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12355 SW 106TH DRIVE 12355 SW '10C"' UR. CITYOF T I A R D ___ PLUMBING PERMIT DEVELOPMENT SE17VICES PERMIT#: PLM1999-00415 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/08/1999 SITE ADDRESS: 12355 SW 106TH DR PARCEL: 2S103AA-01908 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: 011 _ JURISDICTION- TIG CLASS OF WORK: ALT 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 PRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: '10 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of sanitary sewer line. Owner: FEES_ BRUGGER, JUDITH C AND Type By Date Amount Receipt JOHN A PRMT GEO 12/08/1995 $50.00 99-320269 12355 SW 106TH 5PCT GEO 12/08/1995 $4.00 99-320269 TIGARD. OR 97223 _ Total $54.00 Phone 1: Contractor: TED MCBEE EXCAVATING INC 11428 NE SCHUYLER PORTLAND, OR 97220 REQUIRED INSPECTIONS Phone 1: 939-5246 Sewer Inspection Reg #: LIC 110314 Final Inspection ORIGINAL 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 the rules or direct questions to OUNC by ca .'1g (503) 246-1987. Issued By: _ — Permittee Signature:-77 �� 'Z Call (503) 639.4. 75 by 7:00 P.M. for an inspection needed the next busin s day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Recd By TIGARD, OF, 972, Z Date Recd (503) VS-4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will riot be accepted Permit#Am �✓ Related SWR#_,_,___ Called_ Name of Development/Project FIXTURES (individual) QTY PRICE AMTS ,lob I&Wa Sink J 11.50 Address Street Address Suite Lavatory 11.50 Tub or TublShower Comb 11.50 Bldg# Clty/StaleO Zip Shower Only 11.50 Name Water Closel/Urinal (Specify) 11.50 Dishwa•her 11.50 Owner Mailing Address Suite Urinal 11.50 Garbage Disposal- 11.50 City/State ZIP Phone Laundry Tray 11.50 Name - Washing Machine/Laundry Tray (Specify) 11.50 Floor Drain/Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 City/State Zip Phone 4" 11.50 Water Heater O conversion O like kind 11.50 r Name Gas piping requires a separate mechanical permit 4A 1_" _ MFG H,,-,le New Water Service 28.00 Contractor Mailing Address Suite MFG Home New San/Storm Sewer 28.00 "Cf��) yL,,rpHose Bibs 11.50 Prior to permit City/State ZIP Phone Roof Drains 11.50 Issuance,a copy Drinking Fountain 11.50 of all licenses are Oregon Co st.Cont.Board Lic.# Exp.Date required If Other Fixtures(Spoc.ry) 15.00 expired In COT Plumbing Llc.# Exp.Date database Name - Architect Sewer-1st 100' 38.00 or Mailing Address Suite Sewer-each additional 100' 32.00 Engineer City/State Zip Phone Water Service-1st 100' 38.00 Water Service-each additional 200' 32.00 Descrbo work to be done: Storm&Rein Drain-1st 100' 38.00 New Repair O Replace with like kind: Yes O No O Storm 6 Rain Drain-each additional 100' 32.00 Rest ential 3K Commercial O Additional d scripllon of work, -'- -- Commercial Back Flow Prevention Device 12.00 Residenhal Backflow Prevention r1evice" 19.00 Catch Basin 11.50 Are you capping,moving or replacing any fixtures? Insp.of Existing Plumbing or Specially Requested fler1h, Yes O No O Inspections If yes,see back of form to indicate work performed by Rein Drain,single family dwelling fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps WORK COULD RESULT IN INCREASED SEWER FEES. I hereby acknowledge that I have read this application,that the Information QUANTITY TOTAL given is correct,that I am the owner or authorized agent of the owner,and Isometric or riser diagram Is required 0 Quantity Total Is >9 that plans submitted are In compliance with Oregon State Laws 'SU@TOTAL 819nature of Owner/Agent bate Bio buRCHARGE Contac Person Name ` Phone _ `�_---� c � ""PLAN REVIEW 26%OF SUBTOTAL -- Re uired onl H fixture t totalis-9 1 BATH OUSE$178.00 _ _l 3Y- 2 BATH HOUSE$260.00 TOTAL b 3 DATH HOUSE$285.00 (This fee Includes all rlurnhing fixtures In the dwelling and the first *Minimum permit fees$50.s%surcharge,except Residential Backllow Prevention 100 feet of sanitary sewer stonn sewer and water service) Device,which Is$25.81,6 surcharge All New Commercial Buildings require plane with Isometric or riser diagram and plan review I tdetelformelplumspp doc 1011199 I?LEAS� COMPLETE: Fixture Tyke --� - Quantity by Work Performed_—__ New Moved Replaced Removed/Capped Sink; _ -�-- - - -- Lavatory -_ - - -- - ---- TUO v_Tub/Shower Corr bination -- Shower Only -- --- - -- ---- --- Water Closet - ----- --- ---- Dishwasher - - .��----- -_--- - -- --_� Urinal Garbage Disposal _ - --- - Laundry Room Tray-__� --- - - Washing Macriine -- _-- - Floor Drain/Floor Sink 432 111 " - - Water Heater Other Fixtures (Specify) ---ures --- COMMENTS REGARDING ABOVE: - - CITY OF TIGARD BUILDING INSPECTION DIVISIOp 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST Date Rested /�t/��`1 cl / SUP Location_ - �- --AMPM / - BLD r *Ivl�- MEC Contact Person /_ ���9 PLM _ Contractor P11 SWR BUILDING Tenant/Owner �q�b( ELC Retaining Wall -� Footing ELR Foundation Access: - Ftg Drain FPS Crawl Drain Inspection Notes: SGN Slab i Post& Beam - SIT Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing r - Firewall Fire Sprinkler Fire AlarmISusp'd Ceiling Roof Misc: _ Final _ PASS I.-ART FAIL PLUMBING — Post& Beam (hider Slab — op 0 Z. - Ta��� Rain-t ns Final A-S�R PART FAIL _ HANICAL Post&Beam Rough In Gas Line _ 710 Smoke Damper., - -� Final - PASS PART -- ELECTRICAL_ --- . Service - — Rough In -- UG/Slab Low Voltage Fire Alarm _ Final -• PASS PART FAIL SITE ©ackfiIuGf@�tirig ' niF�y_Sgwer — St ram [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ 1 Please call for reinspection RE: ADA I [ )Unable to Inspect-no access Approach/Siriewalk q Other Date l Inspector � Final --- - Ext PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. CITYOF TIGARD _SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR1999-00258 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-417" DATE ISSUED: 12/07/1999 SITE ADDRESS; 12355 SW 106TH DR PARCEL: 2S 103AA-01908 SUBDIVISION: ZONING R-4.5 BLOCK: LOT: 011 JURISDICTION: TIG TENANT NAME: BRUGGER, JOHN AND JUDY USA NO: FIXTURE UNITS: 1 CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Connecation to sewer lateral as part of RelmbUrsement District#12. Reimbursement fee of $5,597.e2 paid on 12/7/99 Septic tank to be pumped, filled or removed and inspected. Owner: FEES BRUGGER, JUDITH C AND Type By Date Amount Receipt JOHN A — — 12355 SW 106TH PRMT DST 12/0i/199� $2,300.00 99-320213 TIGARD, OR 97223 INSP DST 12/07/199 $35.On 99-320213 Phone: Total $2,335.00 Contractor: Phone: Reg # Required InspectionsSewer Inspection Septic Tank Filled ORIGINAL This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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 located, the installer shall purchase a"Tap and Side Se ie I" 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 throw nh OAR 952-001-0080 You may obtain copies f se ruler direct questions to OIINC by calling (503) 246-1987. i Issued by-. ?l Permittee Signature:T �� - Call (503) 639-4175 by 7:00 P.M. for an Inspection deeded ts day he net busines