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Permit CITY TIGARD PLUMBING PERMIT i I` DEVELOPMENT SERVICES PERMIT #: PLM2005 -00150 °'Ill DATE ISSUED: 4/15/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 4171 • PARCEL: 2S111 CA -14300 SITE ADDRESS: 15065 SW 98TH AVE ZONING: R -3.5 SUBDIVISION: ALDERBROOK FARM LOT: 008 JURISDICTION: TIG Project Description: Connect existing house to sewer lateral. Line work previously done under PLM2004- 00350. Septic tank is to be pumped, filled & inspected. 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: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES GARNER, DANIEL T AND Description Date Amount ROSS, PEGGY C 15065 SW 98TH AVE [PLUMB] Permit Fee 4/15/2005 $72.50 TIGARD, OR 97224 [TAX] 8% State Surchar1 4/15/2005 $5.80 Phone : Total $78.30 Contractor: A- AFFORDABLE SEPTIC SERVICE PO BOX 1130 REQUIRED ITEMS AND REPORTS WILSONVILLE, OR 97070 Phone : 503- 969 -9548 Reg #: LIC 158246 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 -000 :: : • rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by callin!, 503 - 246 -66• or - ;0032 -2344. ((�� Issue • By: i �� Permittee Signature: �( UG;; . �,� • 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. - � Plumbin Permit A lic • \® i ►a' -�o7 � FOR„ OFFICI USE. ONLY PIM oro - e0 City of Tigard Received t, l /, j -of- -49- ` Permit No.: \ Q j 7 j5 `` Date/By: : t `/ ,/ 13125 SW Hall Blvd., Tigard, OR 97223 OR �. Plan Review _ Phone: 503.639.4171 Fax: 503.598.1960 R` / -� .rigl \ Other Permit No. (/�� 9,,,�,,0� -00 i.55 ii li Date/By. .`a LCJ 24- Hour Inspection Line: 503.639.4175 Internet: www.ci.tigard.or.us F IV: ; : ='°_ 1- Date Ready/By: s H See Page 2 for g „ cc/ o © w. Notified/Method: j 10 Supplemental information TYPE OF V FEE* SCHEDULE . El New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I 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 VI I- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 El 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: / 56 6 5 _< e j, 98 ,41 Catch basin or area drain 16.60 City /State /ZIP: T /u`ei e/2 9 7.2.2 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 1 Project name: Footing drain (no. linear ft.: ) Page 2 ections to job site: //�� ,1 Manufactured home utilities 110.00 Cross street/directions e l�Glra ��� ,, Manholes 16.60 1 0 /,( ✓-1..4.> - C:',--r._ ! . Rain drain connector 16.60 Sanitary sewer (no. linear ft.: /eV) Page 2 Storm sewer (no. linear ft.; ) Page 2 Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK. Back flow preventer Page 2 "_2 t - '0y7« t=c/403-, 4 4-, - jr,s.S m--, Backwater valve 16.60 ei", Z- ....7/4•Z /-i-4 - Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER I 0 TENANT Drinking fountain 16.60 / Ejectors/sump 16.60 Name: ��QK F ( ?Gt r, t" r Expansion tank 16.60 Address: 25--e)‘_. --<:, I - 74Z- Fixture /sewer cap 16.60 City /State /ZIP: 7 e .,. ei e,R Floor drain/floor sink/hub 16.60 1.4 Phone: ( ) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT El 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:( ) I Fax::( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: mil` _ A 7 c_ Q 4 �n /L _c7,.//e e Water heater 16.60 Address: / / Other: -� I) � � // 3o Subtotal City /State /ZIP: c /S©) ? 0 / //e 67 9 c5 70 / Minimum permit fee: $72.50 Phone: (5'63 ) y ' 7 _ 955/8 Fax: (sO3) $'7t/ - Q 7 7 41 Residential backflow minimum permit fee: $36.25 Z2 CCB Lic.: /S g 7 Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) , -5 _y1 Authorized signature: TOTAL PERMIT FEE ? ,,7 d Print name: • j _ 0n1 s Date: ®QS 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 \Pennils\PLM- PennitApp.doc 12/03 4404616T(I0 /02/COM/WEB) Plumbing Permit Application. City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: • Qty. Fee (ea). Total Square Utilities -- � � ' .. ` � � S uare Foota e, Peiniit.Fee: _ - Footing drain - I 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 f)--70o 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 Storm Be Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: $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 (el) Total additional $100.00 or fraction thereof to and Commercial Back Flow Prevention Device 46.40 including for the first $10,000.00 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 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 *. Quantity by (Fixture) Work Performed Fixture Type: s Replace New Moved Existing Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) . fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total -Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service - Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: • i:\ Building \Permits\PLM- PennitApp.doc 3/03 ,,, . t,{ „ rir � AFFORDABLE SEPTIC SERVICE ` P.0 E30'< 1 130 WILSONVILLE. OR 97070 (503) 682-1929 FAX (303) 8704779 CUSTOMER'S ORDER NO. PHONE } 6Z 6-33e/ DATE g � - NAM /9/ /C.6`/ 7 f /�/�c/ ADD' /, 965 / 75 i /6/"Wi7 a( 77zzy SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT /i(4 S. QTY. DESCRIPTION PRICE AMOUNT Pt) rvP /,000 (AL . .mot , 11 R / rOts Pi 1: 0a /ssi /ail) TAX RECEIVED BY TOTAL All claims and re turnedpoods MUST be accompanied by this bill. - / T 800-22b -a THANK 800-225-63a0 q nabs V CITY OF TIGARD ` BUILDING DIVISION PERMIT #: PLM200S -00160 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/16/2005 Phone: (503) 639 -4171 4 , #u 1 'dylui�� p Inspection Requests (24 Hrs.): (503) 639 -4175 „_'!# °'J.. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 28 SITE ADDRESS: 16066 SW 98TH AVE CLASS OF WORK: SUBDIVISION: ALDERBROOK FARM LOT #: 008 TYPE OF USE: PROJECT NAME: GARNER DESCRIPTION: Connect existing house to sewer lateral. Line work previously done under PLM2004- 00350. Septic tank is to be pumped, filled & inspected. OWNER: GARNER, DANIEL T AND, PHONE #: CONTRACTOR: A- AFFORDABLE SEPTIC SERVICE PHONE #: 503 - 969 -9548 Inspection Request Scheduled For: Date: 4/19/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 606 Sanitary sewer 004863 -01 503- 969 -9548 N Corrections /Comments / Instructions: r „ / ►- e____.1, L ., /__ /�� %i ... / / _ , /fi �� _ __ /�� // ..', 40 ./..(K.w.,,/_._(...z_e, ..,„,,,,....,==_ / / 72/ sdi ( / id i i?e/frzt I f Ak.......____ :(j ° ASS !%" 'ARTIAL APPROVAL ❑ CANCEL r] NO ACCESS ill .e FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED G Inspector: Date: , Phone #: (503) 718-