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10557 SW NORTH DAKOTA ST
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2000-003110
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 10/13/00
SITE ADDRESS: 10557 SW NORTH DAKOTA ST PARCEL: 1S134DA--04200
SUBDIVISION: VENTURA COURT ZONING: R-12
BLOCK: LOT: 007 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 LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 100 ft
Remarks: Connect rain drains from house to street, less than 100 feet._
FEES
Owner: -- — -
Type By Date Amount Receipt
BROOKS, SUSAN PRMT CTR 10/13/00 $72.50 21200000000
10557557S SW NORTH DA.',,,.-'IA ST
TIGARD, OR 97223 5PCT CTR 10/13/00 $5.80 27200000000
Total $78.30
Phone 1:
Contractor.
OWNER
REQUIRE]INSPECTIONS
Phone 1: Storm Drain Insp
Reg#: Final Inspection
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FD This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
wSpecialty Codes and all other applicable laws. All work wil; 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 Orego.i Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain opies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issu d By: Permittee Signature: ^
Call (503) 639-4175 by 7:00 P.M.for an Inspection needed the next bu Iness day
Plumbing Permit Application
City of Tigard
IDatereceived: 10-15-90 Perrrtitno.: N,�I1ra'-Cd,3Sj�
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.:
--
CirvofTigard Phone: (503) 639-4171 Project/appl.no.: ZZ
date: ^`
Fax: (503) 598-1960 Date issued: Receipt no.:
Land use approval: Cast file no.: Payment type:
I &2 family dwellinp,or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New construction U Add ition/aheration/replacement U Food service U Other:
Job address: 10557 o r w tJ _DA kn7-f9' it)kscription Q(Y. Fee ea. Total
Bldg.no.; - - -- Suite no.: -� __�. New 1 2-famlly dwellings only:
(Includes too It.forearh utility connection)
Tax map/tax lot/account no.: Slit(1)bath
Lot: Block: Subdivision: " ' '" SFR(2)bath
Pm)c ct name: SFR(3)bath --
City/county: it"og2 ,> Oil I ZIP: 7 7?9�3 Each additional bath/kitchen
Description and location of ork on premises: — Shetttilitles:
-TD12A/Wf' deo" M976& T alc4x"4' Catch basin/area drain
Est.date of completion inspection: Drywells/leach linc/trench drain
Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: t✓ Manholes
Address: I C).5 ' 1 5 LsO, �IUR k j Q X K 0 T& Rain drain connector
City: j IG State:U ZIP: 9-7�, Sanitary sewer(no.lin.ft.)
Phone:;'1 19.16 IF&x: I E-mail: Storm sewer(no.lin.ft.) ?1C01 r
CCB no.: Plumb.bus.reg.no: Water service(no.Tin.ft.
Cityr,Oetro lic.no.: Fixture or Item:
Contractor's representative signature: Absorption valve
Print name: : Back flow preventer _
Backwater valve
Basins/lavatory
Name: SQ k-A �3 R O K S Clothes washer
Address: C). 1' S W N U Lt 0 O•_ Dishwasher
Drinking fountains) _
City: 7 State:r ) ZIP: 9 1 2 Ejectors/sum
Phone:�31' ,t Fax: E-mail: Expansion tank _
Ivxture/sewer cap _
Name(print): Floor drains/floor sinks/hub
Mailing address: Garbage disposal
Nose bibb
City: State: ZIP: Ice maker
A. Phone: ------IFax: L]E-mail: Interceptor/grease trap
owner installation/residential maintenance only: The actual installation Primer(s)
H will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
N employee on the proorty I own as ptSr ORS apter 447. Sink(s),basin(s),lays(s)
Owner's signature:' �k A-•,� ,� Date: Ik'U U Sum
J Tubs/shower/shower pan
m
Name: llrinal
F3 _ —_ - — Water closet
UJ Address: �. Water neater
-' city: :--' State: ZIP: i Other:
Phone: Fax: E-mail: lbw
Minimum fee..... . $ 72,5
Not all jurisdictions accept credit cants,please call iudediction for more hdonnation. Notice:This permit application
U visa U MartetCarsl _. Plan review(at %) $
expires if a permit is r _iot obtained p
Credit cad number:_ _ r" � within 180 days after it has beeh State surcharge(8%)....$
TOTAL . $ `71k 30
Nano of cardholdrr as shown on nx1i ftd_..may ` accepted as complete .—�--
�r si ' Amount 440-616(6MR70M)
_ FLEA;i"OMPLETE:
FIXTURES (individual) Qty Price Total - --Fixture Type Quami work PoAnrmed
Sink 16.60 -New -
_-- - Ri�lse�d R�mov�dlCipps
Lavatory 16.60 Smk
Tub or Tub/Shower Comb. 16.60 Lav 1-07__---
Tub or Tub/Shower Combination
I�
Shower Only 16.60 Shower On _ _ _
Water Closet -- 1660 Water Closes
Urinal__
Urinal s 16.60 Dishwasher - — ---._
Dishwasher 10.60
Laundry Room Troy
Garbage Disposal 16.60 Washing Machine —
Laundry Tray 16.60 Floor tkakVFkxx Sink 2'
X
Washing Machine 1660 - 4' --
Floor Drain/Floor Sink 2' 16.60 Water Hester _
3' Y 16.60 Other Fixtures —'—
;. -- 16.60 — _ -— ----- —
Water Heater O conversion O like kind 16.60 —
Gas piping requires a separate mechanical permit. _
MFG Home Now Water Service 46.40 ----
MFG Horror New San/Slomn Sewer 46.40
COMMENTS REGARDING ABOVE:
Hose Bibs 16.60
Roof Drains 16.60
[kinking Fountain 16.60 --
Other Fixtures(Specify) 21.75 --
Sewer-1 st 100' — 55.00
Sewer-each additional 100' 46.40
Water Service-1 at 100' 55.00
Water Service-each additional 200' :9.40
Storm G Rain Drain-1 at 100' 55.O
Storm R Rain Drain-each additional 100' 46A0
Gxnmercial Back Flow Prevention Device 4640
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Insp.of Existing Plumbing or SpedC;iy Requested 72.50
Inspections _ rft
Rain Drain,single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram Is required N Ouentity Total Is >9
*SUBTOTAL !-
r:
p, 8%SURCHARGE
N ..PLAN REVIEW 2S%OF SUBTOTAL
R only N fixture 91 ictal b>9 a
TOTAL
'Minimum permit hs Is$72.50+a%surcharge,except Residential Backflow Prevention
Device,whldr Is$36.25♦a%surcharge.
LU "An New Commercial BundIM require plans wsh Isometric or riser diagram and plan review
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"CITY'OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
8UP
_Date Requested__ 3 AM PM BLD _
Location /C9 Suite MECO
Contact Person s Ph �Z �LL
Contractor Ph SWR —
BUILDING Tenant/OwnerELC
Retaining Wall r ELR
Footing Access: �¢/ 15�l1V�
Foundation _ 1Fps
Ftg Drain er/N Rte/A"- sGN --
Crawl Drain Inspection Notes:
Slab ^_
Post&Beam — --
Ext Sheath/Shbar
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall / t�� 74Vf S
Fire Sprinkler _ --'�'__ _
Fire Alarm
Susp'd Ceiling
Root
Misc: —
V'f�
Misc
Final .— _
FAIL
m
Under Slab _
Top Out
Water Service
Sanitary Sewer
Ra' Drains
inal ,^
PART FAIL
QtrA'ANICAL
Post& Beam
Rough In
Gas Line
Smoke Dampers �� -- V c.v•�.—.
Final
PASS PART � � s —
.`':,IL t—-
ELECTRICAL
LL Service
Rough
�
UG/Slab —_1_I ',(/` _ � f� �•�(�l_/ _
Low Voltage
Fire Alarm
M Final W I d•YL,S ___C � - -S _7
PASS PART FAIL
W SITE
-� Backfill/Grading 0 -- -
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _a_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: _ ( ]Unable to Inspect-no access
ADA l 6 l
Approach/Sidewalk Date -�- "�` Inspector �/ L/'` ti--�""� EXI� r
Other
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the Job site.