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12655 SW SULL MTN. RD.
CITYOF TIGARD SEWER CONNECTION PERMIT
a` DEVELOPMENT SERI ICES -
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT#: SOU110
DATE ISSUED: 5/23/0023/00
SI ADDRESS; 12655 SW BULL MOUNTAIN RD PARCEL: 2S109AD-00800
SUBDIVISION:
BLOCK: LOT: ZONING: R-7
-- !URISDICTION[ i IG
TENAN r NAME: P ARSONS
USA NO:
CLASS OF WORK: NEW FIXTURE UNITS:
TYPE OF USE: SF DWELLING UNITS: 1
INSTALL TYPE: LTPSWR NO. O BUILDINGS:
IMPERV SURFACE:
Owner: Remarks. Sewer connection permit, existing septic tank will be Bumped and ,emoved.
PARSONS, ALDORA N coos
—
'AF55 SW BULL_ MTN RD
Type BY Date Amount Receipt
t---—
TIGARD, OR 97224 PRMT DEB —
5/23/00 $2,300.00 0002397
Phone:
INS DEB 5/23/00 $35.00 0002397
Contractor: Total $2,335.00
Phone:
Reg #:
Required Inspections
[Sewer Inspectio,i __—
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 pard will be forfeited if the permit er.pires The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the nreasurernent given, the installer
sh,-ll prospect 3 feet in all directions from the distance given If not so Ionated, the ;ostaller shall purchase a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon l�,w requires you to follow rules adopted
by the Oregon Utility Notification Center Those rules are set forth in OAR 952-0)1-0010 through OAR 952-001-0080 '
You m obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issue by. 1
Permittee Signature- �.tbusin--;
Call (503) f+?19 y . P.M.for an inspection needed tRe nday �_
CITY OF TIGARD --
C, PLUMBING PERMIT
DEVELOPMENT SERVICES
PERMIT#: PLM2000-00165
13125 SW Hail Blvd., Tigard, OR 9722.3 (503) 639-4171 DATE ISSUED: 5/23/00
SITE ADDRESS: 12655 SW BULL MOUNTAIN IRC PARCEL: 2S109AD-00800
SUBDIVISION: ZONING: R-7
i_ BLOCK: LOT: 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:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEVIER I INE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connection of existing house to newly installed sewer lime. No reversed plumbing. Septic tank will be pumped
and removed. _
Owner: _ Y FEES
Type By Date Amount Receipt
PARSONS, ALDORA N
12655 SW BULL MTN RD PRMT DEB 5/23/00 $50.00 0002.397
TIGA.RD, OR 97224 5PCT- DER 5/23/00 $4.00 0002397
Total $54.00
Phone 1: --- _�---- -
Contractor:
OREGON SITE WORKS
DBA MICCLLC
PO BOX 5162 REQUIRED INSPECTIONS
AI-OHA, OR 97007
Phone 1: 649-6208 Sewer Inspection
Reg#: Final Inspection
pRIGINA!
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 mo;a
than 180 day:,. ATTENTION. Oregon law requires you to follow rul%S adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
ou may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By . Dn` L4& Permittee Signature: ll
Call (503) 639-4175 by 7:00 P.M. for ai. ir.pection needed the next business r y�
l
CITY OF TIGARD Plumbing Permit Application -
13125 SW HALL BLVD. Commercial and Residential Planeck# �
Y IGARD, OR X37223 Reed y
(503) 639-4171 Date Recd
Date to to P.E.
Print or Type Date to[AT--
Incomplete or illegible applications Will not be accepted Pennrt#IJ-i �OD6
Related SWR#-
Called
Name of 13evelopment/Pro)ed -� FIXTURES (individual)
.JUb _ _dl QTY PRICE AMT
_ Sink _ 11.50
Address Street A�Id ss Q;�7ySulle Lavatory ——
— 1150
Bldg# �- City/Stale Zi Tub or Tub/Shower Comb 11.50
Zip Shower Only
Name _
11.50
Water Closet 11.50
OWSIP. Mailing Address — 11.50
1 t Suite Dishwasher
- r
rF
rhage Disposal
City/State 7:h Phone 11undry Tray _ - 11 50
Na eashing Machir'ie/Laundry Tray -11 50
I t' oor Drain/Floor Sink 2- 11.50
Occupant Mailing Address Suite
__ 3 11.50
City/State Zip Phone __ 4" _ 11.50
-_-_____ LVater Heater O conversion O like kind 11.50
Name f 1t Gas ipin requires a se_para:e mechanical permit.
r ON jI•TC'_ w1d {�J N 1 12 e- MFG Home New Water Service 32.00
Contractor aili Address '\quite MFG Home New San/Storm Sewer 32.00
5 h0'D' Hose Bibs
Prior to permit City/State Ph on _ _
issuance,a copy j Lz)tT-O Q� c7/� ^ ! d6 Roof Drains 11.50
11.50
of all licenses are Oregon Const.Cont.Board Liao Exp.--Date �P Drinking Fountain -11 50
required If 1;L,5 7 (0-16-D 1 Other Fixtures(Specify) 15.00
expired in COT Plumbing Lic.# Exp.Date -
database _
T Name 91 ( _
Architect L. ig yti-- I �C) � _ —
Sewer-1st 100' 38.00
j 0
Or Mailing Address Suite -- ad —
Sewer-each ditional 100' 32.00
Engineer Cily/Slate Zlp Phone Water Service- 1st 100' _ 38.00
_ 7 Water—Service-each additional 2U0' '1200
Describe work to be done: Storm&Rain Drain-t sl 100' — --
New O Repair O Replace with like kind: Yes O No U 38,00
Residential O Commercial O Storm R Rain D ain-each additional 100' 3200.
Additional description of work: LD00� Ec , - Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device'
10.00
Are you capping, moving orreplacing any fixtures? - Catch Basin 11.50
Yes O No O Insp.of Existing^lumbing or Specially Rrquesled 50.00
If yes,see back of torn to indicate work performed b Inspections _-_� er/hr
y Rain Drain,single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE --
_WORK COULD RESULT IN INCREASED SEWER FEES. hrease Traps `-- -- 11.50
I hereby arknowlede that I have read this applicaton,that the information QUANTITY TO'rAL
given Is correct,that I am the owner or authorized agent of the owner,and Isometric or riser diagram is required n Quantity Total is >9
that lar s submitted are in compliance with Oregon State Laws. 'SUBTOTAL
I n t O er/Agprot +00at8%SURCHARGE0Person Nat $�75 "PLAN REVIEW 26%4F SUBTOTAL
I BATH HOUSE$178.00 bi ' Re used only If fixture qty total is>9
2 BATH HOUSE S1;U.o0 TOTAL
3 BATH ROUSE$285.00 1
Tb,'--,fee In In tho dw
and the first 'Minlmum permit fee Is$50+8%surcharge except Residential Backflow prevention
t t< lid vials Ice) t Device which Is S25+8%C{ W e 1 0,0 r- A–) plan review surcharge
"All New Commercial Bulldings require plans with isometric or riser diagram and
� <�( C
I dsLm
llcxshplumappdOQ 11NM0
PLEASE COMPLETE_
Fixture Tyke -- _ &i� ,,tity by Work Performed----
—� New - Moved Replaced Removed/Capped
-
Lavatory— - —
Il-ub or Tub/Shower Combination -- --
Shower Only _
Water Closet —
Urinal --
Dishwasher —
Garbage Dispos9l
Laundry Room Tray
Washing Machine —,
Floor Drain/Floor Sink 2"
4" —
Water Heater
Other Fixtures (Specify)—
COMMENTS REGARDING ABOVE:
1 ds,.tVmnaWk,m M,!',kc 11119!99