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Permit I TY OF TIGARD PLUMBING PERMIT " ° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00333 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/11/2008 PARCEL: 25101 DB - 00615 SITE ADDRESS:. 13315 SW 76TH AVE ZONING: R - 3.5 SUBDIVISION: ROLLING HILLS LOT: 020 JURISDICTION: TIG PROJECT: WILLIAMS Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement District #44 fee paid this date.. 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 Owner: FEES KENYA WILLIAMS 13315 SW 76TH Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 8/11/2008 $72.50 [TAX] 12% State Surch 8/11/2008 $8.70 Phone : Total $81.20 Contractor: BRIAN CLOPTON EXCAVATING INC PO BOX 509 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 682 -0420 FAX 503- 682 -0967 Reg #: LIC 50337 PLM 3 -517PB 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 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 503.246.6699 or 1.800.332.2344. 1_ Issued By. V\ Permittee Signature: 1t � ,Vyabd 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. Plum Permit Application Buildinc4ixtures FOR OFFICE USE ONLY City Of Tigard Received o / I Date/By: 0 /� 4 ' Permit No.: G 'ill; --CO-55 'y 1 3125 SW Hall Blvd., Tigard,OR 97223 / Plan Review ,3�A� aU[ �j Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Permit No. : Inspection Line: 503.639.4175 D ate Read B Iu ris • ®Se Pa e 2 for " TIG A RD' Ready /By: g Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description Qty. 1 Ea. 1 Total ❑ Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- 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: / 33(y ' ( 9 & Catch basin or area drain 16.60 City /State /ZIP: 7 � Q 7a ,1� f Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: t � 1 LL , it-t-I 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.:Ze r Page 2 55-a° Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 /J r , f J fi< Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: , �iC/ 5 Expansion tank 16.60 Address: 0 LJ 50 Fixture /sewer cap 16.60 City /State /ZIP: VOA& CZ '7,425 Floor drain/floor sink/hub 16.60 Phone: c53) 6t7 , 7 ( ?5 Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 • City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: � p Q (( C em i n i f A ,< 1 G Water heater 16.60 I` Address: 70 40� r � e � 50 , 7 l ` D Other: M inimum permit fee: $72.50 Subtotal City /State /ZIP:L, LSD V(LL ., or. 9 /0-to Minimum Phone: (5O 5) be a „ (4 j O Fax: (€(3 � 3 a^ O(� i Residential backflow minimum permit fee: $36.25 7a ' Sa CCB Lic.: � 7 fs' b 3 � -7 Plum n Lic. no.: 11 Plan review (25% of permit fee) Authorized signature: 7 1 ' j- 6 / 7 P � State surcharge (12 /o of permit fee) S, 70 TOTAL PERMIT FEE 8 I . a.° Print name: Jya 6) LC IA j5 Date - 1I . D This permit application expires if a permit is not obtained within l 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1:\ Building '\Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) 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 dram - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 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 525,000.00 $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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. • 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 Quantity by (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: i: Building \Permits\PLM- PermitApp.doc 12/27/06 fit, SEP IIC SEMnCE P.O.B ©X.1130 WILSONV LLE, OR 97070 (503) 632-1 52@ FAX pm 67040779 CUSTOMERS ORDER NO. PHONE DATE NAME 7 4f.z cte74:9 ADDRESS J/ e / j / c 2:Fr SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT - QTY. DESCRIPTION PRICE • AMOUNT /5° O 6 L 5E e 4 5 • A A . (1/16114,1 a ,; TAX RECEIVED BY TOTAL 41750 All claim.- teturr d s woods MUST be accompanied by this bill. soa t THANK YOU - / 225 -63£0 ° or ria4s.com CITY Of TIGARD ,----- BUILDING DIVISION A PERMIT #: PLM200B-00333 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/11/2008 Phone: (503) 639-4171 it 1 4 411,1lit Inspection Requests (24 Hrs.): (503) 639-4175 . _.,W 1.1.. INSPECTION WORKSHEET FOR DATE: 8/21/2008 TIME: 7:O2AM PAGE: 10 SITE ADDRESS: 13315 SW 76TH AVE CLASS OF WORK: SUBDIVISION: ROLLING HILLS LOT #: 020 TYPE OF USE: PROJECT NAME: WILLIAMS DESCRIPTION: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement District #44 fee paid this date.. OWNER: AiLLIAMS, KENYA PHONE #: CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420 Inspection Request Scheduled For: Date: 8/21/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 07447401 503.849-7607 Y Corrections/Comments/Instructions: _514 r , i.‘- / 1-1 54 PASS {-7 PARTIAL APPROVAL D CANCEL n NO ACCESS 1 1 FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: eftVvIsit-iiVV.---, Date: q a t 1 6% Phone #: (503) 718- CITY OF TIGARD '" �,� BUILDING DIVISION PERMIT #: PLM 00B 00333 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/1102(108 Phone: (503) 639 -4171 nAll,,, ���l� Inspection Requests (24 Hrs.): (503) 639 -4175 ° I .. INSPECTION WORKSHEET FOR DATE: 8/2002008 TIME: 7:02AM PAGE: 17 SITE ADDRESS: 133'I6 Std 76TH AVE CLASS OF WORK: SUBDIVISION: ROLLING HILLS LOT #: 020 TYPE OF USE: PROJECT NAME: WILLIAMS DESCRIPTION: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement District #44 fee paid this date.. OWNER: WILLIAMS, KENYA PHONE #: CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503 - 582.0420 Inspection Request Scheduled For: Date: 8020/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 350 Septic tank 074403 -01 603. 209-6672 Y Corrections /Comments/ Instructions: � ,,�e � -os, , , Q a►c klwc, a-c../ U a, \ 0 <- P U v-. k p -c Z 1 v a- Pod \A eiti. e J v o j e cat ,„ l/ Ve-e c t, t,o'7 ❑ PASS La PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 1 1 FAIL 1 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1rvrn,-V'\1 Date: 7 1 \ DT, Phone #: (503) 718-