Permit ;. � � CITY ®� T�GAR® PLUMBING PERMIT
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e COMMUNITY DEVELOPMENT Permit #: PLM2009-00194
TI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/20/2009
Parcel: 2S102DC01304
Jurisdiction: Tigard
Site address: 8890 SW EDGEWOOD ST
Subdivision: Lot: 0
Project: Mabray
Project Description: Connect existing home to sewer. Install up to (200) feet of sanitary sewer line.
Owner: FEES
MABRAY, LARRY G Quantity Description Date Amount
8890 SW EDGEWOOD ST
TIGARD, OR 97223 200 If Sewer Service 07/20/2009 $101.40
1 12% State Surcharge - 07/20/2009 $12.17
PHONE: Plumbing
Contractor:
LDN CONSTRUCTION LLC
PO BOX 301517
PORTLAND, OR 97294
PHONE: 503 - 254 -2540
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $113.57
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
...._
Issued By: � �QQ nn� �\. Permittee Signature:
.. JIG Q � ���tiX1L�V � '�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
FIC4 mmicznimimin
Building Fixtures F,711/Ei
- City of Tigard JUL 2 0 2009 Received P1 rn za� O l t �c i Q
Date/By: (A Permit No..
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C • Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGARD Date/By: Other Permit No.: c 06
(S�o(�2c l o :1
TIG Inspection Line: 503.639.4175 BUILDING DIVISiOV
A R D ate Reeadyethod By: ®
Juris See Page 2 for
Internet. www.tigard- or.gov otified M: "rle, Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description [ Qty. I Ea. Total
❑ Addition /alteration/replacement [they: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Ell- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ig `6, 70 < L ` ,/y, c v <,, ,„.:-/'
>r ! 5,4 Catch basin or area drain 16.60
City /State /ZIP: 77/ .,.1 f--C) O n.� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.150) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
,4 7c -, .5c: •� Cic>,s,/r e C ) Backwater valve 16,60
r e- `Li 5 -- • L../ / c .e" . ec -7).17-7 6 .,, 5 �Z� Clothes washer 16.60
Xr 1 / ,1 / �, r.../9 Dishwasher 16.60
Q' PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: X..,./ �jk 6,, Expansion tank 16.60
Address: / � Q / 5 ---- <,, 4fa'ti h /6 ,/ •e_.- . C, Fixture /sewer cap 16.60
City /State /ZIP: z....4,,e ,./e,,,,, G Floor drain /floor sink/hub 16.60
Phone: ( 1 (O (, /4-7 Fax: ( ) Garbage disposal 16.60
• ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Z j2 A / f C /4 v f' c' . Interceptor /grease trap 16.60
Contact name: ,/ TM,y� e /t i - 4-c ..c.-- Medical gas (value: $ ) Page 2
Address: PQ /3 3 eC / S -/ 7 Primer 16.60
City /State /ZIP: �., f! 64 r: , , ,t r �..-1 Roof drain (commercial) 16.60
Phone: (S�3) z?,) , -/7_ 0 c // Fax:: ( ) Sink /basin/lavatory 16.60
/ Tub /shower /shower pan 16.60
E -mail: I a /.v : v,, S 1!_ /L G-' e_ ,, C 1-
Urinal 16.60
CONTRACTOR closet 16.60
Business name: ('.„„ Water heater 16.60
Address: • r • 1 )> Other:
City /State /ZIP: 6:2/ Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: R.0 570 7 Plumbing Lic. no.: Plan review (25 % of permit fee)
Authorized signature: State surcharge (12% of permit fee)
TOTAL PERMIT FEE 1(3.57
Print name: Date: This permit application expires if a permit is not obtained' within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I \ Building\Permits\PLMF- PermitApp doc 12/27/06 440- 4616T'(1 0/02 /COM/WEB)
au20 - .3 (3 ! g 50
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1s 100' 55.00 0 to 2,000 $1 15.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm &Rain 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 $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $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 $25,000.00.
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 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
•
Commercial Fixture Work: Plan. Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantitxby (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic - Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is\ Building\Permits\PLM- PermitApp. doc 12/27/06
12/15/2009 10:38 5032542474 LDN PAGE 02
utC: 15 05:5BA FROM:caDDDMAN SANITATION 5034920200
Dm!- *do 70: 5GJ�i_'S4a474 P.1
,. 3. 666.22280 Fax: 503492 -0208 0 L/1, 00 — 00 /
' "iisf 4 , 1 Good .lan Sanitation, __,,, ,.',, V 0 1 -, :, sa-
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- 931 NE Fdarlow Place
v, I - Sh, j Troutdale, Oregon 97060 Invoice #: 00006764
Date: 7121/2009
Page: 1
Bill To: Job Mch-oss:
LPN Construction LON Construction
P.O. Box 301517 8890 SW Edgewood Street
Portland, OR 97294 -9517 Tigard
Service Description _ Amount
Pump for abandonment -1000 gallons at .345 cents per gallon
$35.00
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Customer PO #:
Terms: C.O.D.
Due Date: 7/21/2009 Tok A $345.00
TERMS: Customers, with pre - approved credit, payment Is due Net 18 with a maximum of ( unt : pptie¢!: f $0
one outstanding invoice at any time. I
Checks returned NSF will incur a S30,00 fee. ff collection by an attorney is
Et.. �hc� 4u�• (/ J / $345.00
necessary, customer will be liable for attorneys fees In addition to original
Invoiee(A) And Iste charges of 1 1/2 % -18% per anum will be made on any
invoice 15 days past due
ft eft d ye o� treed g. �'! ®use is m la woice.
NO S TA TLMflvNT WILL >g $EN&
PAGE 03
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DATE SCHED LED: TI
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SIG ,f. TORE (I hem." acknowledge the compretIon of the above deecr10150 PAY THIS AMOUNT'
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1 :7---- 1 -- ni You, We A eciate Your Business!
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i 4 COFFEE LAKE AGGREGATE DAILY 11IVIE /MATERIAL SHEET
k, 11 i SW WALDO WAY LDN Excavation, Inc.
lap v. :., .
- SFfERWOOD, OR
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Time Started y /`-
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>a NA a:.;,- � 3 {503) 344- 3570 /\ ` mi
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rao:, sa£scu conrr}vrr Down Time - Lunch - t V ) f -, } , CI #
Tame Finistted V NI\iy'✓ 4 tt �471EITIA9E: OT/2112a09 `
TRCp(g7 14:32 DRIVER; LDP! Onvei Time
NO: 4062129
TRUCE( NO: LDR152
TRUCK TYPE: SO ? eQ1 ��Q
Begin Mile Ending Mile
--�-- Dale
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GIST NO: 33177 LICENSE:
cUS7 raaf,� L C ®ilf; L L C rc t: Contractor or Employer
P.O.*: G,
O� Pd�: Tuck No. c� Address t�
19282
ANNUAL
-Ica
ADDR: COFFEE LAKE ROCK
I Rale $ per hournon Job Location
889D SW EOG EyyO flD FUALAT!!Y I
Directions:
MATERIAL
I HAULED FROM HAULED TO
LOADS/TONS TIME
I
2
i
z PROD l
11CD
n I
J PROD BESC:
i 1/2 °-3/4" CRUSHED DRAIN
1
GROSS: 39,240 (SG! 1) LES '
p. T. TARE: 24,3635 0 (Scl1) LBS j MIIIIIIIIIIIIIIIIIIIIIII
NET: 14,880 i
7.44 TONS: LBS
.
I
I
v WEIGH MASTER:
r ` DIANE ROBINSON-
v
cNi PLANT PICKUP
LOADS ? I !�� I
in
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m
In
TODAY Driver's Signature TOTALS � `
6,75 — ) EU
o
Mg 6.75 The Parties u erpressfy agree y on the 10th hereto that interestfs following at of
TONS TODAY 7 d
18% per annum on aN past due accounts.
co
rEratAS: H i if this account is placed in the hands of an attorney for collection the Contractor/Employer
�� BTH or rnoarH �PUwPIrJrUPOR agrees to pay Sub- Goanactor/Employees reasonable attorney fees and collection costs even Though
mm a vitho aid Lamm- e AfEnjq chat? Sa m". E,• DUE no suit or action is filed on the account; however, if suit or action is filed, the amount of such reason•
m t
St
RAPE ar'78 \P6160NgL Rug endMMe more P r th otT Oh mor ��6YTHE
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job axov ro�ICE ile rete rvEU,e n E � bQ a. 7yT i s � � � wia to able attorney lees shall be fixed by the court.
�1%.P aRFCIAor Obi teter Erp}r 9Kes :lee 6e^ ' the all liborane �11 it tree r�EM TxGE A lien may be claimed for labor, materials, rentals, and reasonable
"° � "arm, � , y'�Qryr a ues, Chapter 87.
profit under Oregon Revised
m
Contractor /Employer Representative acknowledges receipt of copy and signifies same to be
CD correct by his signature.
cn
N Signature:
Not responsible for damage behind the curb fine.
Signature
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N K'NR£ - Bailing YELLOW - Driver