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Permit
CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00577 A II DATE ISSUED: 10/18/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 CB -02600 SITE ADDRESS: 14915 SW 100TH AVE ZONING: R -3.5 SUBDIVISION: MURDOCK HILL LOT: 007 JURISDICTION: TIG Project Description: 275' of new sewer line. 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: 275 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES RICHARD BARTON 14915 SW 100TH Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 10/18/200` $147.80 [TAX] 8% State Surcha 10/18/200E $11.82 Phone : Total $159.62 Contractor: A- AFFORDABLE SEPTIC SERVICE PO BOX 1130 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS 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 - 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. Issued By: Permittee Signature: /�� y �� , /�--t) �Le �� g is / z 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. . Building Fixtures Plumbine Permit AppliCAGCEIV I OR OFF USE ONLI City of Tigard ter. e 1 C 1 p it` . Permi No:? \ ,200 0,, 13125 SW Hall Blvd., Tigard, OR 97223 OCT 18 11i1 Plan Review t v" Phone: 503.639.4171 Fax: 503.598.1960 DatedBy. Other Permit No.: 24- Hour Inspection Line: 503.639.4175 44 J .J... Date Ready/By. Ju "s: ® See Page 2 for Internet: www.ci.tigard.or.us CITY OF �I(; N otified/Method: pp��((�� f ) (r" Supplemental Information TYPE OF WWRIG U►1F ; L FEE* SCHEDULE ❑New construction 0 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 CONSTRUCTIO -1 i:: :: :; ' SFR (1) bath 249.20 IN I- 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 >" s - Site utilities Job site address: 19"9 5 S, 4'_ / 2 7 f Catch basin or area drain 16.60 City / State/ZIP: % .0/- F7_2. Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft : Page 2 Cross street/directions to job site: j11,,. ft/ '- Ja / //�/� Manufactured home utilities 116.60 Manholes 16.60 _ /1 /ifil�l� _ Rain drain connector 16.60 Sanitary sewer (no. linear ft.: 7S) Page 2 Storm sewer (no. linear ft.: _) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION WO �' " :' , rtPI, , ,, Backflow preventer Page 2 _j /75 / / // K / O � Backwater valve 16.60 c.Gf - � iGC_( 7F' , /DY„, SS/C� Clothes washer 16.60 Dishwasher 16.60 / r .�� - OPERTY WNER Drinking fountain 16.60 � ' ." ` _ . Ejectors/sump 16.60 Name: //-z�0t ,z?"-e, �y, Expansion tank 16.60 Address: //1c5;'/S-- ' 1! s ...;, / 00 " 4 - Fixture /sewer cap 16.60 City /State/ZIP: / ! J „- 1l � _e Floor drain/floor sink/hub 16.60 - Phone: ( ) / Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 ,riiia_ APPLICANT ❑ CONTACT PERSON - Ice maker 16.60 Business name: 16.60 Interceptor /grease trap Contact name: Medical gas (value: 5 ) Page 2 Address: Primer 16.60 City / State/ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) I Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 '< CONTRACTOR , „ „ Water closet 16.60 Business name: -I .4 jr ,,., 4, /... - Water heater 16.60 Address: 7. X ,/ Other: City /State /ZIP: !.i. 2f /so," Cl C ©� 97071 Subtotal i Minimum permit fee: $72.50 y6 Phone: (e'j 3 ) / p 95 . ' - Fax: ( ) Residential backflow minimum permit fee: $36.25 / (/ 7 �7 /�- 4/ Plan review (25%ofpermit fee) CCB Lic.: O � l � Plumbing Lic. no.: p State surcharge (8% of permit fee) %%. d Authorized signature: Ir ,,Z:771---- TOTAL PERMIT FEE J f'7, C Print name: 2 E/ Z �� Date: /0 /3/ e 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:I Building Termits\PLMF- PermitApp.doc 06/05 4404616T(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 drain - 1 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer - 1st 100' 55.00 w 3,601 to 7,200 $220.00 / j 7,201 and greater $309.00 Sewer - each additional 100' 46.40 C', Water Service - 1st 100' 55.00 t��" Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & 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 (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 Fixture Work: Plan Review for Complex Structures Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quaadty by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor /Water Aspirator are being installed for the food service area Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 - multipurpose fire sprinkler system. Eye Wash Floor Drain /sink - 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain Isometric or Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal -Commercial three (3) or more stories in height. - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. i:\ Building \Pertnits\PLM- PennitApp.doc 07/06/05 1 e. A RIDABLE SEPTIC SERVICE A N PU. BOX i 130 5 WILSONVILLE, OR 97070 (503) 682-1929 FAX (503i 578.0779 CUSTOMER'S ORDER NO. PHONE DATE /2 /7 NAM ADD Si / / /� ; I. ill - 74 e- � / .�; ' . 97 22 9°' 1 SO C C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT QTY. DESCRIPTION PRICE AMOUNT i , TAX I RECEIVED BY TOTAL j All claimse 25 turned goods MUST be accompanied by this bill. `+Tc Reorder: THANK YOU ar■O-z or nets Com CITY OF TIGARD - . BUILDING DIVISION PERMIT #: PLM20000577 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10118/2005 Phone: (503) 639-4171 ip p,`lI I Inspection Requests (24 Hrs.): (503) 639 -4175 AA "__.. INSPECTION WORKSHEET FOR DATE: 10/19/2005 TIME: 7:03AM PAGE: 10 SITE ADDRESS: 14915 SW 100TH AVE CLASS OF WORK: SUBDIVISION: MURDOCK HILL LOT #: 007 TYPE OF USE: PROJECT NAME: BARTON DESCRIPTION: 275' of new sewer line. OWNER: BARTON, RICHARD PHONE #: CONTRACTOR: A- AFFORDABLE SEPTIC SERVICE PHONE #: 503-969-9548 Inspection Request Scheduled For: Date: /011912005 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 018731 -01 503 - 969 -9548 Y Corrections • el�.,- ,..........� ,.,. • J J ) 4 i ° ^ 0 4'44 C , - o.--,-,t< .Je t{ (.t, • . /" n � --4-v- w L. P /0 QrAk 0o c, "i - ? a v t 1 . ' ' ✓4 — CO 1... fZ vc e i.J U c L ; r 1. $ ,g glAi / nnetom/ C,.,'74(A., 1- (-11 —., a. Po)( ,.y C LL a ok Sli Sct,c. YO MA C P 9O 0 G (.) iNfl.e. Pe fr■A,1 C OC Zr -OS: ,,4L -S- G 6L 75 3 1 ,' c A L t,r/kc-.t .5 ,cue:. --ip,,,N,9 -- - A g C 'F1 1-1 we d Ce(A- )., —IP ;if ; 94-et ...:1 - L . r 4 :2rd.oc,1, I I PASS gt PARTIAL APPROVAL n CANCEL I I NO ACCESS I FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: (7 ) \- L.A V J ‘---2,— Date: AV/ q O'. Phone #: (503) 718-