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11740 SW GAARDE STREET a V A O D D v m cn --i m m 11740 SW GAARDE STREET CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00340 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/11/03 SITE ADDRESS: 11740 SW GAARDE ST PARCEL: 2S 110BA-01500 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: _ , 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: 120 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install approximately 120 ft. of sewer line io connect house to newly installed sewer lateral. Septic tank is to be pumped, filled and inspected. Reimbursement Dist. #23 24 paid. Rec. #2003-2895, 7-7-03 Owner: FEES Description Date Amount OLSEN, JOHN W/MARY JO _ 11760 SW GAARDE ST 11'1.11,11131 1'ermit I"cc 7/11/03 $72.50 TIGARD, OR 97224 11AX18" stutcTax 7/11/03 $5.80 1111 1AIli1 Permit Pec 7/21/03 $46.40 Phone 1'I:\X1 x stutc Ta.r 7/21/03 $3.71 Contractor: Total 5128.41 A-AFFORDABLE SEPTIC SERVICE PO BOX 1130 WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone : 503.969-9548 Sewer Inspection Misc. Inspection Reg#: LIC 151481 This permit is issued subject to the regulations contained in the Tigard Municipal Code, Staie 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: �:- L_?Z, '_ �- Permittee Signature: Call (503) 639-4175 by 7:00 P.M.for an Inspection needed the next bum sine1w 00Yw A,,- '�-art, . liu►liallig 1, murex PlumbiaPermit Application ' Received Plumbing DalcTy_ _ Permit No.: City of Tigard Planning Approval Sewer 13125 5W HSII Blvd. Date _ Permit No.: Tigard,Oregon 97223 Plan Review OtherDaWBy, Permit No.: Phone: 503-6394171 Fax: 503-5984960 960 Post-Review Land Use Internet: www.ci.tigard.or.us ��' DatcLBcase No.: 24-hour Inspection Request: 503-639-4175mz Contact Juns.: See—PAR-2 for Name/Method _ SupplcmentalInformation. TYPE OF WORK _ FEE*SCHEbULE fors eclat Information use checklist New construction Demolition D_e_scription oQI%,. Fee(ca.) Total Addition/alteration/replacement Other: New I-&2-family dwellings CATEGORY OF CONSTRUC'I<'-nN includes 100 ft.for each ut1111ty connectlo I &2-Family dwelling Commercial/Industrial SFR 1 bath 249.20 Accessory Building Multi-Famil SFR 2 bath 350.00 -- SFR 3 bath 399.00 Master Builder Other: Fach additional bath kitchen 45.00 JOBS[-. INFORMATION and LOCATION Firc s rinkler-s . ft. Pa'c 2 Job site address: --�� Site Utilities Suite#: _ Bldg/Apt.#: Catch basin/arca drain -T 16.60 Project Name: Dr ell/leach line/trench drain IG.60 Cross street/Directions to job site: Footin drain no, linear ft. Pa c2 O,K)y C e l` Manufactured home utilities 110.00 �" �� �� Manholes 16.60 Rain drain connector 16.60 Sanitary sewer no. linear R. re Pae 2 Subdivision Lot#: Storm sewer no. linear ft. Pa C2 Tax map/parcel #: — Water service no. linear ft) P age 2 EESCRIPTION OF WORK Mhwashe _ Fixture or Item n valve _ 16.60— reventer __ Pae 2r valve Ifi G0asher 1G 60er IG.G(1PROPS TY OWNER =T NANT ountain16.60Name: / � � m 16.60 lRoofdrain nsion tank 16.60 Address: l �/ 1,1 4 re/sewer ca 16.60 City/State/Zip: Rrl _!� Zec r drain/floor sink/hub 16.60 Phone: a �/ Fax: age disposal 16.60 PPLI_CCA T CONTACT PERSON bib 16.60 ame: aker 16.60 ce tor/ rease trap16.60 -`- Address: /_ ical as-value: $ Pee 2 Cit /State/ZI ' er 16.60 Phone: drain commercial 16.60FAX: 7T basin/lavatory 16.60 $-mall' shower/shower 16.60 CONTRACTOR l 16.60 Business Name: . r closet 16.60 Address: / K1r heater 16.60 City/State iOther: rtTd Other: Phon . Fax 3 Plumbing Permit Fees* CCB Llc. #:�t/ ! Plull . LIC.#: A _ Suitraal $ — Authorized Minimum Permit Fcc$72.50 $ Signature: - - Doter_ Residential Backflow Minimum Fec$36.25 ~ :� b Plan Review t25%of permit Fec $ �1Srcharge(8% —S _ _ State:iuof Permit Fee $ , ____ ) _ (Please print name) TOTAL PERMIT FEE $ o� j� Notice: This permit application expires if a permit Is not obtained within All new commercial buildings requlre 2 seb of plans with Fit,tetric or 180 days after it has been accepted as complete. riser diagram for plan review. F *Fee methodology set by Tri-t ounh Building industry Service hoard. is\bsts\Permit Forms\l'Imi'etmi(App.dm 01103 5e—t:) 6lTy Plumbing Permit Application - City of Tigard Page 2 - Supplemental Inform.-tion Fee Schedule: Residential Fire Suppressien Systems: Site Utilities4—( Fce_(ca) Tnlal Square Footage: Permit Fee: Footing drain-I"IW' 55.00 0 t SI15.00 Footing drain-each additional 100' 46,40 2 601 to 3 200 $220.00 3 601 to 7,200 $220.00 Sewer-Ist 100' /QD 55.00 7,201 andgreater $309.00 _ Sewer-each additional 100' 46.40 Water Service-Ist 100' 55.00 Medical Gas S stems: Water Service-each additional 100' 46.40 _ Valuation: Permit Fee: Storm&Rain Drain- 1 st 100' 55.00 $1.00 to$5,500.00 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$1.52 for each additional$100.00 or fraction thereof,to and Fixture or Item Qty. Fee(ea) Total including$10,000-00. Commercial Back Flow Prevention Dcvicr 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 f'or Residential Backflow Prevention Device each additional 5100.00 or fraction thereof,to minimum Permit fee$36.25 17.55 and including$25,000.W. Rain Drain,single family dwelling 65.25 $25,001.00 to$50,00.00 $379.50 for the first$25,000.00 and$1.45 for each additional 5100.00 or fraction thereof,to Inspection of existing plumbing or and including$50,000-00. specially requested inspections-per hour 1 72.50 $50,00100 and up $742.00 for the first$50,000.00 and$1.20 for Sublotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping,ntovhtg or replacing;existing fixtures? If "yes",please indicate work performed by fixture. Fpilure to accurately report fixtures could result in increased sewer fees*. Comments regarding fixture work: Quantityb Fixture Work Performed g g Fixture Type: Replace - New Moved Existing CapEd Bu list /Font __--- ----------- — Bath -Tub/Shower -Jacurzi/Whirl I - - - -- Car Wash -Each Stall -- - -Drive Thru Cos idor/Water As iralor - Dishwasher -Commercial ----- ---- - -Domestic _ Drinking 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 iurreRse of sewer EDUs,a sewer permit will be issued and Disposal -Commercial -Industrial fees assessed for the sewer increase must he paid before the Ice Macb,iRcfrilt.Drains plumbing permit can he issued. Oil Separator Gas Station Rec,Vehicle Du Station -- Shower -(fang - -Stall Sink -Bar/l.avatory -Bradley -Commercial -Service Swimming Pool Filter Washer-Clothes Water Extractor Water Closet-1 oilet Urinal Other Fixtures: i.\Dsts\Pe,mit Forms\PlmPetmitAppPg2.doc 01103 Building Fixtures -audY Plumbing Permit Application Received Plumbing Date/13Y. ? ' Permit No.. i, E C E 4 1,I E L Planning Approval Sewer City of Tigard Date/By: Permit No.: 13125 SW I lall Blvd. Plan Review Other Tigard,Oregon 97223LLuu_ LL�11 ��MM Dateffl : Permit No.: r'hone: 503-639-4171 Fax:JS(13-59l�,03 Post-Review Land Use Date/By:: Case No.: Internet: www.ci.tigard.or 7 R Date/Bl Case Sce Page 2 for 24-hour Inspection RequCBT; AW� f, Name/Method: Su lemental Information. TYPE OF WORK _ FEE*SCHEDULE 'for special information use checklist New construction - �-- U_emolition Desert tion (1h. Fcc(ca.) l'otal _ Addition/alteration/rchlacen ent I U Other: New 1-&2-family dwellings CATEGORY OF CONSTRUCTION includes 100 ft.for each utllit y connection m ly dwellin ('ommercial/Industrial SFR I 249.20 1 &2-Fabath 0 __. SFR 2 350.0 bath 5U.00 Accessory+Ruildin_�___ _Multi-Family - SFR 3 bath 399.00 Master Builder Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fires i inkler-sq.fl.: Pae 2 Job site addre zs U $, a Site UtIIItles �� Catch basin/area drain 16.60 Suite#: _ Hid;./A t.#: ---- -- ---p-- Dr ell/leach line/trench drain 16.60 Project Name: Footing drain no.linear fl. 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 fl. Faq 2 Subuivision: Y Y` Lot#:- Storm sewer no.linear fl. _ f'uge 2 Tax map/parcel #: Water service no.linear Il. - Page 2 Fixture or Item DESCRIPTION OF WORK_ Absorption valve 16.60 _ S _____- _ Backflow prevcntcr Pae 2 Backwater valve 16.60 - Clothes washer _ 16.60 ----_ ----_ ___�._--_�--.--_----- Dishwasher 16.60 _ Drinkingfountain I6.60 _ El PROPERTY OWNER TENANT Ejectors/sum 16.60 Name: RC2 _ Expansion tank 16.60 Address: ® f. W 'f-, Fixture/sewer cap 16.60 Cit /State/Zi Cr' Floor drain/floor sink/hub _ 16.60 �_._--� - Garbage disposal 16.60 -- Phone: Fax: Hog,!bib 16.60 APPLICANT CONTACT PERSON Ice maker 16.60 Name: Interce tor/ rease trap 16.60 Address: J Medical gas-value: $ Pee 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 CON'LRA�'J vY -�-�- Urinal 116.60 -- Business Name: 01 �i Water closet 16.60 - Water neater 16.60 Address: &K 10 Other: _ City/State/Zig: is &n - Other: _ Phone 03 Fax: Plumbing PerSubmit te* Subtotal b CCB L1c. #; !` / ; Plumb. Lic.ft: Minimum Permit Fee$72.50 $ Authorized Residentisi Backflow �nimum Fee$36.25 Signature: Date: N plan Revic� '5%of Permit Fee $ QLy��•i - State Surcharge(8%of Permit Fee) $ (Please print name) __ 'TOTAL PERMIT FEE 1 $ Notice: t his permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or 18O dais arter It has been accepted as complete. riser diagram for plan review. "Fee methodology set by Tri-County Building Industry Service Board. i:\DstsV'crmit Forrns\PlmPermitApp.doc 01/03 ' ` () �C' Plumbic Permit Application - City oy Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities (ply. Fee(cr) Total Square Footage: Permit Fee: Footing drain- I" 100' 5500 1 0 to 2,000 $115.00 Footing drain-each additional 100' 46.40 2,001 to 3 G00 _ $160.00 3,601 to 7,200 $220.00 Sewer-Ist 100' ' 55.00 7,201 and greatco $309.00 Sewer-each additional 100' 46,40 Water Service- Ist 100' 55.00 NIC'dical Gas S stems: Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&Rain Drain- I st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Stonn&Rain Drain-each additional 100' 4640 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each Fixture or Item Qty. Fee(ea) Total additional$100.00 or fraction thereof,to and _ including$10 000.00. Commercial hack Wuw Prevention Device 4(,40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to mininwm permit fee$36.2 27.55 and including$25,000.00. Rain Diton,single family dwelling 65.25 $25.001,00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for Inspection of existing plumbing or each additional$100.00 of fraction thereof,to and including$50,000.00. specially requested inspections-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 per-!,-,:"red by fixture. Failure to accurately report fixtures could result in increased sewer fees*. _ Quantity b 'Fixture Work Performed Comments regarding fixture work: Fixture Type: Replace New Muved gclslln Ca J Ba tistr /Font Bath -Tub/Shower _ -Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru — Cus idor/Water Aspirator — Dishwasher -Commercial -Domestic Drinking Fountain Eye Wash — Flour Dram/sink -2" _ .3" 4" Car Wash Drain _ *Note: If the fixture work under this permit results in an Oarbage -Domestic Disposal -Commercial increase of sewer El)LIs,a sewer permit will be issued and -Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refi•i .Drains plumbing permit can be Issued. Oil Se retor Uss Station Rec.Vehicle Dump Station Shower -Gang -Stall Sink -Bar/lavatory -Bradley _ -Commercial -Service Swimming 1'021 1•ilter Washer-Clothes Water Extractor Water Closet-Toilet Urinal Other Fixtures: i:\Dsts\Permit Forms\PimD1ermitAppPg2.doc 01103 Xk . A-AFFORDABLE Y;�� SEPTIC 5ERVICF i ?b.BOX 1130 WIl."VIL LF, 08 gllvo A n. 602-ft" FAX 1803) 570.0779 CUSTOMER'S OF DER NO _ r 74 ADDRESS :^ I ADDRESS SOLD`�. CASH C.O.D. CHARGE ON ACCT. MDSE.RET D.j PAID OUT DESCRIPTION PRIM AMOUNT I . I RECEIVED BY TOTAL d All claims andpads MUST be arcampankd by this till ,00. oro"We" THANK YOU CITU' OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BUP - ------ Received _ Date Requested _ �"� ___ AV. PM -- BUP Location __ �— Suite------ MEC Contact Person Ph(----) _'7 PLM Contractor Ph ( _ ) SWR BUILDING —� -- Tenant/Owner ---- -- - ELC FootingEL.0 _ Foundation Access: Ftg Drain ELR Crawl Drain -- Slab Inspection Notes SIT -- Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler - - - - - Fire Alarm Susp'd Ceiling — Roof Other: _— Final PASS_ PART FAIL PLUMBING Post&Beam Under Slab - - — -- Rough-In Water Service - — S�nitary JeWO Rain Grains - - Catch Basin/Manhole Storm Drain — Shower P r 40er: t11 OAASS PART FAIL MECHANICAL — Post&Beam Rough-in -- Gas Line Smoke Dampers Final PASS PART FAIL _ - — Service Rough-In UG/Slab Low Voltage -- Fire Alarm Final Reinspection fee of$_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL r, SITE C] Please c II for reinspection RE: __ __— u Unable to inspect-no access Fire Supply Line ADA `1 Approach/Sidewalk Data....�L _ __— Inspoetor __ __ tit Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2003-00287 13125 SW Hall Blvd., Tigard, OR 9'1c�6 (503) 639-4171 DATE ISSUED: 7/11/03 SITE ADDRESS; 11740 SW GAARDE ST PARCEL: 2S110BA-01500 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT__ JURISDICTION: 'I'Iti TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS- 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Connect existing house to newly installed sewer lateral. Owner: _ FEES OLSEN, JOHN W/MARY JO Description Date Amount 11760 SW GAARDE ST TIGARD, OR 97224 1SWI SAISwr Connect 7/11/03 $2,400.0fr 1SWUSnISwr Cminect 7/11/03 $0.00 Phone: 1SWINSI11 Swr Inspect 7/11/03 $35.00 Contractor•. 1SWINSI11 Swr Inspect 7/11/03 $0.00 Total $2,435.00 Phone: Reg #: Required Inspections Sewer Inspection Septic Tank Filled 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 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 purchase a "Tap and Side Sewer" Perm l � -- Issued by: ;r�{� _.�i j�, �' Permittee Signature:, Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day