12330 SW MARION STREET N
W
W
O
N
a
N
O
7
N
a
m
K
12330 SW Marian Stree'L
/ CITY OF TIGARD PLUMBING PERMIT _
DEVELOPMENT SERVICES PERMIT lf: PLM2003-00112
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/28x03
PARCEL: 2 S 103CB-04000
SITE ADDRESS: 12330 SW MARION ST
SUBDIVISION: WILLAMETTE NO 2 ZONING: R-4.5
BLOCK: LOT: 019 JURISDICTION: TIG -�
CLASS OF WORK: OTR 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:
LAVA?ORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
nISHWASHERS: RAIN DRAIN: ft
Remarks: Install approximatly 100' sewer line for House connection to lateral
Septic tank to be pumped, filled and inspected.. NO REVERSED PLUMBING
Owner: -
Description Date Arnouni
FICHTNER, WALLACE G + KELLI L
12330 SW MARION ST 111I.l1Mlil I'rrnnt Fee 3/28/03 $72 50
TIGARD, OR 97223 11 AX) S'!,State I ax � 3/2.8/03 _ _ $5.80
Total $78.3C
Phone
Contractor:
HOLLLNBACH + HURD INC
3000 SW 174TH AVE
ALOHA, OR 97006 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 591-5987
Final Inspection
Reg#: ME'l, 4926
LK' 121807
This pen-lit is issued subject to the regulations contained to 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 952-0001-0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 2_46-6699
Issued By: � 7 �f r�� _ Permittee Signature.
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
'4t nbinp_ Permit Application ' ' '
NLY
• Received Plumbing -
bale/139 t Permit No.:llYt'')a"�
City of Tigard Dste/ngApprovol Sewer
\ Date/By: Permit No.:
13125 SW Hall Blvd. \ Plan Review other
Tigard,Oregon 97223 ` Datc/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact Juris: See Page 2 for
24-hour Inspection Request: 503-639-4175 Namc/Method: _ Su rmental Information.
TYPE OF WORK _ FEE*SCHEDULE(for special information use checklist
New construction Ll Demolition Description Qt}. T Fec(ca.) I Total
'IqAddition/alteration/re 1p acement I F10ther: New 1-&2-family dwellings
Includes t00 rt.for each utility ccnoection
CATEGORY_OF CONSTRUCTION SFR I bath 249.20
1 &2-Family dwelling Commercial/Industrial SFR 2 bath 350.00
Accesso Buildi� Multi-Family SFR 3 bath 399.00
EJ Master Builder Other: Each additional bath/kitchen _ _ 45.00
JOB SITE INFORMATION and LOCATION Eire sprinkler-sq. fl.: Pae 2
Job site address: 0 5LL) Site Utilities
��-----
Suite#: _ Bldg./Apt.#: /1)t+k 1 Catch basin/area li drain 16.60
Dr ell/leach line/trench drain 16.60
Project Name: i � NP2_ - Footing drain no. linear R. Page 2
Cross street/Directions to job s te: /) Manufactured home utilities 110.00
0 A.9 f!� ' �-�.� d 41,A Manholes 16.60
Rain drain connector _I6.6(I _
Sanitary sewer no. linear fl. / ['age 2
Lot#y Storm sewer(no.linear fl. Page 2
Subdivision: -
- --- L--_ Water service no. linear ft.) Pae 2
Tax map/parcel #: _ _ -_ Fixture or Item
DESCRIP'T'ION OF WORK Absorption valve _ 1660
._'V P �- Backflow preventer Pae 2 -
�' Backwater valve 16.60
c - Clothes washer _ 16.60
-- -- ------- ---- -- - Dishwasher _ _ 16.60
Drinking fountain 16.60
PROPERTY OWNER TENANT F3ectors/sump 16.60 _
Name_ ,,4 - -6 /L4/Z - Expansion tank 16.60
Address: / v7 3 S 1 c y <4A a 0� Fcap 16.60
City/StatCOP: /C 2 TT__- Fllooroor drain/floor
drain/floor sink/hub 1 _-
Garbage disposal 166.60.60
Phone:S5 C 5~°,�O Fax: (lose bib 16.60 �-
PPLICAN'1 I LJ CON'T'ACT PERSON Ice maker 16.60 W
Name: �.�fmEr _ Intercc tor/ rcase trap 16.60
Medical as-value: S Pae 2
Address 3r-7
14_9 � s
City/State/Zip: � p �rZs� Primer 16.60
Roof drain(commercial) 16.60
Phone: 5 YF ax g >> Sink/basin/lavato 16.60
E-mail: Tub/shower/shower pan 16.60
CONT ACTOR Urinal 16.60
Business Name: o /E'.d�K� _ u r . Water closet - 16.60 --
Water heater 16.60
Address: ���p �l SCS' '`/ Other:
Cil /State/Zip: /1/v 4 14 �2 Other: _ _
Phone: 93&_57 � Fax_ -��v.3� Plumbing Permit Fees*
Subtotal S
CCB Lic. #:/ ' 18tz� 7 Numb. c.#: f --- Minimum Permit Fee 572.50 $
Authorized Residential Backflow Minimum Fee$36.25 112_Ico
Signature: L� Date. `cx� U� Plan Review(2510 of Permit Fee $
u t?t State Surcharge(li%of Pcrmit FE( S r' ,
(Please print name)- TOTAL PERIIIIT FEE S _
Notice: This permit application expires If a permit Is not obtained Nlahin All new commercial buildings require 2 sets of plans Nlth Isometric or
Igo days after It has been accepted as complete. rlser diagram for plan review.
*Fcc(Imethodology set by Tri-('oust% Building Industry Service hoard.
i:\Dsts\Permit Fotms\PlmPermitApp doc 01/03 !/ i
Plumbing Permit Application - Citi' of I•igard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su resslon Systems:
Site Utilities Qty
-Fee ?'Dial Square F Dotage: Permit Fee:_ _
Footing drain-1"100' 55,00 _ 0 l0 2,11(1(1 _ $115.00
4G.40 2,001 it)3,600 _ $160.00
Footing drain-each additional I00' 3 GUI to 7,200 ,_ $220,00
Sewer-1st 100' 55.00 7,201 and greater _ $309.00___
Sewer
309.00 -
Sewer•each additional 100' 46.40
Water Service-Ist 100' 55,00 Medical Gas S stCms:
Water Service-each additional I(HY a6.ao Valuation: Permit Fee:
Storm& Rain Drain- Ist 100' 55.00 91.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional IU(P 46 40 $5,001.00 to$10,000.00 $72.50 for the first 55,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or item Qty. Fee(ca) total includin $10,0WA0. _
Commercial(lack Plow Prevention Device 4640 $10,001.00 to$25,000.00 $148.50 for the first$10,0(10.00 and$1.54 for
each additional$100.00 or fraction thereof,to
Residential Backflow Prevcntiou Device _ _ and including$25,0(X).00.
minimum omit fcc$36.25 27.55 and$1.45 for
Rain Drain,single family dwelling 65.25 — $25,001.00 to 550,0(X).00 $379.50 for the first$25,000.00
each additional$100.00 or fraction thereof',to
Inspection of existing plumbing or and including$50,000.00.
s cciall re ucstcd ins cclions• cr holo 72.50 _ 550,001,00 and up 5742.00 for the first$50,0(X).00 and S1.20 for
Subtotal: _i _ each additional S10U.00 or fraction thereof.
Fixture Work:
Are you capping,Inoving or replacing existing fixtures? If
please indicate work performed by fixture. Failure to
accurately report fixtures could result lit increased sewer fees*.
_ uantit b Fixture 1Vork Perforated C olttltt�niti rc):trtiin( fixture ��ork:
Flxture Type: Replace
New Moved letln Capped
------
Ha tist /Font - -
Bath -Tub/Showcr _ -
-Jacuzzi/Whirl
Car Wash Each Stall -
-D rive'rhru -
Cus idor/Wnlrr Aspirator
Dishwasher -Commercial -
-DomcsticDrinking Fou Fountain -- ---- —__-_Lee Wash -- - - -
Floor Drain/sink 2"
4"
car Wash Drain *Note: If the fixture work under this permit results in all
Garbage -Domestic _ Increase of sewer EDUs,a sewer permit will he issued and
Disposal -commercial fees assessed for thy'sewer Increase must be pa°1 before the
-Industrial _ _
Ice Mach./Rel'ri .Drains plumbing permit can be issued.
Oil Sc aralcrr Cias Station
Rec.Vehicle Dump Station
Shower -(fang
-Stall
Sink -Bard avatory
-Bradley _ -
-Commercial — -----
•Service - -
Swimming Pool Filtcr -- -
Washer-Clothes
Water Extractor
Water Closet-'roast
Urinal -
Other Fixtures:
i:\Dsts\Permit Forms\Plm"cttnitAppPg2,doc 01103
CITY't� OF T'IGARD __ SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: S 00099
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/228/038/03
PARCEL: 2 S 103CB-04000
SITE ADDRESS; 12330 SW MARION ST
SUBDIVISION: WILLAMI 1 17:NO,2 ZONING: 1,' 4 S
BLOCK: LOT: 019 _ JURISDICTION: I I(,
TENANT NAME:
USA NO: FIXTURE UNITS.
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: l_-I PSWR IMPERV SURFACE:
Remarks: Connect existing house to sewer lateral No reimbursement district fees/per Mike White.
Owner: FEES _
FICHTNER, WALLACE G + KELLI t_ Description Date Amount
12330 SW MARION ST
TIGARD, OR 97223 1SWUSAJ Swr Connect 3/28/03 $2,300.00
1 SWUSA I Swr Connect 3/28/03 $0.00
Phone: ISWINSP1 Swr Inspect 3/28/03 $35.00
1SWINS111 Swr Inspect 3/28/03 $0.00
Contractor:
--- - Total $2,335.00
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
gt arantee 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 set forth in OAR 952-001-0010 through OAR 952-001-0100.
You may obtain copies of these rules or direct juestions to OUNC by calling (503) 246-6699. /1 \}
t.
Issued by: ? y�_ - ( ! A Permittee Signature: _ t -i,
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD 24-11our
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171
BLIP -
Received _— - --_-___ Date Requested _�`-��._- _ _�_ AM_ PM HUP
Location ___ �-PZ-330---- Suite _-- MEC
Contact Person -�- _— Ph(__ — PLM �--
Contractor --_- Ph; ) �. SWR — —
BUILDING Tenant/Owner w _-_ .. ELC —
Footing _ EL c
Foundation Access:
Ftg Drain "� S r ELFT
Crawl Drain /
Slab lnspectio N tes: --- SIT
Post&Beam
Shear Anchors ---
Ext Sheath/Shear
Int Sheath/Shear
Framing _ __ _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _-
Fire Alarm
Susp'd Ceiling -— -- -
Roof
Other:
Final -
PASS PART FAIL - ---
PLUMBING
Post&Beam
Linder SlabRough-in
Water
Water Service
'Santt o ,
Plaid trains �
Catch Basin/Manhole
Storm Drain — ---- -----ShowerPan
Other. -- -- __— ------------
Final - _
PASS PART FAIL - - �—
'MECHANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampen -
Final
PASS PART _FAIL ---- - ----
ELECTRICAL -
Service _----_ ----- --_ _— - ------ -- -
Rough-In
U(3/Slab _-
Low Voltage
Fire Alarm
Final L� Reinspection tee of$ required before next inspection. Pay at City Hall, 1312E SW Hall Blvd.
PASS PART FAIL
$S_ - --_ C Please call for reinspection RE:_. __—_�—_--—_—_ [] Unable to inspect-no access
Fire Supply Line
ADA b
l%%
Approach/SidewalkDaIMIpOt..___ v _ _ —_- Itxt
Other:
Final F DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
04/04/2003 08:52 503-848-6832 I1(_ILLF_t4BAr,H & HURD FAf-iE 01
��-
A L__0'_H ASANITARY SERVICE
INVOICE NO
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 7187
503-6144-2797 503-648-6254 503-639-5188
NAME: ,ILC1,1.,ZfAIRA-_-
ADDRESS -
CFTY' STAT!' ZIP:
NOME: WORK:— CELL.
JOB $ITL: P.Q. : — - -
PAirn 8Y CHARGE J�rT CHECK El CASH ❑ CREDI f CAgD U
DATE ! - - Q 7 DRIVER !�� �/� 7r Lr�'^71enc/ AMOUNT
PUMP SEPTIC TANK
J .INE OPENING
U INSPECTION F!E —
U SERVICE CALL
u LABOR, LOCATING, DIGGING, HACKMLL - —
0 MATERIAL
- - TI1IS IS NOT A SFPTIC SYSTEM INSPECTION DEPORT - - TOTAL $ �-
- - REMARKS - -
TYPF OF TANK: STFf_L La CONCRFTF U PLASTIC L] HOMEMADL U
HORIZONTAL ❑ VERTICAL U RECTAyE U U OTHER
SIVE OF TANK: 350 ❑ 500 C] 750 L) 12.50 Ll 1500 L) 2000 O 3000 U
LID LOCATION: INLET r 1 0yhEf U MIDDLE U ENTIRF Top U
TANK CONDITION: GOOD L, FAIR U POOR U
FIT71Nos: BAE S U CONCRETE. U CAST IRON U PLAs'rlc U
NEEDS NFw 1.107 'VES L) SIZE
GROUND COVER OVER TANK
COMML-NIS ON CONDITION OF DRAINFIFl.O ETC.
Fax Transmittal (Nemoof -
- -� 4 l� 5 7 _
�
SIaNkD By
Dept.- �w _ hone # /� nATT
--- Fax M (Q Fax-N - q
RCP714