9130 SW O'MARA STREET 9130 SW O'Mara Street
d #'T\Y OF TIGARD SEWERCONNECTION PERMIT
`DEVELOPMENT SERVICES PERMIT#: s /20/02 -00343
13125 SW Hall Blvd., Tigard, OR 972:23 (503) 639-4171 DATE ISSUED: 12/20/02
PARCEL: 25102DC-00502
SITE ADDRESS; 09130 SW 0WAr A ST
SUBDIVISION: EDGEWOOD ZONING: R-4.5
BLOCK: JURISDICTION: TIG _
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NFW DWELLING UNIT: 1
TYPE OF USE: SI NO. OF BUILDINGS:
INSTALL TYPE: L I PSWR IMPERV SURFACE:
Remarks: Connect existing house to newly installed sewer latera.
Owner:_ � FEES
FULLER, POBERT E AND Description Date _v JAmount
DONNA M ---
9130 SW OMARA ST [SWUSAJ Swr Connect 12/20/02 $2,300.00
TIGARD, OR 97223 1SWUSA]Swr Connect 12/20/02 $0.00
Phone: ISWINSI]Swr Inspect 12/20/02 $35.00
[SWINSI11 SLN•r Inspect 12/20/02 $0.00
Contractor: Total $2,335.00
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 Ir sated,the installer shall purchase a"Tap and S!de Sewer" Perm
lessuad b '( �_ Permittee Signature:
y:� .11
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00494
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/20/02
SITE ADDRESS: 09130 SW OWARA ST PARCEL: 2S102fJC-00502
SUBDIVISION: EDGEWOOD ZONING: P-4
BLOCK: LOT: 013 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: M0 31LE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 9ACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRokPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURESLAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB!SHOWERS: SEWER LINE: 98 ft
WATER CLOSETS: WATER LINE- ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 98 feet of sewer line to connect to sewer lateral. Septic tank is to be pumped,filled and
inspected. Reimbursement District#23 fee paid$6000.00
FEES �
Owner: —
Doscription Date Amount
FULLER, ROBERT E AND
DONNA M i I'I,UMB] Permit Fee 12/20/02 $72.50
9430 SAN OMARA ST ITA X)8%,SIiJIC 'ax 12120/02 $5.80
TiGARD, OR 97223 Total $78.30
Phone :
Contractor:
HOLLENBACH + HURD INC
3000 SW 174TH AVE
ALOHA,OR 97006 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 591-5987
Misc. Inspection
Reg#: MET 4926 Final Inspection
LIC' 121807
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: _i-)12 = '-L�-=�1 1. Permittee Signa ture --- --
Call (503)639-4175 by 7:00 P.M. for an Inspection needed the next business day
I�a�il�lin hi-xtures
Plumbing 1" rmit Application
I, Date received' - �.a Permit no.
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW I hill Blvd,Tigard,OR 97223 pro�ct/a Ino.: Expire date:
City of Tigard phone: (503) 639-4171 j pF
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: _- Case file no.: Payment type:
Em E III IRK111M
"construction
elling or accessory U Commercial/industrial U Multi-family U Tenant improvement
:LU_1 U Addition/alteration/replacement U Food service U Other:
Description Qty. Hee(ea.) Total
Job address: /�L S I,�t Cis-, g�4 _� _�
_ � -Ke" 1-and 2-fan►il�dwellings only:
Bldg. no.: __ Suite no.: _i (includes 11111 ft.for cacti utility connection)
Tax map/tax 1001 ,nnnt no.: SFR(1)bath
Lot: _,17 Block: Subdivision
Project
Project name: SFR(2) ath
SFR(3)bath
City/county: ,r,•q� V:W_ ZIP_ 1 1 Each additional batb:kitchcn
i
Description and loaction of work on premises: Catch basin/
area drain Drywa11s/Ieach line/ti
rich drain
Eat,date of com talion/inspecti n / /5' '
Footing drain(no. lin. tt.) _-
"CONTRAC4M Manufactured home utilities
Business name: �j i> u► .T/, Manholes
Address: 3 0 - J.its Z�7 ��._----
Rain drain connector
State:�r ZIP: C C'G' banitary sewer(no,lin.ft.)
City: �' L , form sewer(no.lin.it.)
Phone:S� - Y' - i,`; Fax: bl 1 E-mail:Acthc l7 2ve ,Ta-c.• �-
+ , : Plumb,bus.reg.no: Water service(no.tin.ft.)
CCIi no•: / ,t_ ^_ _—_ — Fixture or Item:
City/metro lic.no.: �.—j Absorption valve
Contractor's representf,tive signpture_�1 - - Back flow preventer
Print name: J Date: Backwater valve
Basins/lavatory
Clothes washer _
Name: v.� --� - Dishwashet
Address: prinking fountam(s)_
City: -- State: _ ZIP: Ejectors/sump _
Phone: Fex: ► nu+il: Expansion tank —
Fixture/sewer cap
Floor drsinks/hub
Name(print): '\ r r� l G /�t . - ains/Hoerr Garbage de is osal
Mailing address: J',vtI C.� c �r� f Floss bibb
City: i -rt,- Statcr- '. ZIP�121 ice maker
Phone: c YC,' Fax: I E-mail: +( c 6 Interceptor/grease trap
O�iter installation/residential maintenance only: The acturl installatio Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain com,merci---.f--
will
employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s)_,lays(s)
Owner's si malate .__ Date: Sump _
Tubs/shower/shower pan
_Urinal
Name: _ _. — Water closet ___ _
Address: _ Water heater
City: State: ZIP: Other: r
Phone: Fax: �E-mail: _ Total
- -
_ Minimum fee................ E --
Nat aC jurisdictions accept credit code,please call jurisdiction for more infomation. Notice: This permit application Plan review(at -_ %) S
U Visa U S,astetCard expires if a permit is not obtained State surcharge(8%)....$ '
Credit card numbe, -- within ilio days after it has been
Expires accepted as cot*.pietc TOTAL................. ..... $
L-
---
Name of cirdhd•kr as shown nn credit unl s
Card6aldcr algnslurc Amount 41W816;WOOtCOM)
PLUMBING PERMIT FEES:
PRICE TOTAL NAw 1 and 2-famlly dwellings only:
FIXTURES Individual QTY ea AMOUNT (Includes all plumbinp fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the hrst100 ft. QTY (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 3)bath $399.00 _
Water Closet 16.60 - SUBTOTAL
Urinal 16.60 ---E;%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIFW_ 25%OF SUBTOTAL
TOTAL
Garbage Disposal 16.30 - -
Laundry Tray 16.60 A
Washing Machine 16.60
Floc, .rain/Floor Sink 2" 16.60
PLEASE COMPLETE:
3" 1660
q� 16.60
uantic F Work Performed
--
Water Healer 0 conversion O like kind 16.60 Q
Gas piping requires a separate mechanical Fixture Type: New Movr,d ReplaceemovedtCapped
permit. -
MFG Home New Water Service 46.40
MFG Home New San/Storm Sewer 86.40 Tuubb oor _
Tr Tub/Shower
Hose Bibs 16.60 _ Combination
Roof Drains 16.60 Shower Only _-
Drinking Fountain 16.60 i Water Closet
16.80 Urinal
Other Fixtures(Specify) _ Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer-1 sl 100' 55.00 3" _
Sewer-each additional 100' 46.40 4„
Water Service-1st tUV 55.00 Water Heater
Other Fixtures
Water Service-each 46.40 additional 200' Sed
Storm&Rain Drain-1st 100' 55.00
Storm&Rein 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 erlhr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25 --
Grease Traps 16.60 -
QUANTITY TOTAL
Isometric or riser diagram Is required If
Quantity Total Is >9 _
'SUBTOTAL LI
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Required only d fixture qty total Is>9
TOTAL SD
'Minimum permit fee Ir,$72.50•e%state surcharge,except Residential Bickllow
Prevention Device,which is$36 25+a%state surcharge.
"All Now Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
i:\dsts\forms\plm-fees.doc 12/26/01
s
ALOHA SANITARYSERVICE
INVOICE NO
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 7138
503-644-2797 • 503-648-6254 503-639-5188
� NAME:
ADDRESS: ' -- -- — -
CITY:_ t STATE: i—.-- ZIP: 1?7emg
HOME' _ WORK: __ 4 CELL:
Joe SITE: �� KJ• d __ d7 P.O.#:__--
PAID BY CHAFIGC CHECK ❑ CASH ❑ CREDIT CARD ❑
DATE -0- 7-a3 ru DRIVER '7�4r('kaa/ AMOUNT
PUMP SEPTIC TANK Z
❑ LINE OPENING 1
❑ I PECTION FEELJ '
- •-$EFIVICE CALL
^❑ LAeOR, LOCATING, DIGGING, 8ACKFTLL
U MATERIAL
- - THIS IS NOT A SEPTIC SY5TEM INSPECTION REPORT - - TOTAL
- - REMARKS - y
TY4F OF TANK: STEEL ❑ NCRETE ❑ P AST V HOMEMADE L]
HORIZONTAL ❑ VE AL U RE ANGLE ❑ ❑ OTHER
SIZE OF TANK: 350 ❑ 500 ❑ 7 LJ 10 ❑ 1250 ❑ 1500 ❑ 2000 ❑ 3000 LJ
LID LOCATION: INLET ❑ OUTLET MIDDLE ❑ ENTtr.E Ton J
TANK CONDITION: GOOD O FAIR ❑ POOR ❑
FITTINGS: BAFFLES ❑ Comm CAST IRON ❑ PLASTIC ❑
NEEDs New LID? YES ❑ SIZE
GROUND COVER OVER TANM
COMMENTS ON CONDITION OF DRAINFI ETC.
SIQNED B_ DAT[ �� /~- Gt3
,a 3E)Vd (1811 '8 HOVgN3710H ZE89-808-E09 60:80 EM/0t/E0
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST ------ ------- --
INSPECTION DIVISION Business Line-. (503) 6394171
f3UP - -- ---_---
Received _----- Date Requested___._- '_�__-- AM PM _ - -_ SUP
Location — - _y r 3�-- Q��'l .4� --Suite -- - -- MEC
C'
Contact Person --- -- - -- Ph(—) PLM
Contractor -- --- - - - --- Ph( —) -- - SWR ---- –
BUILDING TenanUOwner _ _-- ELC -
Footing ELC -_--
Foundation Access:
Ftg Drain I ELR
Crawl Drain SIT -
Slab Inspection Nates: - -
Post&Beam -------- —
Shear Anchors - -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - -
Firewall
Fire Sprinkler -
Fire Alarm _
Suspd Ceiling
Roof
Other: --
Final G'
PASS PART FAIL
PLUMBING
Post K Beam _
Under Slab —<. --_-- -- -- —
Rough-In
Water Service
i ar ewer
Rain Drains - _--- - - ---- ---- --—Catch Basin Basin/Manhole
Storm Drain --
Shower Pan
Other. -- -- - - --_ ---------
Fina
A' PART FAIL
—_ CHANICAL --- -- -------- —
Post& Beam _^—
Rough-In —_— --------- —
Gas Line
Smoke Dampers --- --- -- - - ------ _---_—
Final
i PASS PART_ FAIL ---- - ----
ELECTRICAL —_
Service— - —
Rough-In - --- ---
UG/Slab
Low Voltage
Fire Alann
Final u Reinspection fee of$_ ._______ __.. ._ required before next inspection. Pay at 01,1,Hall, 13,')5 SW Hall Blvd.
PASS PART FAIL
SITE n "ease call for relnepection RE: _ _—__ Unable to inspsct - no access
Fire Supply Line
ADA )-71D
r-!►
Approach/Sidewalk Dato Litt
Other.
Final I VO NOT REMOVE this inspection record from the job site.
PASS PART FAIL