11480 SW GAARDE STREET A
00
4
i N
C�
G�
f.1
I
CL
CD
CD
c�
i
a
i
11480 SW Gaarde Street
CITYOF TIGARD _SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2001-00215
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417-1 DATE ISSUED: 7/17/01
_
SITE ADDRESS; 11480 SW GAARDE ST PARCEL: 2S110AB-04200
SUBDIVISION: COLE'S ACRES ZONING: R-4.5
BLOCK: LOT: 020 JURISDICTION: TIG
TL NANT NAME: SHUEY
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPS'dVR IMPERV SURFACE:
Remarks: Connect existing house to sewer lateral. Septic lank must be pumped, filled and inspected for
proper abandonment.
Owner: FEES
SHUEY, NEIL E/DONNA M --
13895 SW BOXELDER ST Type By _ Date Amount Re^eint
TIGARD, OR 97223 PRMT CTR 7/17/01 $2,300.00 27200100000
MSP CTR 7/17/01 $35.00 27200100000
Phone: Total $2,335.00
Contractor:
Phone:
Reg #.
Required Inspections
Sewer Inspection
Septic Tank Filled
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency -rhe perwit expires
180 days 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 purcnase a"Tap and
Side Sewer" Permit and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAF, 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987
Issued by: )jj •1 - ilac: __�_ Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00304
13125 SW Hall Blvd., Tigard, OR 9722.3 (503) 639-4171 DATE ISSUED: 7/17/01
SITE ADDRESS: 11480 SW GAARDL ST
PARCEL: 2S110AB-04200
SUBDIVISION: COLE'S ACRES ZONING: R-4.5
BLOCK: LOT: 020 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: SEWER ONE. 13 ft
WATER. CLOSETS: WA-i ER LINE. ft
DISHWASHERS: RAIN DRA!N: ft -
Remarks: Installation of 93'of sewer service to connect existinj house to sewer lateral. -
— -- FEES — -v ---
Owner: - - — -- —==
—" --- Type By Date Amount Receipt
SHUEY, NEIL E/DONNA M -- — - --
13895 SW BOXELDER ST PRMT CrR 7/17/01 $72.50 272001000U0
TIGARD, OR 972.7.3 5PCT CTR 7/17/01 $5 80 27200100000
Total $78.30
Phone 1: — -- --------- �.. —
Contractor:
C & B CONSTRUCTION
DOUGLAS BRUCE K.UGL ER
2255 SW 193RD CT REQUIRED INSPECTIONS
ALOHA, OR 97006
Phone 1: 503649-3969 Sewer Inspection
Reg#: LIC 132137 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 apprcved plans.
This permit will expire if work is not started within 180 clays 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 952-0001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: r ' % /� � ,;�j Permittee Signature: Yy -4- 1.,
Call (503) 639-4175 by 7:0 P.M. for an inspection needed the next business day
- _ Plumbing Permit.Application
— Datereceived: Permit no.;ANA-O/-4`0,30
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223 —
CityojTlgard Phone: (503) 6394171 Project/appl.no.: Expiredatc:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: _— Case tilc,to.: Pay meat type
IN W W111 0 814111
U I &2 family dweaing or acce:;sory U('ununercialfindustlial U Multi-family U Tenant improvement
U New construction U Addition/alteratiort/replacefnent U Food service U Other:
1 t 1
/ Job address: ( ILA E; �w - _ D,.scrlptlon _ Qt . Fee(ea.) Total
Bldg.no.: _ _ Suite no.: New I-and 2-family dwellings only:
Tax n /tax Iol/account no.: (includes 1000.for each utility connection)
P _ SFR(1)bath
Lot: 131ock: Subdivision: _ - SFR(2)bath ^- -_-- -- -
Project name_:_ SFR(3)bath -�
City/county: ZIP: 7 d-J- - -1?ach additional bath kitchen ---
Description and loco ion of work on premises: nA.A.. I°fPsl1_T Siteutilitles:
Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain -
Footing drain(no.lin. ft.) _
ss name _ Manufactured home utilities
siner � Sr ManholesBudAdress:
— —
I.,ZSr Rein drain connector
1 Cit Stater I ZIP: y •Sanitary sewer(no.lin.ft.)
r'home: ��,s fL Fax: E-mail: Storm sewer(no.lin.('t.)
Water r,t rvice(no.lin.ft.)
CCII no.: -7 _ Plumb.bus.reg.no: _ --
City/metro lic.no.. Fixture or Item:
6 retractor's representative signature: „� _- Absorption valve - -
' Back flow preventcr
Print name: i i Date: Backwater valve
Basins/lavatory-- - -- -V-
Name: Clothes washer_
Dishwasher
Address: ------- - - - -- - --- -
-- Drinking fountain(s)
('i(y: _ - State: - ZIP: Ejectors/suinp
Phone: Fax: E-mail: Expansion tank
Fixture/s.wer cap -- _-_-_
Name(print):/y T:I t`v� D o n'rV N SA U C Floor drains/floor sink.0iub_-
Mailing address: / 2jr S >n/ Garbage disposal
Hose Bibb
City; _ _ State: ZIP: 7 a Ice maker -
Phone:r5o - Fax: Email: Inuercc tor,vn ase tn, --
r --� �_I! -- —.
Owner installation/residential maintenance only: The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain(comrnercial) __--
employee on the property I own as per ORS Chapter 447. Sink(s), asin(s) luvs(s)
()�,ner's signature: _ I�;ur Sump ----- _ -_ -_ --_
Tubs/shower/shower pan_ _-
Urinal _
fame' Water closet
Address: Water heater
City: State: ZIP: Other: --- -
Phone: Fnx: E-mail: Totall
Not all jurisdictions accept credit cords,please cell juriedklion for more informationNotice:This permit application
Minimum fee................ , •
U Visa C1 MasterCardPlan review(al — %) $ _
expires if a permit isnot obtained a �
Credit card number: ___L�. within 180 days after it has been State surcharge(896)""$ —
-- -- accepted as complete. TOTAL .......................$ '
Name of cardholder as shown on credit card Expires$
G + 678'
7a 3C
-- Cardholder sigutum Amount l L` 00 4104616(6KWOM)
a,
PLUMBING PERMIT FEES:
PRICE TOTAL r New 1 and 24.imlly dwellings only
FIXTURE8 Individual QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. OTY (ea) AMOUNT
for each utility connection) __ _ _
Lavatory 16.60 One 1 bath _ $249.20
Tub or Tub/Shower Comb. 16.60 Two(2)bath -- $350.00 _
Shower Only 16.60 Three bath -__ _ $399.00
Water Closet 16.60 - SUBTOTAL -
Urinal 16.60 6%STATE SURCHARGE - -
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL -
Garbage Disposal 16.60 TOTAL
Laundry Tray _ 16.60
Washing Machine 16.60
Finer Orin/door+ink PLEASE ('.GMPLETE:
3,. 16.60
a" lsso - _ -- _-
Water Heater O conversion O like kind 16.60 _ Quantity b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit.
Ca ed
MFG Home New Water Service 46.40 Sink
MFG Home New SarUStorm Sewer46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Founts 16.60 Water Closet
Other Fixtures(5peci ) 16.60 Urinal
-
--
41Dishwasher
!Vi.l.h� Z Garbage Disposal --- --- ---
`- La ndrj Room Tray
Washing Machine
Floor Drain/Sink; 2"
Sewer-19t 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
S reci
Sturm&Rain Orain-1St 100' 55.00 -
Storm&Rain Drain-each additionril 100' 4640
Comnterclai 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 f er/hr 'COMMENTS REGARDING ABOVE-
Rain Drain,single family dwelli,ig 65.25Grease 16.60
16.60 ----_. .- --.___----------------_-�--- -
- QUANTITY TOVAL - -- -- - i- -- ------_,-
Isometric or riser diagram is required If
Quantity Total is >9 _ --- --- --'- ----- ---
`SUBTOTAL --- ..-. -- ----.��- - -_ ----
8%STATE SURCHARGEul -- ---- ---- - --
5°/ S
zt qty to s>9V J
TOTAL a
"Minimum permit fee is$72 50-8%state surcharge,except Residential 0ack8ow
prevention Device,which Is$36 25•8%slate surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
fdan review
iAdsts\forms\plm-fees.doc 10/10,'00