11370 SW FONNER STREET-1 O
11370 SW Fonner Street
CITYOF TIGA►RA _SEWERCONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR200:' 000c�l
13125 SW Rall Blvd., Tigard, OR 97223 (503) 339-417*i DATE ISSUED: 112102
SITE ADDRESS; 11370 SW FONNER S1 PARCEL: 2S 1 03AC-021 01
SUBDIVISION: ZONING: R-4.5
BLOCK: _ LOT: JURISDICTION: TIO
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: NO. OF BUILDINGS:
INSTALL TYPE: ! PSWR IMPERV SURFACE:
Remarks: Sewer connection of existing SF residence. Septic tank is to be pumped, filled and in�j..ected.
Owner:, _-_-- FEES — �l--
CHARLES M!+kTljV Type By Date Amount Roneipt
11370 SW FONNER ST —
TIGA Rn, OR 97223 PRMT CTR 112102 $2,300.00 27200200000
INSP CTR —+_112102 $35.00 2720020000
Phove: _—� Total $2,335.00
Contractor:
Phone:
Reg#
_.Required Inspections
Sewer Insp-,�clion
Spp,ic Tank Filled
This Applicant agrees to comply with all the rules and regulation:; of the Unified Sewage Agency. The permit expires 180
days from the date issued. 'rhe notal amount pato will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer L,terals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If i.- so located,the installer shall purchase a "Tap and Side Sewer" Perm
A,�
Is ued by: ) 't � PPI mitteeSl��nature: r
��,�_ iness day(503' 1139-4175 hY 7:00 P.M. for an ins ecCon needed thr n,:xt bu
CITYOF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00001
13125 SW Hall Blvd.,Tigard, OR 97223 (5'):) 639-4171 DATE ISSUED: 1/2/02
PARCEL: 2S10.'HG-02101
SI i E ADDRES:,: 11370 SVV FONNER Sl-
SUBDIVISION: ZONING: R-4.5
LOT: _ ^ JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRA;NS. TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 01 HER FIXTURES:
TUB/SHOWERS: SEWER LINE: !!5 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing SF residence to sewer!aleral.
FEES _
owner:
--- — Type By Date Amount Receipt
CHARLES MARTIN PRMT CTR 1/2/02 $72.50 27200200000
11370 SW F-ONNER ST 5PCT GTR 1/2/02 $5.80 27200200000
TIGARD, OR 97223 _ _----
Total $78.30
Phone 1:
Contractor: _
MOORE UNUEROROUND INC
' 9243 SE STONE. RD
GRESHAM, OR 97080 REQUIRF.v INS,'FCTIONS
Sewer Inspection
Phone 1: 503-663-0212 Final Inspection
Reg#: LIC 12660;
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes arid 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.
'Ycu may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
I984d By: Permittee Signature:e:
—
rall (50.1639-4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application '4w''E A000�
---------- --
City Of Tigard Date received / A /
Address: 13125 S W 111111 131v(I, 'I'ik ard. Ok t)7'2 permit no.: Permit no.:,
Ciry of Tigard Sewer
Phone: (503) 639-4171 Building Permit no.:
Fax: (503)598-1960 Pr41ect/appl.no.: _
Expire date.
Land use approvaDate issued,l:
_ BY: Receipt no.:
—-- Case file no.: -
--- Payment type:
/111 8c 2 family dwelling or accessory U Commercial/industrial
U cw construction U Multi-famil
U Addition/atleration/rcI,lacernent y U Tenant improvement
U Focd servicr
U Olhcr:
Job addr ss: - ---
Bldg.no.:
Ilrscr�►11inn
Tax map/tax IoUacco_untSuite nn.; --- Nc n 1-and 2-family dvtelljrlgs only. �My hec(ca') lbtal
Lot: (Includes 100 fl.foreach 1111111[.connection)
Block: Subdivision: 'iI,R(I)bath
Project name: PW(T)hath--- ^---- -
City/county: — ,3FR(3)bath
LIP. Each additional bath/kitchcn
Description and location of work on premises: y _
F 1 - - ( Slteotllitlea: —
Est.date of c.•mpletion/ins ction: "� '"�6 Watch basin/area drain
brywclls/Icach line/trench drat—
Business name: F( n drain(no,lin. it
Manufactured home utilities
Address:
City: , Manholes -
StateC: Rain drain connector
Phone: ` LIP: Sanitary sewer(no. lin.ft.)
> Fax: _
CCB no.; Z�, #1 E-mail: _ Storm sewer(no, lin.ft.)
Plumb, bus.reg.no: Watcrscrvice
City/metro lie.no,: L��Q� ----- (no.lin. ft.
Contractor�pr_sentative signature, ..,�, Fixture or Item:
Print name; - O�_2' .� AI sorption valve
1 Date: Z Ba,.k fl we everter
Backwater valve
Name: ` Basins/lavatory -
Address: Clothes washer
City -- Uishwas` ham- ---
Phone: - -- -_ __--- State: Zip: inking fo—uniain(9j ---
Fax: E-mail: Ejectors/sump
EUar,sr—'on tank
Nfune(print): FIxture%sewer cap y
Mailing address: CFlcn,r d_ rains/Ooor sin s/hub
City; - �� mot c� Garbage disposal
State ZIP Ho., hibb ------
phone: _ Fax: ----- Ice nlake��
E-mail: ----'--- _
Owner installation/residential maintenance only: The actual installation Intcrcc tore�raP will he made by me or the maintenance and repair made h m Primers) --
employee on the property I own as per ORS"hapter 447.Y Y rE'gular -- -
Rex�f drain(commercial►
Owner's signature: Sink(s),basin(s),lays(s)
- Date: _ Sump --
_Name: Tubs/sh" ower/shower pan — -
, d_dress: Urinal
-- �---"-"-- - r
atcl�'closei
City: Water heater .-------—
phone' -_-- State: ZIP: -
Far: -- Uthcr: ---
----- Email:
Nd ell jwi�ucuau — fo
�'M crMlt cards,rrleaae call JtMuactlan at —. ��•�"`�—
Visa U MearerC'artt "�i"I'mnWla" Notice:This Minimum frt:................$
Credit card number: permit application
------ , , expires ira permit is not obtained Plan review(at __ %) $
-- N of cN,erttrdrtoldr as Ce within 180 days eller it has been Slate surcharge(896).• a ----
°"""rli c� accepted as complete. TOTAI.
__ csdno'Idei iRMtnre — j a — L —
Amount
440.4616(&WcoM)
PLUMBING PERMIT FEES:
TOTAL New-1and 2-famdw
lly ellings only: 1
FIXTURES (Individual) QTY ea AMOUNT (includes all plumbing fixtures In I PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY lea) AMOUNT
16.60 for each utility connection) _ _
Lavatory -_ One 1 bath $249.20
Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00
Shower Only
--- 16 60 ThreeAJ)bath _ - $399.00
Water Closet 16.60 --,---SUBTOTAL
SUBTOTAL
Urinal 16.80 _ 8'/.STATE SURCHARGE
Dishwasher 18.60 PLAN REVIEW 25'/.OF SUBTOTAL
_-- TOTAL
-- .
Garbage Disposal1660 ---f--�----_- -
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" - 16,60 - PLEASE COMPLETE:
16.60
4„ -- 16.60
__ Quantlt b Work Performed
Water Heater O converslon O like kir d 16.60 Fixture Type: New Moved Replaced Removed/
Gas piping requires a separate mechanical - Capped
ermlL
MFG Home New Water Service 46.40 Sink - - - ----
. Lavato _ --- --------
MFG Ho4640
me New San/Storm Sewer Tub or Tub'Shower
Hose Bibs 16.60 Combination -
Roof Drains 16.60 Shower Onl ---
1s.60 Water Closet
Drinking Fountain Urinal
Other Fixtures(Specify) 16.60 Dishwasher
Garbage Disposal
MRoorrSewnr-1 st 100' 5500 Sewer-each additional 100' 46.40 55 00
Water Service-tat 100' --- Other Fixtures
Water Service-each additional 200' 46.40 (Specify)
Storm&Rain Drain-1at 100' 55.00
Storm&VainDrain-each additional 100' '4_640_T6
8.40
Commercial Back Flow Prevention Device A6.40
Residential Backflow Prevention Device' 27.55
Catch Basin 18.60
Inspection of Existing Plumbing or Specially 62.50 COMMENTS REGARDING ABOVE:
Re nested Ina ecUons erlhr _
Rain Drain,single famlly dwelling 55.25 _
Grease Traps 16.60 _
QUANTITY TOTAL _.
Isometric or riser diagram Is required If
Quantity Total Is >p
*SUBTOTAL
8%STATE SURCHARGE -
**PLAN REVIEW 25',,e OF SUBTOTAL
Required only If fixture t total Is>a -
TOTAL $
*Minimum permit fee rs$72'.50•a%state surcharge,except Residential Backflow
Prevention Device,N hlch Is$39.25•a%state surcharge
"All New Commer•:Isi Buildings requkre 2 sets of plans with Isometric or riser
diagram for plan review.
1:ldatglform9\plm-feee.doc 12128101
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4-i 15 Business Line: 639-4171 ----
BUP
^_Date Requested 1 _ —Am k'--� PM _ BLD
Location 2& 2 _ Suite ! — MEC -
Contact Person _- v �LZL4�n — Ph �G '3 / PLM
Contractor _ Ph SWR , �JG
BUILDING Tenant/Owner _ _ �J ELC
Retaining Wail F_LR _
Footing Access —
Foundation FPS
Ftg Drain SCN
Crawl Drain Inspection Notes -- -----
Slab
Post 8 Bear - -------------- ---- ---- --- SIT
n ----
Ext Sheath/Shear
Int Sheath/Shear - -
Framing
Insulation
Drywall Nailing
Firewall _---- ---- -- ----
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - - - -- - --.. -- - —
Roof
Misc: -- ---------— -- --
Final
PASS PART FAIT- ------- --- -- --------- -----------
PLUMBING
Past 8 Beam _. —-- --------- ------------------- —.—
Under Slab
TopOut —_ _.___ _---------_---- ---------
Water Service
Rain Drains
-anal — - ---- -------_—..__-_—
PART FAIL
MECHANICAL _ -
I'nst K Beam - — ---
Rough In
rias Lina - —
Smoke Uarnpei� z
1111,11 - - ---
PASS PART_ FAIL
ELECTRICAL ---
Service
Rough In
UG/Slab
Low Voltage -
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading --_-- - ----- --- -
Saoitary Sewer
Storm Drain ( J Reinspection fee of S.._ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
F m Supply line ( )Please call for reinspection RE:-- _.. --__— [ J Unable to Inspect no access
ADA
Approach/Sidewalkr,
Other Date - y _ lima Inspector _1""�l 14t Ext
Final _
PASS PART FAIL DO NOT REMOVE this Inspection record frorn the job site.