10995 SW 111TH PLACE NDDRE00:
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CITY OF TIGARDPLUMBING f''E►?h1I . PERMF'LM: + _ -..c;
c 02n.
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 1 QI/k��/9b
I 13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)839-4171
10'1 'C 5W 111TH r-"L �
aUBD I V I S I ON. . . . : JEFFREY ESTATES �X��� ZONING: R---4. '— PD
LOGE,. . . . . . . . . . . LOT. . . . . . . . . . :�: ■ ��
7LASS OF WOPK. . :ADD GARBAGE DISPI7SALS. : 0 MfJL'ILf= I#OML�Sp'ACrS. _...._ _.
Y1=E OF USE. . . . :3F WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
'ICCUPANC`.' GRP. . : R3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
T0RIEC,. . . . . . . . .. WATER HE=ATERS. . . . . : n CATCH BASINS. . . . . . . : 0
LAUNDRY TRAY,. . . . . : 0 OF RAIN DRAINS. . . . . : 0
INKS. . . . . . . . . . . URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
AVATORIFS. . . . . . 0 OTHER FIXTURI'0. . . . . 0
"VLA/SHOWERS. . . . : 11) SEWER LINE ',-Ft ) . . . : Ir
IAyI'ER CLOSETS. . : 0 WATEP LII IE (ft ) . . . L71
,:)ISHWAEHERS. . . . t 0 RAIN DRAIN (ft ) . . . t 100
_ema;ri-.s : c," npm-1 DRAIN, CONNECTION TO EXISTING l" STORM SEWER.
'wnr r. __..._. __._...._____.__._ ___.,.__.____._____...,__._...._._._._ ____.... ___ FEES ____.._._,..___._.._......_.
'TI VE L_nNDIr type 2mol-Int b. ; da.t i recpt
0995 SW ! .11TH PL PRMT t 25- 00 DRA 10/02/96 96-42'84634
IGARD OR 1)72,',.-:,,31)72,',.-:,,3PCT $ 1. 2") DRA 10/1 2/96 96-2'34C 34
.
hone ##: r,03-9550
antractor^t
.CRR CONTRACTORS INC
9350 SW B9TH AVE
UALATIN OR 9706
hone #- G9:.1--1j!!,1.4 $ 26. 271 TOTAL
g I#. . . 72599
RE OUIRED IrISPECTIONr, __...___... ..
-is pertit is issued Subject to the regulations contained in the Mi sc. Inspection _
- gard Municipal Code, State of pre. Specialty Codes and all other r=i r1-A1 I nspect i un
alicat'.e laws. All wcrP kill be done in accordarce with _ !
;proved plays. This permit will expire if work is Fiat stv;°ted
'thin 180 days of issuance, or if work is suspended for tore -
�an 180 dais.
J \
t ion —7 1) 41.75
LDw
J
CITY OF TIGARD Plumbing Application Recd By
1.3125 SW HALL BLVD. Commercial and Residential Date Recd ('V
TIGARD, OR 97223 Date to P.E.
(503) 639-4171 Date to DST
Permit# plu. /6-'G g t
Print or Type Related SWR#
Incomplete or illegible applications Wil! not be accepted Called_.
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
r Sink � !3.^U
Job S re -5-5-tti�'cS
Lavatory 9.00
Address Street Address Suite
t Tub or Tub/Shower Comb 9.90
Bldg# City/State Zip Shower Only 9.00
'I �✓ ZZ Water Closet 900
Name p Dishwater i 900
Owner Mailing Address
Suite Garbage Disposal 9.00
"S a W VL t_~�'f Washing Machine 0,00
lyl tate Zip Phone Floor Drain 2' 900
1 r �7 rl 6f� 3' 9.00
Namej
L-� Z�y 3 J Cs 4• 9.00
IL
Occupant Mailing ddress :',uite ter Heater 9 00
_ Laundry Room Tray 9.00
City/State Z.p Phoire Urinal 900
Name
Other Fixtures(Specify)— 900
// 1
G 1'�✓ l'd ti AIA G 4t✓S 711 C 900 —7
Contractor Mailing Address Suite 9.00
`{ Jt
9.00
City/State Zip phone
9.00
Oregon Const.C nt.Poard Lic.# Exp.Llate 9.00
Attach Copy of 9 r 9.00
Current) Plumbing Liq-, Ex .Date Sewer-1st 100- 9Z0
Licenses ' Sewer-each additional 100' 30.00
COT Business Tax or Metro# Exp. Date Water Service- 1st 100' -�
25.00 1
Name Water Service-each additicnal 200' 30.00
Architect Storm&Rain Drain- 1st 100' '5 00
l�,.� ell 1. _
or M/ailing1 Address Suite Storm&Rain Drain-each additional 100' 30 00
Mobile Home Space25.00
Engineer 01Y—Slald ZO Phone Commercial Back Flow Prevention Device or Anti- 25.00
_ Pollution Device
Describe work New O Addition Alteration O Repair O Residential Backflow Prevention Device' 1500
to be done: Residential O Non-residential O Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin
1100
(� rr✓ Gh �r'c.r •� t C ch V1 Gu •'sT 1 0 �keU 9
ty Insp of Existing Plumbing 40.0.0
0
N r S t0✓ov1 S t:NlGr, _ -_ Specially Requested Inspections 40x
hr
use of 00
Existing
building or property - per hr
-- Rain Drain single family dwelling 3000
~ Proposed use of Gmase Trs s
p 9.00
J building or property_
C13
M . QUA ATITY TOTAL
0 Are you capping, moving or replacing any fixtures? Yes❑ NoICY Isometric or neer dug- rn Is regw�-rf Quanity Total is >9 _
(Ify!s see back of form) ''C 'SUBTOTAL.
I hereby acknowledge that I have read this application,that the information _ L7
given is correct,that I am the owner or authorized agent of the owner.and 5% SURCHARGE 2 S
that plans submitted are in compliance with Oregon State Laws
Signa re o!Ow riAgent pate —�- PLAN REVIEW 25%OF SUBTOTAL
Required onty K lixti re qty total is>9
J rL-t (D ( J (. TOTAL 21t
Co Penton
ct Name Phone
U •Minimum permit:ye is$25+ .5%surcharge except Residential Backflow
Prevention Device,which is$i5 ? 5%surcharge
V9
I:tdststplmapp.doc&N
7v p I •- OC-q I z G;C 0-.
PLEASE COMPLETE AS APPRQPRIATE 'O PROJECT: ,
Fixtures to be capped, moved or replaced Qty
Sink _
Lavatory
Tut or Tub/Shower Combir,atio i
Shower Only
Water Closet
Dishwasher
Garbac Disposal
Washing Machine �-
Floor Drain 2"
_ _4" _
Water heater
Laundry Roor- Tray
Urinal _ _
Other Fixtures (Specify) M
COMMENTS REGARDING ABOVE:
G.
L
COTTONWOOD LANE
11115 Cottonwood Lane
PROPERTY LINE
NOT TO SCALE
I `\ PIPE OUTLET (APPROX. 1 O('FFET)
EXISTING CLEAN-OUT
END OF 6' PIPE -� EXISTING F. STORM PIPE
11105 SW Cottonwood Lane
0N,VCT FRENCH DRAIN PIPE
11 STORM PIPE
CONNECT 6' STORM PIPE �fti4
TO END OF EXISTING 6" PIPE
CLEAN-OUT TO REMAIN _
I PROPQSED FRENCH DRAIN
W/ 4 FRENCH DRAIN PIPE
2.5 WIDE, 3 DEEP 4.5'
10995 111th Place ( '
PROPOSED PRIVATE
6` STOR14 PIPE �)
PROPERTY LINE
IPROPOSED AREA DRAIN V� _
15 G -1
Ey. PROPOSED CLEAN-OUT --
—.— 111 TH PLACE
15' FIRr
9" TREE (2)e
r 12" TREE 2 HA7EL (15) /
11225 North Dakota Street
� 24' FIR �?
24" FIRC 11013 111th PI()ce i
J
PRELIMINARY PLAN FOR:
,6- FIR Q 10995 SW 111 TN PLACE
STORM DRAINAGE IMPROVEMENTS
CITY OF TIGARD CEPTIFICAIE OF
OCCUPANG Y
PERMIT #. . . . . . . : MST94-90!:,
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/11/94
13125 SW Hall Blvd,Tigard,Oregon 97223n8199 (503)839.4171
PARCELs IS1,34AC-07700
kDUHL�6�a. . . : 10'P)!5 SW 111TH PL
CWSDIVI310N. . . . : JEFFREY ESTPTES Z 01\1 I NO:R•-•4. 5 PD
. . . . . . . . . . : LOT. . . . . . . . . . . . . 1010
0--ASS OF WORK. :NEW
TYPE OF USE. . . :5F
;:)(",I-UPQNCY GRP*. -R3
OrCUPANCY LOAD-. 1f'20 4
rF.,'Nr4NT NAME. . . ;
Remarks : PATH I
Owners
FOUR D CONSTRUCTION
P 0 BOX 1577
0EAVERITON OR 97075
Phone #. 041-0935
1'OUR 0 CLINSTRUC11ON
("(11 BOX 1.577
ol-OVERTON OR 97075
''hong #3 641 .0935
)r,9 0. . - 71037
ft�cupanry -3f the above referenced bux1dinq is hereby given, avid certifies
;:he camp I I eince with the State Of Or egnn Specialty Codes for the Ql-fl,-tpq
'-)cc:upancy, ind ItSe Under which the referenced permit w4s issued.
.1 D INS 1(0)FR
UILDING L
POST' IN CONSPICUOUS PLACE
INSPECTION NOTICE
City of Tigard Building Department
13125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phcne: 639-4171
Inspection• -"
Footing Pl . Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line
Poet/Beam Struct. San. Sewer Framing
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Wat r L e Gyp. Bd.
Date Requested: — Time: 11M Q PM
Address-_L ! ! I ` _� Permit
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
/4
Inspector:— -_- _ Date?_ ► �' ��
^"PROVED DTSAPPROVED APPROVED SUBJECT TO ABOVE
call For Reinsp.
�.r
MASTER PERMIT
Cirf OF TSG PERMIT #. . . . . . . : MST94-9081
COMMUNITY DEVELOPMENT D TDATE ISSUED: 03/09/94
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171
PARCEL: 15134AC-JEO1O
't-)ITE ADDRESS. . . . 10995 SW 111TH PL.
SUBDIVISION. . . . : JEFFREY ESTATES ZONING: R-4. 5 PI)
BLOCK. . . . . . . . . . . L�. F. . . . . . . . . . . . . :010
- BUILDING _--.----_.--__--_-_------_._-----_
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :O 5f
CLASS OF WORK. :NEW BE:DRMS:3 BATHS:2 GARAGE. . . . . . . . . . •435 sf
TYPE OF USE:. . . :SF FLOOR AREAS----------- REQUIRED SETBACKS-----
'TYPE OF CONST. :`:;N FIRST. . . . : 1827 sf LEFT. . : 12 ft RIGHT, :8 ft
OCCUPANCY GRP. :RI SECOND. . . :0 sf FRONT. :20 ft REAR. . :2") ft
STORIES. . . . . . . : 1 THIRD. . . . :0 sf REQUIRED---------------------
HEIGHT. . . . . . . . :,-:.0
EQUIRED---•---------------.---
HEIGHT. . . . . . . . :,-:.0 ft TOTAL - -: 1827 sf SMOKE DETECTORS, :Y
FLOOR LOAD. . . . :40 psf VAL.UE:. . 92232 PARKING SPACES. . : 1
Remarks : PATH I
-- PLUMBING --------------------------------------- -
SINKS. . . . . . . . . . : 1
--------_--.--------------___-_--_-___ .SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :0
LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . .0
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . :Ill
WADER CLOSETS. . :2 SEWER LINE (ft ) . :0 GREASE TRAP'S. . . . . . . :N
DISHWASHERS. . . . : 1 WATER LINE (ft) . : 100 OTHER FIXTURES. . . . . :Ill
GARBAGE DISP. . . . 1 RAIN DRAIN (ft ) . :0
WASHING MACH. . . : I SF RAIN DRAINS. . : 1
__---------____-- MECHANICAL _._____________ ___--•------_-.____..._...... FEES
FUEL TYPES--- ---- --- UNIT HTRS. . :0 type amor.rnt by date recpt
/GAS/ / VENTS . . . . . :0 TIF $ 1520. 00 JH 0.3/09/94 -
MAX INPUT:0 BTU VENT FANS. . -4 BPRT $ 412. 00 JH 03/09/94 -
F URN ( 1O0K . . : I HOODS. . . . . . : 1 BPLC $ 267. 80 JLH 02/17/94 94--
FURN ) :=100K . . :0 WOODSTOVES. -0 BSPC t 2111. 60 JH 03/013/94 --
FLUUR FURN. . . . :0 CLU DRYERS. : 1 SSDC $ 280. 00 JH 03/09/94 -
BOIL/CMP ( 3HP:0 OTHER UNITS: 1 PARK $ -.,00. 00 JW 03/O9/44 -
GAS OUTLET5: 1 MP9T $ 43. 50 JH 03/O9/94 -••
Owner : --_..________ ___._____._._.___.______._____HPLC 8 10. 88 P; 03/09/94
FOUR D CONSTRUCTION MSPC t 2. 18 J:; 03/09/94 -
P 0 BOX 1577 PPRT $ 140. 00 JH 03 /09/94 -
P5P'C $ 7. 00 JH 03/09/94 -
BEAVERTON OR 970*75
i--'hone #: 641-0935
Contractor : -------------_-_--_--._---_-_--_--
FOUR D CONSTRUCTION
PO BOX 1577
BEAVERTON OR 97075
Phone #: 641--0935
R F g #. . : 71037 ----------------------------------------
$
--------------------------------------
f 3203. 96 TOTAL
This permit is issued subject to the regulations contained in the -- - --- REQUIRED INSPECTIONS ----
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/foo.rnd Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/Beam Strr-rct Gas Line Insp
plans. ?his permit will expire if work is not started within 188 Post/beam Meche,n Insi.rlat T.on Insp
days of issuance, or if work is suspended for sore than 188 days. P1m/i.indsIAb I n s u Gyp Board Insp
-�/ - PLM/Underfloor Rain drain Insp
Permittee SiynFture: ' 'i Mechanical Insp Water Line Insp
750
P1i-rmb Top Ol.rt Appr-/Sdwlk Insp
IsF,1..ied By Framing ITl5p Mechanical Final
Call for inspection - 639-4175
�— SEWER CONNECTiUN
CITYP®F TIGARD PERMIT
ERMIT #. . . . . . . SWR94-0087
DATE ISSUED: 03/09/94
COMMUNITY DEVELOPMENT D9*A*NbJT
13125 SW Hall Blvd.Tigard,Oregon 9722308189 (503)639-4171 PARCFL: 1 S 134-AC -JE0I O
SITE ADDRESS. . . : 10995 SW 111TH PL
SUBDIVISION. . . . : JEFFREY ESTATES ZONING: R-4. `; PL)
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :010
---------------------------------------------------------------------------------
TENANT NAME.. . . . .
USA NU. . . . . . . . . . : FIXTURE UNIT-:3. . . '
CLASS OF WORT:. . . ;NEW DWELLING UIV I TS. . : 1
TYPE OF USE. . . . . :SF N0. OF BUILDINGS: 1
INSTALL TYF'L. . . . ..BUSWR I.MF'ERV SURFACE. . : : sf
Remarks : PATH I I �
_ ________ ----------- FEES
- --------
Owner.: ------------_----_____________
V70UR D CONSTRUCTION- type amor.rnt by date recpt
U BOX 1`i77 PRMT $ 2200. 00 JH 03/09/94 -
r
INSP $ ,: 5. 00 JH 03/09/94 -
BEAVERTON OR 97070
Phone #: 641-0935
Contractor : _______.___-----•-----__.___._____
CONTRACTOR NOT ON FILE I
Phone #: $ 223 5. 00 TOTAL
Reg #- . : ES E, ---- --
------- REQUIRED IIV�h�f'7IONS -
This Applicant agrees to comply with all the rules and reuulations Sewer Inspection
of the Unified Sewage Agency. The permit expires i80 days fromthe 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 fromthe distance giver,. If not so located, the installer shall purchase -
a "Tap and Side Sewer" Permit and the Agency wi 1 install a lateral. __...____.�__ —-• -
oe
Permittee S gnat r-tree
Issr_red Dy : —
1
Call for^ inspection 639-4175
N
J
G7 /
W
����a�9�����. • . : i ����i�E�.������+ A _ pAipA
a ,--'?19Cp____-_�f�R13��€ SPOSALS. . a i
f YPE OF . . :1►�,SF WASH I N MA . . . . . . . 1 BACKF L PRLN ''T RS. . :0
U�EUPA GRFr. . FLOOF UF2A 1 NS. . . . . . :0 i RAR '. . . . . . . . . . . -0
STOR I .moi. . . . . . . . a 1 WAT HEATERS. . . . . . e 1 LAT BASINS. . . .0
FI X RES------ L NDRY TRAYS. . . . . . :0 RAIN DRAINS. . . . . : 1
{ Q,
Residential Building Permit Application
City of Tigard A
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 039-4171
Jobslte Address: C 9
Office Use Only
Subdivision: LTE_ Lot# 0 _
-- PlandclRec#
Valuation: '" '
Perrrtit #T•%J`����� �t
Owner: � tR CeNStI?tic.r[.otJ Reissue of
Address: X I S 7 7 Map &TL# f Syler "S��IttS
�� icAV� �-Mlo OV--
Phone:
SW 4 :.0�/0
� {a 3 y( !O �� 5 Approvals Required
F hone: --�_ _.
Planning
Contractor: S AM E A4 Also u L- _ Engineering
Addrnss: Other
Items Required
Phone:
Subcontractors
Contractor's License t._ 7103
(attach copy of current Oregon license) Truss Details
Subcontractors: Other
Plumbing: (�-� 1� r Ltj WkA /N
Mechanical G/A L-Vle AT
(attach copy of cumo6t OR Contractor's License)
Arch ltect/E ngi neer:
Address: 1 �; 6�,s _NW I(o 9 TN 'F'LA( E
70tj Of, 9700
Phone: z CO �--
COMMENTS:
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I
Applicant Signature & Phone number
Received by: Date Received.
Permit # Account Description Amount Amt. Pd. Bal. Due
f5t9�( If r Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH) 3 5 3• y
State Tax (TAX)
Bldg: 0��1 . 60 1'
Plumb: UO
Mech: �Y 11'
Plan Check (PLANCK)
Bldg: rd !�
Plumb:
Mech: G'
Sewer Connection (SWUSA) a-2 D 0
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) �U o 5
Storm Drainage Chg (SDSDC)
Residential TIF (TIF-R)
Mass Transit TIF (I IF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
L�
Institutional TIF (TIF-IS) _
Office TIF (TIF-0)
m
LL Water Quality (WQUAL)
Water Quantity (WQUANT) _
Fire District (FIRE)
TOTALS: