9190 SW O'MARA STREET ;eaI6S eJew,3 "AS 066E
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9190 SW a'MARA ST i
CITY OF
TI GARD SEWER CONNE 'ION PERMIT -
DEVELOPMENT SERVICES PERMIT#: SWR2003-00080
1312E SW Hall Blvd.,Tigard,OR 97223 `503)639-4171 DATE ISSUED: 3/7/03
PARCEL: 2S 102DC-00506
SITE ADDRESS; 09190 SW OWARA ST
SUBDIVISION: EDGEWOOD ZONING: R-4.5
BLOCK:_ LOT: 013 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: I
TYPE OF USE: SF NO.OF BUILDINGS:
INSTALL TYPE: Ll'PSWR IMPERV SURFACE:
Remarks: Connect existing house to newly installed -ewer lateral. Reimbursement District#23 fee paid on
3/6/03.
Owners FEES
MUELLER, RULF K + NANCY J Description Date Amount
9190 SW OMARA ST
TIGARD, OR 97223 [SWUSA]Swr Connect 3/7/03 $2,300.00
[SWUSA)Swr Connect 317/03 $0.00
Phone: [SWINSP]Swr Inspect 3/7/03 $35.00
[SWINSPI Swr Inspect 317/03 $0.00
Contractor:
----- -— Total $2,335.00
Phone:
Reg#:
Required Inspections
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ED Thi. Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
udays from the date issued. The total amount paid will be torfeited if the perr-tit expires. The Agency does not guarantee
J the accuracy of the side sewer laterals. 9 the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from tht i" -.lance given. If not so located,the instal;er shall purchase a"Tap and Side Sewer" Perm
Issu by: �� Permittee.Signature: -
Call(503) 9-4175 by 7:00 P.M.for an Inspection needed the new:husiness day
M •
CITY OF T1GARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#. PLM2003-00078
13125 SW Hail Blvd.,Tigard,OR 97223 (503)639-4171 n4TE ISSUED: 3/7/03
PARCEL: 2S 102DC-00506
SITE ADDRESS: 09190 SW O'MARA ST
SUBDIVISION: EDGEWOOD ZONING: R-4.5
BLOCK: LOT: 013 JURISDICTION: TIG
1
CLASS OF WORK: OTR GARBAGL DIS"OSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHIN i MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRv TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATC)RI.ES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing house to newly installed sewer lateral. Ins'allation of less than 100'of sewer line, reverse
plumbing. Septic tank is to be pumped&filled.
FEES
Owner:
-- Description Dates � Amount
MUELLER, ROLF K + NANCY J [PLUMB] Permit Fee 3/7/03 $117.50
9190 SW OMARA ST
TIGARD, OR 97223 [TAX] F"/"Stare Tax 3/7/03 $9.40
Total $126.90
Phone
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Sewer Inspection
Misc. Inspection
Reg#: Insp existing/capped fixtures
Final Inspection
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m This permit is issL,ed 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 mnrp than 180 days. ATTENTION: Oreyon law requires you to follow rules adopted by the Oregon
Issue By: - 6j"' Pe►mlttee Signature;
EAO����_e5ZL
Call(503)639-4175 by 7:00 P.M.fcr an Inspection needed the next business day
Building Fixtures
PlunNng Permit Application Received 7 Plumbing 11
ihte/By _ Pcrtnit No._
Planning Approval Sewer
City of Tigard Date/6� PermitNo.:Awz GCS
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 D le/By: Permit No.:
P'one: 503-6394171 Fax: 503-598-1960 Poet-Re-iew Land Use
Dtte/N : Case No.:
Internet: www.ci.tigard.or.us Contact --- -" Juris.: Sec _a_e
2 for -�
24-hour Inspection Request: 503-6394175 Name/Method: Su lemental lnformatlon.
_-_- TYPE OF WORK _ FEEVSCHEDULF.(for special dthi "lou if' ,tbt;Wlst
Ncw construction Demolition Description - Qty ce(rs.)) Total
Additiordalteration/r lacement Other: New 1-&2-faml.y dwellings
ATECr 1. r CO �1 O Ancloaa Iia tt.for tech li'(lilt �A>lbectwi)
- ---- - SFR I bath 249.20
1 &2-Family di _.lin Commercial/Industrial SFR 2)bath _ 3.50.00
Accessory Building - Multi-Family SFR 3 bath 399.00
Master Builder Other: Each additional bath/kitchen _ 45.00
JOS 61 rE INFORMATION had. 0C.AT ON Fires sprinkler- P. _ Pa e2
Job site adtaess: � �/ --J ,. _L. , _Rte:lC1tU1 "I
-Suite
_.
Juite#: B1d ./A t.#: Catch basin/a ca drain MAO
Project Name: Drywell/leach line/trench drain 16.60 -
- Footing drain(no.linear ft.) P;\ e 2
Cross street/Directions to job site: Manufactured home utilities 1 .0.0n
Manholes -� 6.60
Rain drain connector 1560
Sanitwy sewer no. linear ft. ?age 2 Y r a
�—Subdivision: _ Lot#: Storm sewer no.linear ft. Pae 2 1
' Tax 'nap/parcel#: k Water set vice no.linear R. P
Absorption valve 16.60
Ou�lrc� fXis�_ir� .�� tU Backflow preventer Page
Backwater valve _ 16.60
Clothes washer 16.60
--- Dishwasher 16.60
T NAN-T- - -- Drinki� fountain ountain 16.60
Eject^istsump 16.60
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/Zip: - - Floor drain/floor sink/hub - 16.60
— Garbage disposal 16.60
Phone: Fax: Hose bib _ 16.60
41M APPLI �4_ I U,001TAC3'' „E[t50NIce maker 16.60
Name: _ _ Interco tor/ a trap 16.60
Address: Medical gas-value: S Rte 2
-----— � �-_-y_--
City/State/Zip: Primer 16.60 _
Roof drain commercial) _ 16.60
IL Phone: Fax: Sink/basin/lavato 16.60
E-mail: Tub/shower/shower pan 16.60
v! _
CONTRACTOR _ _ � Urinal 16.60
Business Name__�� u�♦-� Water closet _ 16.60
Water h er P 16.60
Address:
Cit /State/Zip: _ Other: -
t9
LU Phone: Fax:
--i —�' Subtotal S
CCB Lic. #: Plumb. Lic.#: Minimum Permit Fee$72.50 S ) /
Authorized 0 Residential Backflow Minimum Fee$36.25
" Signature: _ ate: —?171,0r —Plan Review(25%of Permit Fee) S
State Surcharge 8%of Permit Fee S
_�. (Please print name) TOTAL PERMIT FEE S
Notice: Thi,-pen.:t application expires if a permit Is rat obtalrued within All new commercial buildings require 2 40%of plans with Isometric or
190 dais after it►,as been accepted as complete. riser diagram for pian review.
*Fee methodology set5y Tri-County Building Industry service Board.
01111:s\Permit Fomrs\PlmPennitApp.doc 01/03
Plumbing Permit Application-City of Tigard
Page 2 -Supplemental Information
_Pee Schedule; Residential Vire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Fouialte: Permit Fee:
Footing drain- I"100' 55.00 .±_!q 2c000 —1115-00
2,001 to 3,690 __ $160.00
Fooling drain-each additional 100' 46.40 3,601 to 7,200 $220.00 _
Sewer-Ist 100' •`5.00 7,201 and greater _ $309.00
Sewer-each additional 100' 46.40
Water Service-I st 100' S_00 Medical Gas S stems'
Watet Service-each additional 100' 46.40 V uation: Permit Fee:
Storm&Rain Drain-Is(100' 55.00 $1\W to 55,000.00 Minimum_fee 572.50_
Storm_&Rain[rain-each additional 100' 46.40 $5, i W to 510,000.00 $'2.50 for the first 55,00V 00 and 51.52 for each
additional 5IOt7.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ea) Total _ including 510,000.00.
Commercial Back Flow Prevention IX-vice 46.40 $10 LC I to 525,00000 $148.5]for tot 1$10,00000 and 5L54 for
Residential Backilow Prevention Nvicc each additional$100.w or t:_ .ion thereof,to
minimum permit fee S36.25 27.55 and neluding W 000.W_
Rain Thain,single dwctling t 65.25 f2 001.00 to$50,000.00 $37).50 for the first$25,000.00 and SI 45 for
cact,additional SI00.00 or fraction.thereof,to
Inspection of existing plumbs __ and it,-luding$50,000.00.
s cislly requested inspections- ur 72.50 S ,001.00 and up S742.00 lot the first S50,000.00and 51.20 for
Subto each addib,mal$100.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? I/e,
"yes",please indicate work performed by fixture. Failure
accurately resort fixtures could
ttlt bull Mat re)Work PeIncreased rformed ewer r menta regarding fixture work:
Fixture Typt; Replace _New_ Moved E1latin
Ba tis /Font
Bath -Tub/Shower _
-Jacumi/Whirl I --
Car Wash -Each Stall
-Drive 7hru
Cuspidor/Water Aspirator
Dishwasher -Commercial _
-Domestic _
Drinking Fountain
Eye Wash _
Floor Drain/sink 1"
Car Wash Thain *Note: If the fixture work under this permit results in an
Garbage -Domestic increase of sewer EDUs,a sewer permit vt'lll be Issued and
Disposal -Commercial
r -Industrial fees assessed for the sewer increase must be prid before the
Ice Mach./Refi .Drains plumbing permit can be issued.
Oil Separator Gas Station
~ Rec.Vehicle Dump Station
J Shower -Gang _
-Stall
Sink -Ber/Lavatory
U -Bradley
J -Com 121
-Se , c
Swimmin P ilia
Washer- , t —r
Pater l(tractor
Wester Closet-Toilet
Urinal _
Oti:or Fixtures:
i.\I)os\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OFTIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Lina: (503)639-4171
BUP
Received ___. _—Date Requested 3.1 —AM--_-_--_PM____ __ BUP
Location MEC
Contact Person __ _ Ph PLM 3
Contractor_`_ _ _� _ Ph( ) SWR —
BUILDING Tenant/Owner _RAJV _ _ _ ELC
Footing
Foundation --- ELC
Access:
Ftg Drain ELR �—
Crawl Drain
Slag Inspection Nu(es: SIT
rue:&Beam
Shear Anchors
Ext SheathShear
Int ShAath/Shear — _Framing -------- -- -- _�.
Insulation
D.ywall Ne.iling — ---�_ - - --.-- -
Firewall
Fire Sprinkler ---- - — —.-_--_-
Fire Alarm
Suspd Ceiling -
Roof
Other: -- — - -- -- --_
Final �--r�..�^'r -►rl��..
PASS PART FAIL --
PLUMBING
Post&Beam
Under Slab -- -- --
Rough-In
Water Service - - — ---- - -
12 �
Rain Drains ---- - --
Catch Basin/Manhole
Storm Drain - - --
Shower Pan
Other:LMW --- - - -- — - --
PART FAIL —
MECHANICAL
Post&Beam
Rough-In
Gas line
Smoke Dampers ---- -_— - ---- -- —
Final
F-
PASS PART FAIL - - - - --_ -
ELECTRICAL
Service
Rough-In
m UG/Slab
j Low Voltage
�
Fire Alarm
Final Reinspection fee of g _. required before next inspection. Pay at Cit} Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 11 Please call for reinspection RE.---.- Unable to inspect-7,10 aures
Fire Supply Line
ADA
Approach/Siddwalk Do ----- Inspectott� --T- ----
Other:
Final DO NOT REMOVE this Inspection record from the Job sits.
PASS PART FAIL
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