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i CITY OF TIOARD' — PLUMBING PERMIT
DEVELOPMENT SERVICES ,
PERMIT#: PLM2000-00126
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE DATE ISSUED: 4/18/00
SITE ADDRESS: 14915 SW 103RD AVE `'`-��
PARCEL: 25111 CB-00200
SIIBL:IVISION: DEL MONTE SUBDIVISION �� ZON;NG: R-3.5
►jl_OCK: LOT: 001 �,4 JURISDICTION: TIG
CLA'3F OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
763F.. OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
CCCUP/04CY GRP: R3 FLOOR DRAINS: TRAPS:
i STl3RlES: WATER HEATERS: CATCH BASINS:
r IXT'URES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIFS: OTHER FIXTURES:
TUB/SHOWERS. SEWER LINE: 100 it
WATER CLOSETS: WATER LINE: ft
DISHWASHERS. RAIN DRAIN: ft
P.ernarks: Connect existing house to newly installed sewer lateral. Less than 100 feet of line, plumbing does not require
reversing under the house.
Owner: __ FEES —
"- Type By Date Amount Receipt
HART, THOMAS J AND I_EONA M PRMT DEB 4/18/00 $50.00 0001515
14915 SW 103RD AVENUE
TIGARD, OR 97224 5PCT DEB 4/18/00 $4.00 0001515
Total $54.00
Phone 1:
Contractor:
CANTRELL &SONS CONTRACTING
6860 SW NORSE HALL RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phoria 1: 503-638-0800 Sewer Inspection
Reg#: LIC 97005
Final Inspection
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 Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued 0y: �_ = yv>�'a�ifPermittee Signature: _ :�lQ..ada —
Call (503) 639-4175 b 7:00 P.M. for an ins ection needed th ne�ness
Y p day
CITY OF TI "ARD Plumbing Permit Application Plan Check#
13125 %3WHALL TALL BLVD. Commercial and Residential Recd Bf
TIGARD, OR 97223 Date Recd
(503) 639-4''71 Date to P.E.
Print or Type Date to DST -
Incomplete or illegible applications will not be accepted Permit#Ft_►- .�y00-6t11;1
Related SWR#l ^O�G1G>v 0
Called—
Name of Development/Project 1FIXTURES (individual) QTY PRICE AMT
Job I Sink 11.50
Address Street Address Suite Lavatory 11.50
Tub or Tub/Shower Comb. 11.50
Bldg# City/State Zip Shower Only 11.50
Name Water Closet 11.50
Urinal 11.50
Owner Mailing Address Suite Dishwasher 11.50
916-- .-A,LL,_ Garbage Disposal 11.50
City/Slate Zip r� 1 Phone Laundry Tray 11.50
Namer Washing MdchineiLaundry Tray 11.50
? C Flour Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
City/Slate Zip Phone 4" 11.50
Water Heater G conversion O like kind 11.50
Gas piping re uires a separate mechanical permit,
Nr,mpa j MFG Home New Water Service 32.00
4 ——
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 3200
Hose Bibs 11.50
Prior to permit City/State Zip Phone Roof Drains 11.50
Issuance,a copy c ' 1` G'i^ Drinking Fountain 11.50
of all licenses are Oregon Const.Cont.Board Lic.# Exp.Dale
required if C Other Fixtures(Specify) 1500
expired in COT Plumbing Lie.# Exp.Date
database
Name +� —
Architect Sewer-tsl 100' 38.00 ,
or Mailing Address Suite Sewer-each additional 100' 32.00
Engineer City/Stale Zip Phone Water Service-1st 100' 38.00
Water Service-each additional 200' 32.00
Describe work to be doneStorm&Rein Drain-1s1 100' y 3800
New O Repair Q Replace with like kind. Yes No O Storm&Rain Drain-each allditional 100 3200
Residential 01) Commercial O
Additional description of work Cornmer aal Back Flow Prevention Device 3200
Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping,moving or replacing any fixtures? Insp of Existing Plumbing or Specially Requested 50.00
Yes O No M Inspectionsper/hr
If yes,see back of form to indicate work performed by Rein Drain,single family dwelling 4500
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11 50
WORK COULD RESULT IN INCREASED SEWER FEES. -- TOTAL
G1lIANTIT.Y T
I hereby acknowledge that I have read this application,that the Information Isometric or riser diaglddi In ierwred h Quantity TBT is >9
given is correct,that I am the owner or authorized agent of the owner,and *SUBTOTAL
that Ian:.submitted are in compliance with Oregon State Laws.
Signature of Owner/Agent Date --—
, .� •_ S%SURCHARGE
,• �- If moi,r r. _u:l. L i -=Ir �,
Contact Person Name Phone
**PLAN REVIEW 26%.OF SUBTOTAL
Required only B fixture qty tofal is,9 _
TOTAL
'Minimum permit tee is$50+e%surcharge.except Residential Backflow Prevention
Device,which is$25+8%surcharge
All Now Commettlal Buildings requirr plans wflh Isometric or riser dingrom and
plan review
mow.. / �
1 klelxiformlWumaPP dM lI1tn199 . ry �;_ "„ �) / M�,!) ( ,�/".�C,)
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed —
� E _ New
inMoved Replaced Removed/Cap
ped
- - -
Lavatory
Tub or Tub/Shower Ca—Mb inatiun -- ---- -
Shower Only
Water Closet -
Urinal _ — —
Dishwasher - - -
Garbage Uispasal -- --
Laundry Rom Tray - --
VAfashing Machine
Floor Drain/Floor Sink 2--;
----------
_ _ 4"
--_.-_.
Water Heater -
Ot --- -
her Fixtures ( y)
COMMENTS REGARDING ABOVE:
i k1i.vom,ebumann nuc i vnrsa
CITYOF Ta GARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: S18/00 00080
DATE ISSUED: 4/18/00
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S1'11 CB-00200
SITE ADDRESS; 14915 SW 1,03RD AVE
SUBDIVISION: DEL MONTE SUBDIVISION ZONING•. R-3.5
BLOCK: _ LOT: 001 JURISDICTION: TIG
TENANT NAME: HART
USA NO: c�\� FIXTURE UNITS:
CLASS OF' WORK: NEW `�.J DWELLING UNITS: 1
TYNE OF USE: SF �� NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection of existing house to newly installed sewer lateral. Septic tank must be pumped, filled
and inspected for proper abandonment. Reimbursement fee of$8,000.00 was paid on 4/18/00,
receipt#oan 15ILJ
Owner: _ FEES
HART, THOMAS J AND LEONA.M Type By Date Amount Receipt
14915 SW 103RD AVENUE
TIGARD, OR 97224 PRMT DEB 4/18100 $2,300,00 0001514
INSP DEB 4/18/00 $35.00 0001514
Phone: Total $2,335.00
Contractor: _
Phone:
Reg#:
Required Inspections _
Sewer Inspection
Septic Tank Filled
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days frorn the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given,the installer
shall prospect 3 feet in all directions from the distance given. if riot so located, the installer shall purchase a"Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. I
Is$ ed by: C^� r � _ Permittee Signature:
f
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business 6ay
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST --
_ _Date Requested _PM BLD _
Location__ cel cam_ Suite G nn MEG _
Contact Person Ph z� PLM ZW ')-�
Contractor Ph SWR
BUILDING fenant,iOwner EL.0
Retaining Wall ELR _
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ---
Slab — - -- -- --- — --- SIT
Post&Beam — -
Ext Sheath/Shear
Int Sheath/Shear
Framing
---- ------ —
Insulation
Drywall Nailing —_—
7 7
Flrewall
Fire Sprinkler /� I �_ ✓li�/� _ •%� �-'�-
Fire Alarm
Susp'd Ceiling —_—
Roof
Misr: 7' - --
Final
PART FAIL
9LYMBIN _
Post&Beam -- 'C - —� �.-- - -----�
Under Slab
Top Out
WPSe
nitrRain -�� -Z ��Z
Final
PART FAILVEInANICAL
Post&Beam .--
Rough In
Gas Line —
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL ----- - --_�—._
Service
Rough In
UG/Slab _
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading --- - - -- ---- --
Sanitary Sewer
Storm Drain ( J Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Please call for reineoectinn RE: Unable to inspect-no access
Fire Supply I.ine ( 1 — ( 1
ADA
Approach/Sidewalk
Other Date �—Inspector Ext
Final �—.—..^.—.------ —
PASS PART FAIL_ Nd REMOVE this inspection record from the job site.