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10175 SW Inez Street
CITYOF TIGAR® SEWER CONNECTION PERMIT_
LiEVELOPMENT SERVICES PERMIT#: SVVR2003-00158
13125 SW Hall Blvd., Tig-rd, OR 97223 (503) 639-4171 DATE 153UED: 5/12/03
SITE ADDRESS; 10175 SW INEZ ST PARCEL: 2S111BU-00800
SJBDIVISION: TIGARUVILLF 11FI(II ITS ZONING: It-3.5
BLOCK: LOT: IIIA) JURISDICTION: •IIc;
TENANT NAME:
USA NO: FIXTURE UNITS'
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE Oc USE: SF NO. OF BUILDINGS:
INSTALL TYNE: LJ PSWR IMPERV SURFACE:
Remarks: Connect existing house to sewer lateral.
Owner: ----
FEES
W.A.KNIGHT ---- — -----
10175 SW INEZ Description Date Amount
TIGARD, OR 97223 1SWUSAISwr C'onnect 5/12/03 $2,300.00
[SWUSAJ Swr C'onmct 5/12'03 $0.00
Phone: ISWINSP]Swr Inspect 5/12/03 $35.00
jSWINSI'j S\vr Intil,cct 5/12/03 $0.00
Contractor: -- —
Total $2,335.00
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the pry mit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at thr. mea::urement given, the it staller shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
Issued by: , %= � -- Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
I rry OF TIG/o RD 24-Hour
BUILDING Inspection Line: (593) 639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
1 BUP _. - ------- --
Received - Z Date Requestpe�". G� �— AM PM__.. SUP
location -7 4C �'+'�1�- _ _—Suite— MECIf /
Cc)ntact Person Le _ Ph(�`�'3 ) �1Z 5 PLM
Contractor Ph( /" 7 7�- SWR —.v.
BUILDING Tenant/Owner �[ L�'Gtl _- __ _`__ ELC
Footing
Foundation - ELC
Access:
Ftg Drain ELF!
Crawl Drain _ --
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors - --- -------- - _---
Ext Sheath/Shear
Int Sheath/Shear
Framing --- - --- -
Insulation
Drywall Nailing - - ---- - --
Firewall
Fire Sprinkler - ---- - - - -
Fire Alarm
Susp'd Ceiling _ f----- - -- - -
Roof
Other: --
Final
PASS PART FAIL
DLUMBING _-- --------.___—_
Post& Beam
Under Slab -----___---
Rough-In
Water Service 41Z —
Sanitary Sewer
Rain Drains
Catch Basin/Manhole `-
Storm Drain -
Shower Pa r f
Other:_ eL
aH
PART FAILANICAL
-
Post&Beam
Rough-In
Gas Line
Smoke Dampers -
Final
PASS PART FAIL - - - ---- --
ELECTRICAL
Service ------------- --- -- - - -
Rough-In
UCS/Slab - _ _ ------------ ----
' Low Voltage
Fire Alarm
Final Reinspection fee of$__ _ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE i Please call or reinsp ction RE:.____ -_ _— Unable to inspect- no access
Fire Supply Line
ADA, /
Approach/Sidewalk Date 1. _ --_ Inspector
-- - _ - --- Ext- --
Other:
Final ADO NOT REMOVE this Inspection record from the,fob site.
PASS PART FAIL
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00193
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 GATE ISSUED: 5/12/03
SITE ADDRESS: 10175 SW INEZ ST PARCEL: 2S111BC-00800
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R-3.5
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKPLOW PREVNTRS:
OCCUPANCY r3<P: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASIN::
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of approximately 100' of sewer line. Septic tank is to be pumped, filiPd and inspected.
Reimbursement District#13 fee paid.
FEES i
Owner: --
—" Description Date Amount
W.,-^.KNIGHT --i
10175 IG INEZ 1I'LlJMIJI Permit I C" 5/12/03 $72.50
TIGARD, OR 97223 J"I'A\l x Staw I;ix 5/12/03 $5.80
Total $78.30
Phone : 'V
Contractor:
7-i1116Q�Ulyt- z:*-,Ko t4V*-riNC�
k P.3,1/6
REQUIRED INSPECTIONS
Phone : 3 C 89/• 7g 70 Sewer Inspection
Final Inspection
Reg #: I Ic 152663
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other ipplir,able laws. All work will be done in accordance with approved
plans. This permit will expire if wrrk 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,( `� i�L __ Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day
Building Fixtures j
Plumbing Permit Aiv ir..ation :received � Plumbing
-` 7ate/B .:
Permit Nn
Planning Approval Sewer s
City 0f Tigard Date/By: Permit No,:'
13125 SW Ball Blvd. / \ Plan Review Other -
Tigard,Oregon 97223 Dat-/By: Permit No.:
Post•Revicw Land Use
Phone: 503-639-4171 Fax: 503-598-1960 Date/B : Case No
Internet: www.ci.tigard.onus Contact Juris.: FO See Page 2 for
24-hour inspection Request: 503-639-4175 Namc/Method:-- supplemental Information._
TYPE OF WORK FEE* SCi1L DULE for special Information use checklist
�H-�Aid-ditio
ew const a Demolition Description _ (►ty. Fates.) Tntai
New 1-He 2-fandly dwellfts
alteration/r lacement Other: _ (includes 100 ft.ren-ea-h u iiit cotneetion
RY OF CONSTRUCTION_ SFR(1)bath _ 249.20
I &2-Family dwellingC(lmmercial/Industrial SFR 2)batt, 350.00
AccessoryBuildingMulti-Family SFR 3 bath 399.00
L-J
Master Builder Other: Each additional bath/kitchen 45.00 _-
oy:=SITE INFORMATION and LOCATION _ Firesprinkler-s ft.: Pae 2
Job site address: /O�'7 ,(Afez Sr- Site Utlitles
Catch basin/arca drain 16.60 _
Suite#: Bldg./Apt.#: __ Dr well/leach line/trench drain 16.60
Project Name: _.-_. Footing drain(nolinear ft.) Page 2 _
Cross street/Directions to job site: Manufactured home utilities i 10.00
Manholes 16.60
Rain drain connector _ 16.60
EAbsotion
wer no. linear ft. / Pae 2
LOt r(no. linear fl.) _ Pa e 2
Subdivision: - - ce(nu.linear ft.) t
'Tax ma / arcel #: Fixture or lte;.i
DESCRIPTION OF WORK valve 16.60
/00 FT OF I-We 6d0tt<; Backflow preventer Pae 2
Backwater valve 16.60
-- -' Clothes washer _ _ 16.60
_--.-�- -- - - Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER TENAN Ejectors/sump _ 16.60
Name: Ind t t. F -eO n I eM(G t,l T _ Expansion tank 16.60
9
Address: 10175 S 4J t 4E z sr Fixture/sewer ca 16.60
T2z¢-- _�
Floor drain/floor sink/hub _ IGGO
Cit-/State/Z.ip:7-ctA R P C1Q Garbage disposal 16.60
Phone: -J--TFax: Dose bib 16.60
APPLICANT CONTACT PERSON Ice maker i0.60
Name- - Interco tor/ rease trap 16.60
- --- 'j""'"`"------- Medical gas• value: $ Pae 2
Address: �, Primer 16.60-.-
City/State/Zip:
6.60Cit /State/Zl : hoof drain(commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower X.to
CONTRACTOR 16.60
r Urinal 16.60
Wat^r closet 16.60
'Business Name:
Plumbing I_'e 'mit_Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: _ Residential Fire Supprssion Systems:
Site Utilities Qty. Fee(Cu) Total Square Footage: — Permit Fee:
Footing drain-I" 100. - 55.00 0 to 2,000 $11500
Footing drain-each additional 100' 46.40 2,001 to 3,600 — $16000
3,601 to 1,200 $220.00
Sewer- I sl 100' 55.00 7,201 and greater $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' 55.00 Medical Gas Systems:
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 tee$12.50
Storm&Rain Drain-each additional 100' 46,40 $5,001.00 to$10,000.00 $72.50 for the first$',000.00 and!1.52 for each
_ additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fes(ea) Total including$10,000.00.
Commercial Back How Prevention Device 46 40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Preve cion Device— each additional$100200 or fraction thereof,to
minimum permit fee$36 25) 27.55 and including$25,0')11.00. _
Rain Drain,singtc family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$'-`,,)00.00 and$1.45 Im
--_ each additional$100.00 or fraction thereof,to
Inspe,.00n of cxb ting plumbing or B',u mclodlya$50,900.00.
s cially requested�,spections per not,, }— 72 t) $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: I _ i 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. Failare to
accurately -, tort fixtures could result in increased sewer fees*.
-- — - — ('onunents re g trdin g fixture work:
ENe
b Fixture Work Performed t.` I-
FI:tore Type: Vel'ince
M_eved Existing -
3aptistry/Font __. __-----------_.__-------- ---
Iiath -Tub/Shower
-1acuizi/Whirl I ---------- - ----.----...___ --�.
Car Wash -Each Sfall �_ --- ---- — - _----- - - -- - --
-(hive Thru
Gus idor/Water Aspirator
Dishwasher -Commercial _ _ ----------- -- —
_ -Domestic
Dni kur Fountain _ ---T--- ---
ti ---__.—�-._— ----------
Floor Drain'smk .2" -
3"
4"
Car Wash Drain *Note: If the Fixture work tinder this permit results in an
Garbage -Domestic increase cf sewer EDI Is.a sewer permit will be issued and
Disposal -Commercial
fees assc-•.'al for th^sewer iucrcasc must be paid before the
-Industrial
be
Ice Mach./Refrig.Drains �_ — plutnbi►tt Ire(twit t att issued.
Oil SeLretor Gas Station —__
Rec Vehicle Dump Station
Shower -Gang
-Stall —_
I Sink -Bar/Lavatory -
-Bradley
-Commercial
_ -Service
Swim ning fool Filter
Wasn0 r-Clothes
Water°xtractot _
Water Clraet-Toilet —
Urinal
Other Fixtures _
is Nts\Permit Foy ms\PlmPermitAppPg2.doc 01/03