Permit C ITY OF TIGARD PLUMBING PERMIT
Ir COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00068
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/25/2008
PARCEL: 25111 BD -01514
SITE ADDRESS: 14950 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: ALDERBROOK FARM LOT: 006 JURISDICTION: TIG
PROJECT: RIVERMAN
Project Description: Sewer connection work.
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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
RIVERMAN, WILLIAM E INA
14950 SW 100TH Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/25/2008 $72.50
[TAX] 12% State Surch 2/25/2008 $8.70
Phone : Total $81.20
Contractor:
A AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -9548
FAX 503 -570 -0779
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. /. .40/01011111°A.
Issued By:
44
- / • Permittee Signature: j
Al liPP
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.
EIVE®
Plumbing Permit Applicat n. 3 ^
FEB 2 ( � FOR OFFICE USE ONLY
B 2 2008 5 Received
City of Tigard Date /By: e:73/42.571/' cf- , ' -_Per nit N°,,°2, 6 "000(0d'
e 13125 SW Hall Blvd., Tigard, OR p.mg Plan Review
o 2. Phone: 503.639.4171 Fax: 503. 8.1950OF TIGARD Date/By: Other Permit Nos, , eao 0,p-do e 5"
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION DateReady /By: Juris: ® SeePage2for
Internet: www.tigard- or.gov Notified /Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ Ne onstruction ❑ 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
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ 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: / $ / 9 l 7 .. Catch basin or area drain 16.60
City /State /ZIP: 7;c4,,,,6./ / 972711 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
c J"
Cross street/directions to job site: /1.4. /t ay I4- p M anholes 16.60
/�e
//jam Rain drain connector 16.60
Sanitary sewer (no. linear ft.: .V0 Page 2 S$, 0 -6
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 OF WORK / I�/.L Backflow preventer Page 2
/77 11 11,575 0 _,X/5/ '_,X/5/ _,X/5/ e" JCL - Backwater valve 16.60
J� 7,f / ( / Clothes washer 16.60
/ �/> Dishwasher 16.60
❑ PROPERTY OWNER I El TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: // U e'../ arm Expansion tank 16.60
Address: / . 5;4 ��0 _,4z--- Fixture /sewer cap 16.60
City /State /ZIP: ,e Floor drain/floor sink/hub 16.60
Phone:-(-- ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
PLICANT ❑ . CONTACT PERSON
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: Sink/basin/lavatory 16.60
( Fax: )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: c l E7)l43 c /Z ". 5'/7v Water heater 16.60
Address: , it) 36k. 1130 / ' Other:
Cit /State /ZIP: / // Subtotal
y CN / �� /` "r / ®� 9 7D < -7 Minimum permit fee: $72.50
Phone: ( 563 ) `/e� ', F , Fax: ( ) Residential backflow minimum permit fee: $36.25 /a ' 5 5
CCB Lic.: / 6. / /99 /oZ- Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of permit fee) ,p, 20
TOTAL PERMIT FEE Pi, .,„? d
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\PLM- PermitApp.doc 12/27/06 440- 4616T( 1 0/02 /COM/WEB) p2
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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
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
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
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
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous ' Capped Added. Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
• Each T ani ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometrics or.Riser-Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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 *Note: If the fixture work under this permit results in an
- Bradley
• - 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.
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CUSTOMERS ORDER NO. - • - PHONE DA E '
NAME ,MS
ADDRESS( ti p
SOLD 131 CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT - ;
` QTY DESCRIPTION
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RECEIVED BY l "
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All claims and returned goods MUST be accompanied by this bill. '
Pia* ToReerisr. . THANK YOU •
_ . _ _ _ , _ __ WO-2254380 or no ia.con_ ,_ _ __
MAR -18 -2008 TUE 02 :08 PM BONES CONSTRUCTION ligillI NO 5036491717 P. 04
ALOHA SANITARY S ERVICE .
INVOICE NO.
8600 SW Hillsboro Hwy., Hillsboro ® , � ° �,
503 -644 -2797 • 503 - 648 -6254 * 5034 , $.k ,�
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NAME: d C .i • ' y t' 1..3 i " ,t' 0. C T, c' `,,...1 v
ADDRESS: /�'g0 �Q 6
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CITY: STATE: 1 L008 ZIP: .
HOME: Al
WORK: 66 y` n � � - g0PaRD CELL: „,,,,,,.. L...)....1 .. - - i<; � • .
OB SITE: `� , ice, (.-‘, '- �d iiv ,�' l curio NGDI ° P O. #: _ 'r -' () I
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PAID BY CHARQ,E ' CHECK ❑ CASH ❑ CREDIT CARD ❑
DATE 6i .. 6 L %._ e7 ;, J DRIVER 0( Li c„, 7lsa441/444/ AMOUNT
D PUMP SEPTIC TANK ” ., ..' f;i.1
❑ LINE OPENING t
❑ INSPECTION FEE
❑ SERVICE CALL
❑ LABOR, LOCATING, DIGGING, BACKFILL
❑ MATERIAL t
,,
- - THIS IS NOT A SEPTIC SYSTEM INSPECTION REPORT - - I TOTAL $ — ( ' ` =� 1
j,� - - REMARKS - -
TYPE OF TA : / STEEL ❑ CONCRETE ❑ PLASTIC ❑ HOMEMADE ❑
- HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ ❑ OTHER -
SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 1000 ❑ 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑
LID LOCATION: INLET ❑ OUTLET ❑ MIDDLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑
FITTINGS: • BAFFLES ❑ CONCRETE ❑ CAST IRON ❑ PLASTIC ❑ . 4 3 1 -, ..
NEEDS NEW LID? YES ❑ SIZE ,
GROUND COVER OVER TANK j, _-- /
• ,, , 3 _ z2 ., / COMMENTS ON CONDITION OF DRAINFIELD ETC.
_eW a'- a 00 6 6 (Ira . l :i o ;: C. .,. K '
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SIGNED BY > \‘'' � ' ' o " ' 4 ,) ' ; ' I i . i . DATE 1
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CITY OF TIGARD - • ,
BUILDING DIVISION PERMIT #: PLIv12003-00068
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/25/2008
Phone: (503) 639-4171 A
v
Inspection Requests (24 Hrs.): (503) 639-4175 ,_a IL ..
INSPECTION WORKSHEET FOR DATE: 2126/2008 TIME: 7:00AM PAGE: 58
SITE ADDRESS: 14950 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 006 TYPE OF USE:
PROJECT NAME: RIVERMAN
DESCRIPTION: Sewer connection work.
OWNER: RIVERMAN, WILLIAM E INA, PHONE #:
CONTRACTOR: A AFFORDABLE SEPTIC SERVICE PHONE #: 503-969-9548
Inspection Request Scheduled For: Date: 2/26/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 065621-01 503-969-9548 Y
Corrections/Comments/Instructions:
—C -e e : tvt—A--z.,,L.,..st_ P
e—c,, e
Ca-4
t&PASS PARTIAL APPROVAL D CANCEL NO ACCESS
_
FAIL 7 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: ("V•"-'j \IV\N---' Date: '2Al2-C Phone #: (503) 718-