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CITYOF TIOARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR1999-00202
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 09/23/1999
SITE ADDRESS; 12270 SW 116TH AJE PARCEL: 23,103BA-00120
SUBDIVISION: LERON HEIGHTS ZONING: R-4.5
BLOCK: LOT: 019 _ _ JURISDICTION: TIG
TENANT NAME: STEVE &ZOLA RAYE
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection to sewer. Septic tank to be pupmped,filled, capped or removed.
Owner:
STEVE/ZOLA RAYE v_ FEES
12270 SW 116TH AVE Type By Date Amount Receipt
TIGARD, OR 97223 PRMT GEO 09/23/199E $2,300.00 99-318576
11\1'�P GEO 09/23/199£ $35.00 99-318576
Phone: 590-4068 Total $2,335.00
Contractor:
OWNER
Phone:
Reg #:
Required Inspections
Septic Tank Filled
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 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 sit forth in OAR 952-001-00 rough Of-&. 52-001-0080
You may obtain copies of these rules c4 direrl questions to rOUNC by calling(503) -1 87. I
Issu 9d b permittee Signature:
_
Call (503) 639-4175 by 7:00 P.M t,-)r an inspection needed the next business day
CITY
OF TIGARD PLUMBING PERMIT _
DEVELOPMENT SERVICES PERMIT#: PLM1999-00310
`n DATE ISSUED: 09/23/1999
L` 13"25 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103BA-00120
SITE ADDRESS: 12.270 SW 116TH AVE
SUBDIVISION: LERON HEIGHTS DICTIO : 'IG
BLOCK: LOT: 019 _ JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SF ACES:
TYPE OF USE: SF WASHING MACH: BACKFI OW 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of sewer line. Existing septic must be pumpod,tilled, capped or removed.
_ FEES
Owner:_ — Type By Date Amount Receipt
RAPE, STEVEN D AND ZOLA TPRMT GEo 09/23/199E $50.00 99-318576
12270 SW 116TH AVE 5PCT GEO 09123/1991 $3.50 99-318576
TIGARD, OR 97223 --
Total $53.50
Picone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: Insp existing/capped fixtures
Reg #: 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
thwn 10.0 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 o,f#hese r les or direct questions to OUNC by calling 3) 246-1987
Issued By: C� �/� Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#_ _
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Recd
(503) 639-4171 Date to P.E. ,
Print or Type Date to DST
WvxIncomplete or illegible applications will not be accented Permit Related SWR
�j jj:0O3i
_ OR 0.7,
f Called
Name of Development/Pro ect FIXTURES (individual) 111 Q-Y PRICE AMT
Job 1 . Sink _ _ 11.50
Address 1Street Address Suite^ Lavatory 11.50
6 ZZ-70 Tub or Tub/Shower Comb. �11 50
Bldg# I City/State Zip Shower Only 11.50
JL)`�C 7� Water Closet/Urinal (Specie;) 11 50
Name -
V c Dishwasher 11.50
Owner M�all7in AddressSuite Garbage Disposal _ 11.50
-IL11.1a-0 Washing Machine/Laundry Tray (Specify) 11.50
Of ;Stat 1 ti
t Phone yd Floor Drain/Floor Sink 2" 11.50
-
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater U conversion O like kind 11.50
Gas piping requires a separate mechanical permit.
City/Stale Zip Phone MFG Home New Water Service 28.00
MFG Home New San/Storm Sewer 28.00
Name Hose Bibs 11.bu
Contractor Mailing Address Suite Drinking
Drains 11.50
Drinking Fountain 11,50
Prior to permit City/State Zip Phone Other Fixtures(Specify) 15.0r
issuance,a copy
of all licenses are Oregon Const,Cont.Board Llc.# Ex i.Date
required It
expired In COT Plumbing Lie.# Exp.Date _
database
Name Sewer-1 at 100' 1 38.00
Architect Sewer-each additional 100' 32.00
Or Mailing Address Suite Water Service-1st 100' 38.00
Water Sirvice-each additional 200' 32.00
Erigineer Clty/State Zip Phone Storm 8 Rain Drain-1st 100' 38.00
Describe work to be done: Storm 8 Raln Drain-each additional 100' 32.00
New O Repair O Replace with like kind Yes O No O Commercial Back Flow Prevention Device 3200.
Residential O Commercial O Residential Backflow Prevention Device' 19.00
Additional description of work:
Catch Basin 11.50
Insp of Existing Plumbing 50.00
Are you capping,moving or replacing any fixtures? _ per/hr
Yes O No O Specially Requested Inspections 50.00
If yes,see back of form to indicate work performed by per/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain,single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Greece Traps 11.50
1 hereby acknowledge that I have read this application,that the information QUANTITY T01 AL
given Is correct,that I am lh er or authorized agent of the owner,and Isometric or riser diagram Is required d Quantity Total Is �9 _
thiiii,pMfiI ubmitted are In om ince with Oregon Stat a Laws. *SUBTOTAL
Owner/Agan T Date
w f 7%SURCHARGE 3 v=
Co�Pct Person Nam P - - ,
**PLAN REVIEW 2566 OF SUBTOTAL
1 BATH fI0U9 1178.00 Required onlyif fixture qty total Is>9
2 BATH HOUSE$290.00 TOTAL
3 BATH HOUSE$289.00
(This fee Includes all plumbing fixtures In the dwelling and the first 'Minimum permit tee Is$50+7%surcharge.except Residential Backflow Prevention
100 feet of sanitary sower storm sewer and water service) Device,which Is$25.7%surcharge
**Ali New Commercial Buildings require plans with isometric or riser diagram and
plan review
I ktstslrurmslplumapp drx i 119199
PLEASE COMPLETE:
Fixture Type _ --� Quantity by Work Performed
—__— New (MovedReplaced Removed/CappPd
Sink
Lavatory ----- -- ----- — _
Tub or Tub/Shower Combin_a_tio_r, - ---
Shower Only_ —�---- -
1,I ater_Closet -- - --
Dishwash4r
Garbage_Disposal
-`— -= -- - —{
Washing Machine __ __ --
Floor Drain/Floor Sink 2" _ �— -
Water Heater —_ - ---- --- - — -
_Laundry Room Tray ---
Urinal
COMMENTS REGARDING ABOVE:
I Wstellormslph,mapp doc 7(19190
ALOHA SANITARY SERVICE
P.O. Box 309, BANKS, OREGON 97106
644-2797 648-6254 639-5188 ,. .. ,
//J Al — — —
FcirY: STATE: zip: — --
HOME: �L�.. / WORK', CELL:
JOB SITE: �/?1G2�' s�S�' /l r; //�.�_ _- P.Ol:
PAID BY CHARGE CHECK 71 CASH 1 CRE--!T 17ARD I
DATE DRIVER �),q/� 7�rauE /Laic! - AMOUNT
_ ® PUMP SEPTIC TANK _
n LINE OPENING
O INSPECTION FEE
71 SERVICE CALL
_ LABOR,LOCATING, DIGGING 8c BACKFILL
I MATERIAL
---T HIS IS NOT A SEPTIC SYSTEM INSPECTION REPQkT--- TOTAL �-�
- - REMARKS - -
�YPE OF TANK: STEEL 171 CONCRETE71 PLASTIC O HOMEMADE
HORIZONTAL G VERTICAL 7 RECTANGLE ❑ OTHER____—__—_
SIZE OF TANK: 350 '"1 500 Cl Iso 0 1000 n 1250 1 15001 2000 '-1 30001
LID LOCATION: INLET -1 ,-OUTLET MIDDLE O ENTIRE TOP `'1
TANK CONDITION: GOOD I FAIR 1 POOR 1-1
FITTINGS: BAFFLES 1 CONCRETE -1 CAST IRON '--I PLASTIC 71
1 NEEDS NEW LID? C_1 YES SIZE
GROUNU COVER OVER TANK
COMMENT ON CONDITION OF DRAINFIELD ETC.
- n
JIGNEDIJJATE
sA�
CITY OF TIGARD BL111 DING INSPECTION DIVISION
24-Hour Inspection Lina: 63:, _ 075 Business Line: 639-41. , MST — _—
BUIL
D� Requested d--� �cl AM —PIVI X BLD _
Location ,fid - /ala 14
�� Suite MEC
Contact Person t M YYt cr-s tXyl\ .60X-f _ Ph PLM
Contractor Ph — SWR ��/-
BUILDING Tenant/Owner EL.0
Retaining Wali
Footing ELR
Foundation Access:
Fig Drain C7 FPS _
Crawl Drain Inspection Note SGN
Slab ,
Post&Beam `{ I
- T
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ----
Drywall Nailing —_
Firewall --- ---_—
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof —----
Misc:_
Final
PASS PART FAIL
PLUMBING ---
Post&Beane --
Under Slab
Top Out - — ------
Water Service
rntery Sew
R IS
PART FAIL
ECHANICAL
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
Fire Supply Line ( )Please call for reinspection RE:_— ( )Unable lo Inspect-no access
ADA �^
Approach/Sidewalk 6 ( v G'/�
Other Date VV ( Inspector / �' /�
Final �- _ _—Ext"
PASS PART FAIL 00 NOT REMOVE this Inspection record from the job site.