10705 SW FONNER STREET r
O
J
O
t11
oil
O
O
O
U
111705 SIV Foillicr St
CITYOF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SEWOCES PERMIT#: SWR2003-00182
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/5/03
Si-'E ADDRESS; 10705 SW FONNf:R ST
PARCEL: 2S 103AD-00107
SUBDIVISION: 'ZONING: It-4.5
BLOCK: LOT: ulJURISDICTION: IIc;
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NC. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connect existing house to lateral. Reimbursement District#21 fee or$4,956.00 paid.
Owner: FEES _
DAILY, THOMAS C III i-CINDY E Description Date AmoL-11t
10705 SW FONNER ST
TIGARD, OR 9722:3 �ISWUSA] SwrConnect 6/5/03 $2,300.00
ISWUSA] Swr Uminect 6/5iO3 $0.00
Phone: ISWINSP]Swr Inspect 615/03 $35.00
1SWINS111 Swr Inspect 6/5/03 $0.00
Contractor: -- —
---- Total $2,335.00
Phone:
Reg#:
Required Inspections
This Applicant agrees to comply with all the rules and reputations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expire- The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement give,:, Ih-installer shall prospect
3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Seder Perr*
......... —�
Issu�d h�: ► e_.1N I( _� �� ( Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
A MAM E
-AFFOkk L
fir
SEPTIC SERVICE
P0.6ox 1131)
WILSONVILLE,OR 97071)
(503) 6'12-1929 t--AX (503) 670.0779
TU—SIOMFW—SOR—DER NO 1 11 1 I—TPHONE �--'
f
le 71, �N
DATE
ADORES
S,
7
soLD Py C CHARGE— - RGE ON ACCT, MDSE.RLrro PAID70
T
t
F--
-----------------
TAX
-RECEIVED BY
TOTAL
_7
All claims andood accompanied hv:hl��bill
"�TOn►1
=
THANK YOU
CITY OF TIGARD 24-Hour
BUILL.NG Inspection Line: (503)639-4175
INS�PECI-ION DIV1ISION Business Line: (503) 630-417MST -
BUP
Received __ -_ _ Date Requested � �"/� _ AM _ PM BUP -
Location .. -- 10 7 d, eh1YtL� ----_Suite __ MFC
Contact Person __ -- Ph(--.-- -) ---- - --- - PLM
Contractor _ _ _ -- — Ph(_- ) ---------- --._ ._. SWR -
BUILDING Tenant/Owner __ __. _ ELC -
Footing ELC
Foundation - - -----
Access:
Ftg Drain ELR
- -- -
Crawl rain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors ----
Ext Sheath/Shear
Int Sheath/Shear —
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
lgtoll -120"
Fire Alarm
Susp'd Ceiling -- --
Root
Other: - ----
Final
PASS PART FAIL - ---' --
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service _ - ---— - --- -- ----. _ -
a`nitarySear-
_Rai n raiU ns
Catch Basin/Manhole
Storm Drain --------- -- _
Showbr Pan
Other: ----
Flnw
-
2ASH',A_N_1CAL
PART FAIL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL—
Service---- - -- --_. _
Rough-In _
UG/Slab
Low Voltage
Fire Alarm `—
Final _ Reinspection fee of$ required before next Ins
PASS PART FAIL l 4 Inspection. Pay at City Nall, 13125 SW Hell Blvd.
SITE Please call for reinspection RF:_ - ❑ Unable to inspect-nn access
Fire Supply Line
ADA ,. //, j/" -'�
Approach/Sidewalk ' Inspector twit
Other:
Final OO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIOARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLI'02003-00253
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/9/03
SITE ADDRESS: 10705 SW FONNER ST
PARCEL: 2S 103AD-00107
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: 015 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 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 approximately 100' sewer rile to connect to lateral. Septic tank is to be pumped, filled and
inspected. Reimbursement District#21 PAID.
^~� FEES
Owner: — — —_-------
—`--��' Description Date Amount
DAILY, THOMAS C III +CINDY E
10705 SW FONNER ST 1lll-LJM131 11cr1111t Fee 6/9/03 $72.50
TIGARD, nR 97223 11 Ax]8°b State Tax 6/9/03 $5.80
Total $78.30
Phone : - --
Contractor:
A-AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVIL.LE, OR 97070
REQUIRED ;NSPECTIO�'
Phone : 503-969-9548 Sewer Inspection
Final Inspection
Reg #: LIC ISI J�I
This permit is issued subject to the regulations contained in the TigarJ Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work vv1I1 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
Issued By: �� ' ��j ,, ,' : , Permittee Signatrtre: / y
Call (503) 639-4175 by 7:00 P.M. for an inspection needed-the next bu mess day
Buijaing r fixtures
Plumb ;' Permit Application '
.:. Received Plumbinb
,1 PermitNo.t
CityCit of Ti Planning Approval Sewer
gaI-la Datc/B : Permit No.:.. 0
13125 SW Hall Blvd. Plan Review Other --
Tigard,Oregon 97223 Da B : Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review land Use
Internet: www.ci.tigard.or.us Contac : — Case No.
Concoct Juris.: Sec Nage 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: , , Supplemental Information.
TYPE OF WORK _ _ FEE"SCHEDULE for special Information use checklist
New construction El Demolition Description I Qty. I Fec(ca.) I Total
Addition/alteration/replacement ❑Other: New 1- 2-family dwellings
CATEGORY OF CONSTRUCTION includes 100 ft.for each u Ility connection
1 & 2-Family dwelling Commercial/Industrial SFR(1)bath 249.20
SFR 2 bath 350.00
Accessory Building Multi-Family SFR 3 bath _ _^ 399.00
Master Builder Other: Each additional bath/kitchen _ 45.00
JOB SITE INFORMATION and LOCATION _ Firesprinkler-N.ft.: _ Page 2 _
Job site address: Site'Jtilities
Suite#: TTT Bld�./A�t.#: Catch basin/area drain 16.60
5
Suite Name: Dr ell/leach line/trench drain 16.60
ProjFooting drain no.linear fl.) Pae 2
Cross street/Directions to jol site: Manufactured home utilities 110.00
K�5[Ckc., Manholes 16.60
ri0 ,fes' Rain drain connector
Sanitary sewer no linear ft.
Subdivision _ _ Lot#: Storm sewer no.linear ft. q_ F .a 2
Tax ma /parcel # Water service no.linear ft. Page 2-
DESCRIPTION
DESCRIPTION OF WORK Absorption valveFixture or Item
_ _ 16.60
Backflow prevcntcr _ Pae 2
Backwater valve 16.60
Clothes washer _ 16.60
-- --�--- ---- Dishwasher 16.60
PROPS TY OWNER TENANT Drinkinpyfountuin 16.60
—— _ E Wors/sump 16.60
Name: Expansion tank 16.60 _
Address: 01 Fixture/sewer cap 16.60
Cit /State/Li 7,�Z Floor drain/floor sink/hub 16.60
Garbage disposal _ 16.60
Phone: I FAX: Hose bib 16.60
APPLICANT I CONTACT PERSON Ice maker 1660
'Name: S w� lntcrceptor/grease trap 16.60
Address. 1130 — Medical gas-value: $ Pae 2
Cit /Sta a/Zl 707 Primer 16.60
Roof drain commercial 16.60
Phone: Fax: Q • 0774 Sink/basin/lavatory 16.60 _
E-mail: Tub/shower/shower pan _ 16.60
CONTRACTO Urinal 16.60
Business Name: Water closet 16.60
Water heater 16.60
Address: &0 X Other: s
City/State/Zip:/,J �n 77e Other.
Phone: - 'F�Z _ Fax: S 70 -07 7 7 Plumbing Permit Fees"
Subtotal $
CCB L1c. #: / cob. LiC.#: Minimum Permit Fee$72.50 $
Authorized Residential Backflow Minimum Fee$36.25 Z1•
Signature: Date: V Plan Review 25%of Permit Fee $
State Surcharge(8°.o of Permit Fee) $
(Please print name) TOTAL PERMIT FEE
Notice: 'Phis permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of pians with Isometric or
180 days after It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service hoard.
is\Dsts\Permit Forms0mPermitApp doe 01103
Plumbing Permit Application - City of Tigard ' Z
Pape 2 - Supplemental Information
Fee Schedule: Residential Fire Suppcession Systems:
Site Utilities Qty. Fee(#A) Total $ uare Footage Permit Fee:
Footing drain-I"100' 55.00 0 to 7,000 $115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 _ _ $160.00
3,601 to 7,200 _ $220.00 _
Sewer-Ist 100' 55.00 7,201 and grcatct $309.00 -
Sewer-each additional 100' 46.40
Water Service-Ist 100' 55.00 Medical Dias Systems:
Water Service-each additional 100' 46.40 Valuation• Permit Fee:
Storm&(fain Drain-1st 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$101000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Iriztuteorltem Qty. Fee(ea) Total i.icluding$10000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to$75,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25 27.55 and including$25,OW.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Inspection of existing plumbing or each additional$100.00 nr fractio-thereof,to
and including 550000.00.
specially requested inspections-per hour 72,50
Subtotal: $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or traction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"Yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
uantl b ixture Work Performed Comments regarding fixture work:
Fixture'Type: Itdplace
New Moved R116dris Capped, --- -Baptistry/Font
Bath -Tub/Shower
-Jacuzzi/Whirlpool -
Car Wash -Tach Stall v
-Drive Thru `-
Cus idor/Water As irmor -
Dishwasher -Commercial
-Domestic
Drinking Fowtain
Eye Wash J
Floor Drain/sink 2"
3.. -
4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic
Disposal -Commercial increase of sewer EDlis,a sewer permit will be issued and
-Industrial fees assessed for the sewer Increase must be paid before the
Ice Mach./Refri .Drains plumbing permit can be Issued.
Oil Separator Gas Station
Rec.Vehicle Dump Station
Shower -Clang
-Stall
Sink -Bar/Lavatory
-Bradley
-Commercial _
-Service
Swimming Pool Filter
Washer-Clothes
Water Littractor
Water Closet-Toilet
Urinal
Other Fixtures.
i\DstsTermit Forms\PlmPcrnmAppPg2.doc 01103