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10780 ".'W Errol Street
CITYOF 1 I G A R® _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00030
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/28/03
SITE ADDRESS: 10730 SW ERROL ST 2S103AD-00100
SUBDIVISICN: ECF'sO HEIGHTS ZONING: R-4.5
BLOCK. LOT: 015 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: 95 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 95ft. sewer line to connect to sewer lateral. Septic tank to be pumped, filled and inspected.
FEES
Owner:
Description Date Amount
LINDBLOM, RUSSELL J JR — --
STEPHANIE L 11-1 UNIBI I'rrniit FCC 1/28/03 $72.50
10780 SW ERROL ST l"I AX1 .S",State Tax 1/28/03 $5.80
TIGARD, OR 97223 Totnl $78.30
Phone : S03-019-53;2
Contractor:
TED MCBEE EXCAVATING INC
1142A NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone : 919- 240 Sewer Inspection
Final Inspection
Reg#: I W 110.114
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.
.r his permit will expire if work is not started within 180 days of issuar,-e or if work is suspended for more
than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility
Notificatior, 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 calling (503) 246-6699.
Issued By: � ;�� f�, t Permittee Signature:'1( ;
Call %y03) 639-4175 by 7:00 P.M. for an inspection needed the next business day
i
Building Fixtures
Plumbiniz Permit ,application Received Plumbing
Date/By: — J a• Permit No.: `�l( ) �� &(Xi
Planning Approvai Sewer
City of Tigard Date/By: Permit No.:
13125 SW 1-lall Blvd. Plan Review other
Tigard,Oregon 97223 Date/By: _ Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review tPhd Use
DateB . Ce;e No.:
Internet: www.ci.tigard.or.us —Date/By.
Contact Juris.: N See Page I for
24-hour Inspection Request: 503-6394175 Nat je/Method: I Supplemental Inrormatloo.
TYPE OF WORK FEE'SCHEDULE fors ectal Information use 6 xklist
New constructionDemolition Description I Qty. I Fee(ra.)ITotal
Additiantalteration/re lacement Other: New 1-&2-family dwellings
CATEGORY OF CONSTRUCTION (ncludes 100 R.for each utility connection
i & 2-Family dwellin Comm5FRI bath 249.20ercial/industrial SFR 2 bath 350.00
AccessoryBuildin Multi-Family_ SFR(3)bath 399.00
Master Builder I Other: Lach additional bath/kitchen 45.00
SITE INFORMATION and LOCATI N Firesprinkler-sq. R.: Page 1
Job sit( r' Site Utilities
Suite#; $ld ./A t.#: Catch basin/area drain IG.GO
Dr well/leach line/trench drain 16.60 _
Project Name: __ Footing drain no.linear R. Pa c 2
Cross street/Directions to job site; Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer no linear ft. <> Pae 2
Subdivision: Lot#: Storm sewer no, linear fl. Pae 2
-- -- t—_ Water service no. linear fl. Pae 2
7'ax map/parcel #: Fixture or Iten,
DESCRIPTION OF WORK Absorption valve 16.60
Backflow pivventer Pae 2
Sic e Backwater valve 16.60
Clothes washer 16.60
-- Dishwasher 16.60
_
Drinking fountain16.60
PRO ^RTY OWNER I Q UNANT Ejectors/sump
— 16.60
ame: r F t Expansion tank 16.60
Address: Fixture/sewer cap 16.60
Cit /Stale/ 1 Floor drain/floor sink/hub 16.60
--- --- -- -- Garbage disposal 16.60
Phone: ax: _ Hose bib 16.60
PPLI T I U CU TACT PERSON Ice maker 16.60
ame' _ Intercetur/ rcase(tap 16.60
Address: Medical gas-value: $ Pae 2
--- Primer 16.60
City/State/Zip: -- Roof drain commercial 16.60
Phone: _ Fax: Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan _ 16.60
CONTRACTOR Urinal — _ 16.60
� 5is S4 Water closet _ 16.60
Business Name:
�--- Water heater I6.60
Address: t- C other: _
Cit /State/Zi � other:
Phone: Fax: I'lumbing Permit Fees•
-- — Subtotal $
Plumb. Lig.#:— _ Minimum Permit Fee$72.50 S
Authorized Residential Backflow Minimum Fee$36.15
Signature, _ _ Date ^z8�� plan Review 259io of Permit Fee $
State Surcharge 11%of Permit Fee S
(Please print name) TOTAL PERMIT FEE S
Notice: Thas permit application expires If a permit Is not obtalned within All new commercial buildings require I sets of plans with Isometric or
i90 days after It has been accepted as complete. riser diagram for plan review.
"Fee methodology set by Tri-County Building Industry Service Board.
!:\DSts\Permit Fomu\PlmpernitApp.doc 01/03
'."umbinE Permit Application • City of TiPard
Fage 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression Systems:
ik
e Utilities Qty- Fee(ca) Total S uare Foots e: Permit Fee:
55.00 U to adx)0 $115.00----
Footing
115.00 __-____
Footing dr100' 2 001 to 31500 $160.00 _
Footing d -each additional 100' 46.40 3,601 to 7,200 — $220.00
Sewer-I 55 M 7,20,and eater $309.00
Sewer-eachitional 100' 46.40
Water Sest 100' 5S 00 Medical Gas S Stems:
46.4o Permit Fee:
Water Seach additional 100' foo
ion:
Storm& in Ist 100' F46.40
$5,000.00 Minimum fee$72.50 0 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Storm& rain-cuch oddm.nal 100'_ additional$100.00 t, fraction thereof,to and
ture or Item t?ty. 'total includin 510-000.00.
Commercial Back Flow Prevention Device } 46,40 $10 oo1.00 to$25,000.00 $148.50 for the first SIO,OW.UO end$1.54 for
each additional$100.00 or fraction thereof,to
Residential Backflow Prevention Device 27 55 and includin 525 tH)<1.00.
minimum ennit fee 536.25 $25,001.00 to$50,000.00 $379.50 for the first S2",000.00 and$1.45 for
Rain Drain,single family dwelling 65.25 _ each additional S1U0.00 or fraction thereof,to
Inspection of existing plumbing or and including$50 000.00. _
s eciall requested ins ctions- r hour 72.50 $50,001.00 and up S742A0 for the first S50,000-0()'nd S1.2U for
Subtotal: _ each additional$100.00 or fraction thereof
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately report fi,aures C1unngt by(Flxresult bireeWu kk Id'csiwer uimed"y* Comments regarding fixture work:
- ni nl►er.
Fixture Type: New Moved 13xil IV Ca it
Be list /Font -
Bath =rub/Shower -
-Jacuzzi/Whirl wl
Car Wash -Each Stall -
-Drive Thru
Cua idor/Water Aspirator _
Dishwasher -Commercial
-Domestic -
Drinkin Fountain _ -
E e Wash
Floor Drain/sink .2"
3„
4"
Car Wash Drain *Note: If the fixture work under this permit results in an
llarbage -Domestic increase of sewer FDUs,a sewer permit will be Issued and
Disposal -Commercial fees assessed for the sewer Increase must be paid before the
Industrial plumbing permit can be issued.
Ice Mach./Refri .Drains -
Oil Se orator Gas Station
Rec.Vehicle bum Station
Shower -Gena
-Stall
Sink -Bar/Lavatory
-Bradley
-Commercial
-Service
Swimmin Pool Filter -
Washer-Clothes
Water Extractor
Water Closet-Toilet
Urinal
Other Fixtures:
1:\Data\PetmitFonns\PlmPemiiiAppPr2.doc 01/03
CITY OF TIGARD _
SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2003-00041
13125 SW Hall Blvd., Tigard. OR 97223 (503)639-4171 DATE ISSUED: 1/24/03
SITE ADDRESS; 10780 SW ERROL Sl PARCEL: 2S 103AD-00100
SUBDIVISION: EC IO IIEIGHTS
BLOCK: ZONING: R-4.5
---- LOT: UIS JURISDICTION:
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGF
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: Remarks: Sewer connect. Reimbursement district#21. Paid
LINDBLOM, RUSSELL J JRL--on
FEES
STEPHANIE L Date Amount
10780 SW ERROL ST
TIGARD, OR 97223 Connect 1/24/03 $2,300.00Phone: 503-G39 5ag2 onneet 1/24/03 $0.00
Inspect 1/24/03 $35.00
Contractor: Inspect 1/24/03 $0.00
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 am)unt paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side s%,wer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from `he distance given. If not se located,the Installer shall purchase a "Tap and Side Sewer' Perm
Issued by:
Permittee Signature: '( 'A
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plu, ni b i n e Permit ApplicatioI I< Received Plumbing
Date/By: Permit No.:
Planning Approval Sewer
City of Tigard Date/By: _ Permit No.:
13125 SW Hall Blvd, Plan Review Other
Tigard,Oregon 97223 Date/B _ Permit No.
Phone: 503-6394171 Fax: 503-598-1960 Post-Review Land Use
Date/By: I Case No.:
Internet: www.ci.tigard.or.us Contact Juris.. N See Page 2 for
24-hoar Inspection Request: c03-639-4175 Name/Method: W_ Supplemental Information.
TYPE OF WORK Fr EE"SC!XDULE(for special Information use checklist
NeW CUnstruction Demolition Description Qty. I Feetes.) Total
Addition/alteration/re 1p acement Other:_ New i-&2-family dwellings
CATEGOR 'OF CONSTRUCTION Includes 100 ft.for each u IlIty connection
SFR 1 bath 249.20
1 &2-Famil dwellin r Commercial/Industrial
_ �' _� _ _ .__._ SFR(2)bath _ 350.00
iAccessory_pui!d in _ . Multi-Family SFR(3)bath 399.00
_ Master Builder I E9 Other. Each additional bath/kitchen _ 45.00
JOB SiTE INFORMATION e.nd LOCATION Firesprinkler-sq, ft.: Pa c 2
'} ,lob site address: 0 c) l ti Egra / S /- _ Site Utilities
Suite#: Bld ./A t.#: Catch basin/area drain IG.ao
— D ell/leach line/trench drain 16.60
Pro'ect Name: / n l Footing drain no.linear ft. Pae 2
Cross street/Directions o job site: Manufactured home utilities 110.00
pv(,,c�_ LL'c i bra Lk T FU Yl Y1 F F' Manholes _ 16.60
Rain drain connector 16.60
Sanitary sewer no. linear fl. Pae 2
Subdivision: Lot#: Storm sewer(no,linear It. Page 2
Tax ma / steel #_ Water service no. linear fl. Pae 2
_ Fixture or item
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer _ Pae 2
_ `---_.----- ^—_s-- Backwater valve _ 16.60
--` —v` Clothes washer 16.60
— --- Dishwasher 16.60
Drinking fountain 16.60
PROPlE TY OWNER ectors/sump 16.60
Name: Expansion tank _ 16.60
Address: C Fixture/sewcr cap 16.60
Clt /Stale/Zt : !Ci (' t� Floor drain/floor sink/hub 16.60
Garbage disposal 16.j0
Phone: Fax: Hose bib 16.60
APPLICANT 1 171 C_ONTAC_I'PERSON Ice maker 16.60
Name: _^ Interce tor/ tease trap 16.60
Address: —�` Medical gas-value: S Pae 2
— Primer 16.60
Cit /State/Zi
Roof drain commercial 16.60
Phone: Fax: __ _ Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: eye{, : c'c. Water closet 16.60
1 -------� Water heater 16.60
Address: , ��r other:
Cit /Sta.o/Zip: pl. C1 ttC Other: _
Plumbing Pci mit Fees"
Phone: _5 Z .,?.S x:a —
Subtotal S
CCB Lic. #: Plumb. Li .#: Minimum Permit Fee$72.50 $
Authorized Residential Backflow Minimum Fee$36.25
Signature: t - 5�� Plan Review 25%of Permit Fee $
State Surcharge 8%of Permit Fee S
(Pleuse print name) TOTAL PERMIT FEE I S
Notice: This permit application expires it a permit Is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days atter It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Trl-County Building Industry Service hoard.
ODstsU'ermit FormsTImPermitApp.doc 01/03
Numbing P,.rntit Application -City of Tigard
Page 2 - Supplemuntal Information
Fee Schedule: Residential Fire Suppression Systems:—Y_v
Sltc Utilities Qty. Fee(es) Total Square Footage: _ Permit Fee: _
Footing drain• I" 100' 55.00 0 to 2 0)0 $115.00 _
Footing drain•each additional 100' 46.40 2 001 to 3,6(10 $160.00
_ 3,601 to 7,200 $220.00
Sewer-1st 100' 55.00 7,201 and greater $309.0^
Sewer-each additional 100' 46.40
Water Service-1st 100' 51 00 Medical Gas Systems:
Water Service-each additional 100' 46.40 Valuation: Permit Fee:
Storm&Rain Drain• I st 100' 55.00 51.00 to S5,000.00 Minimum fee$72.50
Storm&Rain Drain each additional 100' 46.40 $5,001.00 to 510,000.00 572.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ea) Total imuding S10 000,00.
Commercial(lack Flow Prevention De%ice 46.40 $10,001.00 to$25,000.00 $148.50 for the first S10,000.00 and$1.54 for
Residential dackllow Prevention I:evic• each additional$100.00 or fraction thereof,to
minimum permit fee$36.25) _ 27.5.i and including$2j,000.W.
Rain Drain,single tamily dwelling 65.25 $25,001.(x)to 550,000.00 $379.50 for the first$25,000.00 and 51.45 for
each additional$100.00 or fraction thereat,to
Inspection of existing plumbrm,,or and including$50,000.00.
specially requested ins ections•per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal; each additional$100.00 or fraction thereof _
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*. Comments regarding fixture work:
Quantity by Fixture Work Performed g �'
Fixture Types Replace
New Moved Existing Capped
Baptistry/Font —
Bath -Tub/Shower
-Jecuzzi/Whirl ool
Cor Wash -Each Stall
-Drive Thru
Cusidor/Water Aspirator _
Dishwasher -Commercial
-Dom^stic
Drinking fountain
_f,Y5 Wash
Floor Drain/sink 2" —
Y
4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic increase of sewer Ebtls,a sewer permit will be issued and
Disposal -Commercial fees assessed for the sewer Increase must be paid before the
-Industrial
Ice Mach./RcM .Drains plumbing permit can be Issued.
Oil Sc orator Ons Station
Rec.Vehicle Dump Station _
Shower -Gang
Stall _
Sink •13ar/1-avalory
-Bradley _
-Commercial
-Service
Swimming Pool14tcr
Washer-Cl(thes
Water Extrec:or
Water Closet•Toilet
Urinal
Other Fixtures:
is\Dsts\Permit Forms\Plml'cmntAppPg2.doc 01/03
CITY k71= TIGARC 24-Hour
BUILDING Inspoction Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171 —
BUP — .-
11 0-
Received _�__ v Date Requested__--f�q_-.. AM PM BUP
Location .__..__—�G �' n -�� ___Suite MEC
Contact Person � �r_-Q- Ph PLM . d..fid
Contractor— `_—. Ph
BUILDING Tenant/Owner _____ — _____ ELC _
Footing ELC
Foundation I Access: -
Ftg Drain ELR --_
Crawl Drain
Slab Inspection Notes: SIT _-
Post&Beam -
Shear Anchors -
Fxt Sheath/Shear
Int Sheath/Shear
Framing - -- ----- -— ------ -- --
Insulation
Drywall Nailing - ---- -- - -
Firewall
Fire Sprinkler — - - -
Fire Alarm
Susp'd Ceiling ------ -Roof
Other: /
Other.--------- — T - - ----
Final
PASS PART FAIL
PLUMBING —_—_--
Post&Beam
Under Slab ----- -
Rough-In
Water Service -- — ----
t3anftery S�idev
dein brains - - ---- ---- - -
Catch Basin/Manhole
Storm Drain —- ---
Shower Pan
Othe•: -
F
/PA,%S PART FAIL --- ----- --- _—__
_CHANICAL --------- ----- -- ------------
Post&Beam -
Rough-In - - -------- — ---
Gas Line
Smoke Dampers ----- - --- ----- --- -----------
Final
PASS PART FAIL -- -- ----- --- - --- - -------ELECTRICAL
Service Service---_._...- - - ---.. --- __— ------------- ---
Rough-In
UG/flab •---- ---- - _--------
Low Voltage
Fire Alarm
Final ❑ Reir,sppction fee of$ _required before next Inspection. Pay at City Hvll, 13125 SW Hall Blvd.
PASS PART_ FAIL
SITE --� ❑ Please call for reinspection RE: .. ❑ Unable to inspect-no access
Fire Supply Line
ADA
DOS
- L•- --- Inspector
Other.
Final DO NOT REMOVE this Inspection recor►i from the Job site.
PASS PART FAIL
invoice
Name S 72FUe / , e 6 Date 1 'l i-3" O
Address /070- 0 �("" CI PO -1Phone ZY 7 --
_ i
City- I _fkflu — Initial -.LOn Acct. i
012.
State..-.._____ Zip Code —�. _ _
Price Amount
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NOT RESPONSIBLE FOR DAMAGES PAST CURB LINE OR LANDSCAPING
• A service charge of 1.5%will be levied on all past due accounts. Total: V
• Returned check fee is$20.00.
• In case suit, action or-,bitration is instituted by either party for breach or to enforce any
provisions herein, the court shall award reasonable attorney's fees and actua'costs to the !
prevailing plarty at trial or arbitration, or upon any appeal taken therefrom
r �\A provaI`
Custom rgig-nature'
?'hank YouP.O. BOX .136 • Canby, OR 97013 DEQ#37464
(503) 263-2087 or (503) 632-6138 CCB# 104320