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10775 SW Errol Street
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CITY OF TIGARD
___ _PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2CO2-00489
13125 SW Ha ' Blvd., Tigard, OR 97223 (503) 639-4171
DATE ISSUED: 12/18/0:
PARCEL: 2S 103AA-01704
,-ITE ADDRESS: 10775 SW FRROL ST
SJBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 002 JURISDICTION: T'G
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE NOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFI-OW 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: 90 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Rei-iarks: Install approximately 90 feet sewer line and connect house to newly installed sewer lateral. Septic tank is to be
pumped, filled and inspected. Reimbursement fee paid. ^_
FEES
Owner: — —
Description Dato Amount
ROSCH, MERIDETH ANNE +
JOHN M (I'LUMI31 Permit Fee 12i18/02 $72.50
10775 SW ERROL ITA X1 t;" State Tax 12/15/02 $5.80
TIGARD, OR 97223 rota) $78.30
Phone :
Contractor:
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone : 939-5246 Sever Inspection
Misc Inspection
Reg#: LIC 110314 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 %vi;), approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work w ;,,ispended 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 952-000 i-0100.
You may obtain copies of there rules or direct questions to OUNC by calling (503) 246-6699.
Issued By: Al r" 4 ,, ,�_�___� -- Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application Lei DR U1
Date received Permit no.: '31 -00
City of Tigard Sewer permit no.: Builiing 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 Da a issued: Byej Receipt no.:
Land use approval: Case file no.: Payment type:
&2 family dwelling or accessory 17 Commercial/industrial U Multi-family tU Tenant improvement
U New construction ,Addition/alteration/replacement U rood service U Other:
08 SITE IN I FORMATION
Job address: r' ��Z�`'- SW ��QO Description Qty. hee(ea.) Total
-New 1-and 1-family dwellings only:
Bldg. no.: =Suite no.:
(includes too ft.for each utility connection)
Tax map/lax lot/account no.: SFR(1)bath
Lot: _— flock: Subdivision: i SFR(2)bath _
Project nam • SFR(3)bath
City/county; _ ZII P: Each additional bath/kitchen
Des ription and location of r on pr nises: _ _ Site utilities:
�11-1,t,� ear - -- Catch basin/area drain
"Tafpletion/inspection: Drywalls/each ine/trench drain
Footin drain(no, in. R.)
Manufactured home utilities
. C 'z<• C Manholes
Address: _ Rain drain connector
City: State: 1111,7 11111, Sanitary sewer(no.1'n. R.)
Phone: Fax: I E-mail: Storm sewer(no.lin. R.)
Plum bus.re _ Water servicer tin. R.
CCB no.: g'no: Fixture or iten+:
City/metro lic.no.:
Cc-ntractor's representative signatur . - — Abso tion valve
Back(low preventer
Print name: bate: Backwater valve
' t Basins/lavatory
Name: __ = 4 — Clothes washer
Address: Dishwasher
Drinking fountain(s) —
City: Stattr ZIP: Ejectors/sump
Phone. Fax: �E-ma'.I• Expansion tank _
Fixture/sewer cap
Name(print): Floor drains/floor sinks/hub
-- Ga- rUai c disposal _
Mai Iingaddiess: _ _ Hose bi b
City: State: ZIP: _ lee maker
Phone: Fax; E-mail: !nterceptor/grease trap
Owner instal lation/residential maintenance only: The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof raincomme�)
employee on the property I own as per ORS Chapter 447. Sink(s), asin(s),lays(s) _
Owner's signature:, _ Date: Sump
Tubs/shower/shower pan
Urinal
Name: Water closet _
Address: __ _ Water heater
City: State: ZIP: _ Other:
!''.one: Fax: E-mail: Total
I t,all jurisdictions accept credit cards,please call jurisdiction for m.ae inrorrnation. Notice: This permit application Plan review(at Minimum fee...........o ) S
S
J visa U MasterCard expires if a permit is not obtained u /o) �..__
Credit card number __ / / within 180 days after it has been State surcharge(8%).... $
Name of cardholder as shown on credit card Expires
as complete. ........................ _
�- Expires TOTAL _0
S
Grdholder signature Amount 44114616(Na920M)
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 firstlGO ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connectionL
_ One 1 bath _ $249.20 _
Tub u ''ub/Shower omb. 16.60 Two2 bath $350.00
9
Showei Only 16.60 Three bath _ $399.00
Water Closet 16.60 L SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE
Uishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 ___ ^, TOTAL
Laundry Tray 16.60
Washing Machine 16.6r
Floor Drain/Floor Sink 2" 16.60
3" 16.60 - PLEASE COMPLETE:
4'- 16.60
WLter Heater O conversion u like kind 16.60 uantity b I Work Performed
Ub;,piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
ermit_ _ _ Capped
MFG Home New Water Service 46.40 Sink
MFG Hon.d New San/Storm Sewer 46.40 Lavatory
Hose Bibs 16.60 Tub or Tub/Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundiy Room TTX
_Aashlng Machine
Floor Drain/Sink: 2"
Sewer-1 st 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-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 62.50
Requested Inspections er/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.7.5
Grease Traps 16.60 -..-- - ----
QUANTITY TOTAL
Isometric or riser diagram is required If -- -
Quantity Total is >9 -- -- ---
*SUBTOTAL -
8%STATE SURCH,%RGE -
"PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qty.total Is>9
TOTAL f
"Minimum permit fee is$72 50+8%state surcharge,except Residential Backilow
Prevention Device,which is$38,25*8%state surcharge
"Ali New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan roviex.
1:\fists\forms\plm-fees.doc 12/26/01
CITYOF YI GAR D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00501
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/26/02
SITE ADDRESS: 10775 SW FRROL 5T
PARCEL: 2 S 103AA-01704
SUBDIVISION: ECHO HEIGHTS ZONING: R-4.5
BLOCK: LOT: 002 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 BASIN&
FIXTURES_ _ LAU!.-)RY TRAYS: SF RAIN DRAINS:
SINKS: Y URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing reversal. Connection to se Iver lateral to be done under permit#PLM2002-00489.
Owner:
FEES
-------.— —
Description Date Amount
ROSCH, MERIDETH ANNE +
JOHN M II'Ll1MB1 Permit Fee 12/26/02 $72.50
10775 SW ERROL I FAX 18",',,State lax 12/26/02 $5.80
TIGARD, Op 97223 Total $78.30
Phone :
Contractor:
LARRY CAMERON PLUMBING
1812 SE 158TH AVE
PORTLIND,OR 97233
REQUIRED INSPECTIONS
Phone : 5113-256-2705 Final Inspection
Reg#- i I( 49792
Il %I 26-360PB
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
Issued By: t (� <lf% 4 / Pei inittee Signature: T
Call (503)639-4175 by 7:00 P.M. for an inspection needed the next btisl ss day
FOR USEUNLY
FFICE
Pi amlbin� Permit Application Received a Plumbing
Datc/13 Permit No.: - 5;
City of Tigard Planning Approval Sewer
Date/By: Permit No.:
13125 SW Ifall Blvd. Plan Review Other O
Tigard,Oregon 97223
Date/By:: Permit No.: a/ -CXR 0
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review land Use
Date/BInternet: www.ci.tigard.or.us Contac Case No.:
$ TM Contact Juris.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: _ T/ su I!Mental Information.
TYPE OF WORK FEE"SCHEDULE(for special Information use checklist
New construction Demolition _ Description I Qty, I Fee(ca.) I Total
Addition/alteration/replacement Other: New 1-&2-family dwellings
Includes 100 ft.for ea.h u IlIty connection
CATEGORY OF CONSTRUCTION _
i &2-Famil dwelling _ Commercial/Industrial SFR t bath 249.20
— SFR 2 bath 350.00
Accessory Building Multi-Family SFR 3 bath 399.00
Master Builder _ Other: Each additional bath/kitchen 45.00
JOB SITE,INFORMATION and LOCATION Firesprinkler-sq.It.: Pape 2
Job site address: ZO ?7 a-/ C"jlui d Site Utilities
Suite#: B]dg,/Apt.': — Catch basin/area drain _ 16.60
S
Suite Name: D ell/leach line/trench grain _ 16.60
Proj -- Footing drain no.linear ft. Pae 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer no.linear R.) Pae 2
Subdivision: LUt#: Storm sewer no.linear It. Pae 2 _
Tax map/parcel#: Water service no.linear ft.)_ Pae 2
Fixture o►'Item
DESCRWJION OF WORK Absorption valve 16.,)0
v' iiC/6 t� L'
Backflow'; everter Page 2
Backwater valve 16.60
Clothes washer _ 16.60
-- — Dishwasher _ 16.60
Drinking fountain 16.60
PROPERTY OWNER =TENANT Ejectors/sump 16.60
Name: Jif/N' C /�£Yff_ C' Expansion tank 16.60 _—
Address: /0 7 _I'c<.� 77X-4, Fixture/sewer cap 16.60
City/State/Zip: 7_161g, 44 ASC— y 702 Floor drain/floor sinkthub 16.60
— Barba a disposal 16.60
Phone: / 9/5 Fax: _ Hose bib _ 16.60
APPLICANT _I El CONTACT PERSON Ice maker 16.60
Name: Interceptor/grease trap --- 16.60
Address: Medical gas-value: S Page 2
: Primer 16.60
Cit /State/Zi
p Roof drain commercial 16.60
Phone: _ Fax: Sink/basin/lavato 16.60
E-mail: Tu6showe1shower pan 16.60
CONTRAAC R 4 Urinal' 16.60
Business Name„(AMf2r C Water closet 16.60
Water heater 16.60
Address: d 2 Sr'f -•S'Ic l�'�n�S Other:
City/St at e/Zijt U/L Other: L1111.5,f <<< ti
Phone:,--Zs—AV Fax: 34"r- Plumbing Permit Fees*
CCB Lic. #: Plumb. Lic.#: ,J =J/ _Minimum Permit Fct_ $
Authorized / Residential Backflow Minimum Fee$36.25 7i�• S'U
Signature: --flate;/.�—o2b Plan Review 25%of Permit Fee $
State Surchar a B%of Permit Fee S r
(Please print name) TOTAL PERMIT'FEE S
Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of plans wit i Isometric or
100 days after It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Bnliding Industry Servicc Board.
!:\Dsts\Pemut Forms\PlmPer.niLApp.doc 01/03
Plumbing Permit Application -City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fec(ca> Total S uare Footage: Permit Fee:
Footing drain-1"100' 55.00 0 to 2,000 $115.00
Footing drain-each additional 100' 46.40 2 601 to 3 600 $160.00
_ 3 601:0 7,200 $220.0
Sewer-1 st 100' 55.00 __ 7,201 and greater $309.00
Sewer-each additional 100' 46.40
Water Service-I st 100' 55.00 Medical Gas S stems:
Water Service-each additional I(V 46.40 Valuation: Permit Fee:
Storm&Rain Drain-I st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and S1.:12 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(en) Total including$10,000-00.
Com,ercial Back Flow Prevention Device 46.40 S10,001,00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Resi :ntial Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25 27.55 and includin $25,000-00.
Rein Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
_ each additional$100.0f,or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00.
seccially requested inspections-per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: cacti additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,moving ov replacing existing fixtures? If
"yes",please Indicate work performed by fixture. Failure to
accurate!y report fixtures could result in increased sewer fees*.
uentl by(Flit re)Work Performed Comments regarding fixture work.,
Fixture Type: Replace
New Moved_ Existing Copped
Baptistry/Font _
Bath -Tub/Shower
-Jacuzzi/Whirlpool —�—
Car Wash -Each Stall -
-Drive Thry
Cus idor/Water Aspirator _
Dishwasher -Commercial
-Domestic
Drinkinit Fountain
Eye Wash
Floor Drain/sink 2"
3"
.4 _
Car Wash Drain _ *Note: If the fixture work under this permit results in an
Garbage -Domestic -- increase of sewer EDLJs,it sewer permit will be issued and
Dispo:;al -Commercial
-Industrial fees assessed for the sewer increase mast be paid before the
Ice Mach./Refri .Drnins plumbing permit cnn be issued.
Gil 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-Toilct
Urinal
(Other Fixtures:
i-\Dsts\Pennit Forms\PlmPermitAppPS2.doc 01/01