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Permit
• CITY TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00415 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/10/2007 PARCEL: 25111 BA -00806 SITE ADDRESS: 14080 SW 100TH AVE ZONING: R -3.5 SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 025 JURISDICTION: TIG PROJECT: COFFEE Project Description: 300' line work to sewer lateral. Septic system to be pumped and filled or removed. 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: 300 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 3 ft Owner: FEES WILLIAM COFFEE 14080 SW 100TH Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 9/10/2007 $147.80 [TAX] 8% State Surcha 9/10/2007 $11.82 Phone : Total $159.62 Contractor: EVANS EXCAVATION, INC 17675 SW FARMINGTON RD. #145 ALOHA, OR 97007 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 - 319 -7102 Reg #: PLM 152785 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: 6. Permittee Signature: j 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 Applic - CE1VE liali Building`Fixtures l " _ FOR-' OFFICE .USE` ONLY- - City of Tigard SEP 1 O 2007 Date/B y9 /D / 6 1 36 Permit qt rl. ` ' _� y/ II e% . 13125 SW Hall Blvd., Tigard, OR 97223 {{{ 111 1 N Plan Revie . Phone: 503.639.4171 Fax: 3°. .1 0 ' �' Other erm Q 3 Inspection Line: 503.639.4175 z �� �� A, MI ua Re Oh P i ` IZ a 2for - a T I G A R D P 1 at; Ready /By: la See Page 2 for Internet www.tigard- or.go , . a 6 I, - r. .. `.: ted/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ 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 Al- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 I=1 Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: / cazi /Go ✓le „ -e-," Catch basin or area drain 16.60 City/State /ZIP: - � -,L -7 ,2� i,/ 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.300) 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 eOzthriGeti 1 c f:GOit y �� , e � Av-eJ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: ff//�1r�0.1 -� � � Expansion tank 16.60 Address: / /Ddrr ( 5� yCiL Fixture /sewer cap 16.60 City /State /ZIP: ,j/ d,.-- ,'7223 Floor drain/floor sink/hub 16.60 Phone: (J ) , fj 15 Fax: ( 3 ) 6,0Z 7:rf_c" Garbage disposal 16.60 [g, APPLICANT Hose bib 16.60 - ❑ CONTACT PERSON Ice maker 16.60 Business name: Interceptor /grease trap 1 6.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Sink/basin /lavatory 16.60 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: ee/li.✓.s g�. // Water heater 16.60 Yloxy ...,- 4_, \ Q Address: Other ,N �A / 76 7S cfGe) �i716N.,,4./ /1i! Ae /f�S Subtotal , City /State /ZIP: ��1G � -76 JJ 7 ■ 7 Minimum permit fee: $72.50 Phone: ( ) 3 /f vez Fax: ( ) Residential backtlow minimum permit fee: $36.25 ' f 7. 0 CCB Lie.: 45-4 �p (� �/d Plumbing Lie. no.: Plan review (25% of permit fee) Authorized signature: &.„ ���� State surcharge (8% of permit fee) l 8y TOTAL PERMIT FEE /59. t off Print name: / .4.,,,t G'��.. Date: q_ xoa 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 L Building Industry Service Board. i\Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10/02 /COM/WEB) a. 2 3 cam. 00 /� T Plumbing Permit Application - City of Tigard . , ••: " i i • Page 2 - Supplemental Information `� s d ` ' Fee Schedule: _ Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total y Square Footage:. . Permit Fee: ° - Footing drain - U' 100' 55.00 • ;, " z0,to2;0,00, o ' • , r q, . „ 2 $115.00 Footing drain - each additional 100' 46.40 ;001 Yo 3;600'" ' u $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 5,3 co 7,201 and greater $309.00 Sewer - each additional 100' a t . 46.40 9a $v 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 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 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for /4/7S 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 Future 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 - - / - .."' - - nADIE ‘ ' „ N. 1,, 4 1. V 4 . , ) R , ,, ,0 ,e-,.0 ,- Ill l'• i 1 :. : -. 4 ' 41k , '', , -., ,,..'; ' .40 '' .."1..,!... / • .1' , / 1,, , ..-1 ''' .....'%,. ..; ,` ” I` • L ) , , A, , . - , ,.- .1,..t v 4 • - LIPIIIL 4 `'`,'‘ , ,=;-:- - — '',' r s•i• -,,', .:.; , ' ; ilt " ' ' ' . CE , c>, .. ..Ny. - 14' " i.“ : •,.! - . 2 1 . ',1.,..., AL , VP L' : . , : ■.t " : • , . ;" ' ' '. ,, ' . 'I , , Tikinni ",'-'',.„ ( ' 4 ' ' ,. I, .. , 1,... ., , ..f ,' •4A* . Yr V '''= ' ,, ,,: 4 , , , t ' ' , _ .:-., • - • , . ‘tlt',1;'-!t•-, %,..,-1,' vi ''';'': -. t - • -.'• , ''',', .',, - a ,;131 4,FP,t,. 4 2 , ',.. 3, Acv0 t, 4 .7 ,.' ,;,..11:1 , " ..: ; '1, ":*- .L' Y'-' ''''' ‘ 7.. it'hile' • I "' - ;0' . --k 4.- - ., ,,,,,.. ., -.7, • ,,,,, . ,,, ,, CUSTOMER'S ORDER NO. PHONE DATE NAME ADDRESS /96gc, c&) i'aft ' 7 /7 a,t-oe ,ele '722? SOL CASH C.O.D. CHARGE ON ACCT. M E. REVD. PAID OUT y B Meill _... PRICE AMOUNT CITY , DESCRIPTION .p rz0,717 dosZ / 4/ afep ovw,;:s.s-ezzltir_ 7/ f• TAX RECEIVED BY TOTAL . --- ii .A.0 ,z. f ',■'.' n frlt.l ■ ';', t OpIpans an, . Ph,' ,' v■ ',. ,,, ; , ,, „ I..: ' ' ''ti.t. '. * ei ''.1y ' ; ,, , 1 :t I. ' :!*' 4.4. f„ti‘1'.1,4%;,,' ?H ANK you to., , , L... Wd Gz: Z T L00Z-2. T Z 0 - d CITY OF TIGARD BUILDING DIVISION PERMIT #: 1'LM2007 00A`1r 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/10/2007 Phone: (503) 639 -4171 A,„„ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/17/2007 TIME: 7:00AM PAGE: 45 SITE ADDRESS: 14080 SW 100TH AVE CLASS OF WORK: SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 025 TYPE OF USE: PROJECT NAME: COFFEE DESCRIPTION: 300' line work to sewer lateral. Septic system to be pumped and filled or removed. 9/12/07, ADDING 300' OF STORM LINE. OWNER: COFFEE, WILLIAM PHONE #: CONTRACTOR: EVANS EXCAVATION, INC PHONE #: 503-319-7102 Inspection Request Scheduled For: Date: 9/17/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 055775 -01 503-639-1847 N Corrections /Comments/ Instructions: P /Z) \A' AL Co p j Pte, w e- c "IT Q " w \ i a/c) p d p c -�'� A— TC∎� II. G A irk: t.-./Let 9.1) • PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: al 1 x Phone #: (503) 718- CITY OF TIGARD _ _ BUILDING DIVISION PERMIT #: PLM2007 -00415 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9110/2007 Phone: (503) 639 -4171 N4puYil Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/14/2007 TIME: 7 :00AM PAGE: SITE ADDRESS: 14080 SW 100TH AVE CLASS OF WORK: SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 025 TYPE OF USE: PROJECT NAME: COFFEE DESCRIPTION: 300' line work to sewer lateral. Septic system to be pumped and filled or removed. 9/12/07, ADDING 300' OF STORM LINE. OWNER: COFFEE, WILLIAM PHONE #: CONTRACTOR: EVANS EXCAVATION, INC PHONE #: 503 - 319 -7102 Inspection Request Scheduled For: Date: 9/14/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Rain drain 055755 -01 503-639-1847 N Corrections/Comments/Instructions: C Q �.,z - 3 a ,.. r :t �r� -� �, —t d �" (� z p a� o�, �. 0 1 .0 7 ,„ 1 �_ 9 ., r k., —rep ReA L I . s r,.._ F J .z.' A A L T yl PeA r galiffrFv1 I CANCEL • NO ACCESS ❑ FAIL CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: Cr!J k„1 Date: at 19 / Phone #: (503) 718- .. CITY OF TIGARD _ , '-- BUILDING DIVISION %' PERMIT #: PLM2007 -00415 13125 SW Hall Blvd., Tigard, OR 97223 f DATE ISSUED: 9/10/2007 Phone: (503) 639 -4171 d O :ill � Inspection Requests (24 Hrs.): (503) 639 -4175 �.' INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7:01AM PAGE: 26 . SITE ADDRESS: 14080 SW 100TH AVE CLASS OF WORK: SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 025 TYPE OF USE: PROJECT NAME: COFFEE DESCRIPTION: 300' fine work to sewer lateral. Septic system to be pumped and filled or removed. 9/12/07, ADDING 300' OF STORM LINE. OWNER: COFFEE, WILLIAM PHONE #: CONTRACTOR: EVANS EXCAVATION, INC PHONE #: 503 - 319 -7102 Inspection Request Scheduled For: Date: 9/13/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Rain drain 055656.01 503.51 6,9509 N Corrections/Comments /Instructions: • 1 ( \ qt 1 '—' 6 A''A / \OA.C &// KI-e-,42, Lam-,- (_ ±D-1 U - --,-._ir LA5 e--(_+--,:->-\ -1,./,,k. kA-r7„,..-.` - o ' - k4sL. N o Ubwv1 .e--,J -,.. , vlA- --- vv_ \, fie I LAAA c.. --- ./.) -P,:,---Vi,\.,-g. 1._J--.2--0---. - P . 0' g --. , . -- _ .... . /- s OIL- - I - v b dt- P-0 l . • s ,l _ 2�, 3 ' , "w• v A 1 I I PASS , PARTIAL APPROVAL n CANCEL ' A C, ESS FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 604- Date: 1 / q Phone #: (503) 718- 74 • CITY OF TIGARD • _ d, BUILDING DIVISION PERMIT #: PLM2007- 00415 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8//012007 Phone: (503) 639- 4171M Inspection Requests (24 Hrs.): (503) 639 -4175 ,K INSPECTION WORKSHEET FOR DATE: 9/12/2007 TIME: 7 :01AM PAGE: 11 SITE ADDRESS: 14080 SW 100TH AVE CLASS OF WORK: SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 025 TYPE OF USE: PROJECT NAME: COFFEE • DESCRIPTION: 300' line work to sewer lateral. Septic system to be pumped and filled or removed. OWNER: COFFEE, WILLIAl i PHONE #: CONTRACTOR: EVANS EXCAVATION, INC PHONE #: 503-319-7102 Inspection Request Scheduled For: Date: 9/1212007 Pour Time: Code # Inspection Description Confirm # Contact # Message 350 Septic tank 055584 -01 503 -516 -9509 N Corrections /Comments /Instructions: Li I 1 l4 cif Co � ,-wi s TD f' c - L/ i , 1.L. � �s �.- c d .-' Ar A c� i ve v; Co ti AM5 Ta � t--i- , (G lJ ,� eLk i- V:4 1 S o - I� l f Z \i Az, -1 LA iw l� eciS Y. art— I I PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: N 4 \ Date: ©) I i 2')0D) Phone #: (503) 718- • •