2000 $150.00 0003986
Total $150.00
Phone: •
Engineer:
Phone: REQUIRED INSPECTIONS
STM /SAN SEWER STREET
Permittee / Applicant: MH /CB /CO CRB LINE & GRADE
EDMUND SULLIVAN PIPE LN & GRD SUBGRADE
13585 SW WALNUT LANE BCKFLL & CMPCT BASE ROCK
TIGARD, OR 97223 AIR & TV TEST LEVEL COURSE
WEARING COURSE
Phone: / GRADING TRAFF & PED CONT
CONTOURS MONUMENTATION
DRAINAGE STREETLIGHTING
Pemiittee/ EROSION CNTL. WALK/APRON /RAMP
Applicant ,
Signature:0# A
/ REPR'S /ADJ'S PATHWAYS
Issued By Al • , L
FOR INSPECTIONS, CONTACT THE CITY OF TIGARD,
SPECIAL CONDITIONS: (SEE ATTACHED) ENGINEERING DEPARTMENT, AT: (503) 639 -4171
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Houk Inspection Line: 639 -4175 Business Line: 639 -4171 MST
Date Requested /— 2 y AM PM BLD
Location ( 3 ) .5 S w ‘44.11.7 w� G ' Suite MEC
Contact Person C Ph f Z3 O 0 - Q&O / 7
Contractor Ph 241 ./.041 a 40 of- � 'U -
BUILDING Tenant/Owner P /, C ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Sla � SIT
Post & Beam `o
Ext Sheath /Shear
Int Sheath /Shear
ToLt Q t - 0 0 0\ 1
Framing I
Insulation � \\ ) /
Drywall Nailing ++W U 0002,0 (
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling . i) . A &-. _ •
Roof
Misc:
Final
PASS ART FAIL C
r Post & Beam
Under Slab
Top Out
Water Service
knit ary S��ete�
Rain Drains
Fig
iltrP PART FAIL
CHANICAL
Post & Beam (t)7
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
VC:
Approach/Sidewalk E I S
Other Date 1 7 Q Inspector
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1
Feb 07 01 11:25a Ed Sullivan 503 575 6328 p.l
y a
_ �' SERVICE ,( 2d
_., SEPTIC
. P.G.BGX 1134 TT 0 �
WILSONVILLE, OR 97070 � V
'' '.. ( ) 6$�9l FAX $ 1
We
P ign E�
CiySTOMER'S ORDER N0. /� e� � 3 ;
ADDRESS . / k°4142It _F
✓ .%
r/ : - 7 -.: I . RETO. PAID O UT _ .
} ON ACCT. M
C.O.A. CHARGE
SOLD BY AMOUNT
PRICE "
7. - DESGRIPT 1 —
�
QTY. d , 1 Ls ,a {
_ 1
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1
am 1 _ _________________________ .......
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_____ _________ _:� -,-f
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___________ willowv., ;
iiimmiwywrAlielim---- I .
, 1111q, ' _ i ' 11111 I
TOTAL t
RECEIVED BY this hill.
Dods MUST be accompanied by THANK YOU
1— All claims andf9 u�
Feb 07 01 11:25a Ed Sullivan 503 579 6328 p.2
Invoice
A- AFFORDABLE SEPTIC SERVICE
DATE INVOICE f!
P.O. BOX 1130
WILSONVILLE„ OR 97070 1/30/2001 10472
BILL TO 1 'JOB SITE ADDRESS
- ED SULLIVAN 13585 S.W. WALNUT LANE
4 TOUCHSTONE #74 I TIGARD, OR 97223
• LAKE OSWEGO, OR 97035 L 6 J —...
P.O. NO. TERMS PROJECT
ITEM QUANTITY DESCRIPTION 1 RATE
I SERVICED ' AMOUNT
s eptic truck 1 I cleaned septictank — ^ — 250.00 41(29/2001 - 250.00
i i
V
I
1
J
C if (..---
, (0-7{ .
I
IF ANY QUESTIONS, PLEASE CALL (503) 682 -1929 THANK YOU! — 1 —
Total 5250.00