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Permit ' /, CITY O TIGARD . PLUMBING PERMIT n+ I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00267 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/16/2005 PARCEL: 2S103BA -00126 SITE ADDRESS: 12000 SW 116TH AVE ZONING: R -4.5 SUBDIVISION: LERON HEIGHTS NO. 2 LOT: 040 JURISDICTION: TIG Project Description: Line work to connect existing residence to sewer. Septic system must be pumped and filled or removed. 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: 115 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES WILSON, EUGENE A Description Date Amount JOSEPHINE R 12000 SW 116TH AVE [PLUMB] Permit Fee 6/16/2005 $101.40 TIGARD, OR 97223 [TAX] 8% State Surcharl 6/16/2005 $8.11 Phone : 503 - 590 - 1684 Total $109.51 Contractor: FLYING H CONSTRUCTION CO PO BOX 2533 REQUIRED ITEMS AND REPORTS WILSONVILLE, OR 97070 Phone : 503- 678 -4224 Reg #: LIC 104699 PLM 3 -348PB 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 -6.699 or 1- 800 - 332 -2344. ,( Issued By: ����� i Permittee Signature !� 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 Fixture E II V E D n/ v 6-' Plumbing Permit Application FOR OFFICE USE ONLY • City of Tigard JUUN 1 2005 Received Permit N (, 0c3C70S - �(0 Q l 7 13125 SW Hall Blvd., Tigard, OR 97223 Date/By. e Plan Review / l Phone: 503.639.4171 Fax: 503.$7l�KQDF TIGARD /� " . W� Date/By. Other Permit No.5 � cx2s -vv /(/ 24- Hour Inspection Line: 503.G �UIL � II\IG DIVISION Date Ready/By: Juris °S El See Page 2 for Internet: www.ci.tigard.or.us `�+ Notified/Method: i 1 Supplemental Information TYPE OF WORK • 'FEE* SCHEDULE • ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total Additi alter ation/ placement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 j .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: 1 'ZCjO (w I I (r h Catch basin or area drain 16.60 City /State /ZIP: cl ay, D 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. //5 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 1 r (.1 lA)10 J / Backwater valve 16.60 (10 - 1^Nl a (r l j Clothes washer 16.60 �� l • Dishwasher 16.60 • • ❑' PROP ERTY OWNER ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: 1 A j 1 U riNN___, Expansion tank 16.60 Address: l ,. X1--0--A Fixture /sewer cap 16.60 City /State /ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) 9 0 - 1 (,.., 4 7 Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 ❑ APPLICANT ❑ 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 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: - (l 0 O Q j � �f- /f l '� Water heater 16.60 Address: ,0 _ i' n A 2533 �V` Other: City /State /ZIP: Cl_) ii)S __ ` ) �� Subtotal �Gy '!jJ Minimum permit fee: $72.50 Phone: ( `� 6,? s5 - ,c,C�a L / Fax: ( ) --) - I Residential backflow minimum permit fee: $36.25 /o� w CCBLic. )(7 .4,1a 7 q ! i//p�p Plumbing Lic. no.: 3 - 3� 'Po Plan review (25% of permit fee) J , A State surcharge (8% of permit fee) g, Authorized signature: �-C--1y1 TOTAL PERMIT FEE loci 1 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\PLMF- PermitApp.doc 06/05 440- 4616T(l0 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information ' Fee Schedule: Residential Fire Suppression Systems: ' Site Utilities Qtr. Fee,(ea) Total 'Swore Footage: :Perir iit:Fee :. -, , `. . ` ) :w °:` ; 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 ,jc.31 of Medical Gas Systems: Water Service - each additional 100' / 46.40 . ,� , , fv 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 `ry 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: Pl Review for C Structures Are you capping, moving or replacing existing fixtures? If A "complex structure" is defined as an installation of a plumbing "yes ", 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. `° Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. New . - Moved° . Existing Capped ❑ 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 -D 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 v Isometric or Riser D - 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 \Permits\PLMF- PermitApp.doc 06/05 a 1 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00267 13125 SW Hall Blvd., Tigard, OR 97223 DATE'ISSUED: 6/16/2005 Phone: (503) 639 -4171 :ffzlipil qul�' �hyt` _.. Inspection Requests (24 Hrs.): (503) 639 -4175 ' `__IL. INSPECTION WORKSHEET FOR DATE 6/23/2005 TIME: 7:10AM PAGE: 49 SITE ADDRESS: 12000 SW 116TH AVE CLASS OF WORK: SUBDIVISION: LERON HEIGHTS NO. 2 LOT #: 040 TYPE OF USE: PROJECT NAME: WILSON DESCRIPTION: Line work to connect existing residence to sewer. Septic system must be pumped and filled or removed. OWNER: WILSON, EUGENE A, PHONE #: 503-590 -1604 CONTRACTOR: FLYING H CONSTRUCTION CO PHONE #: 503 - 670 -4224 Inspection Request Scheduled For: Date: 6/23/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 009982-01 503 -7130 -4916 V Corrections /Comments /Instructions: O _ , . k 0 . .- 1 4 - / _ 0 / i / <.. i/ -- :, m i ,, id • ...-- --- V ( PAS PARTIAL APPROVAL fI CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: /911 Date: _ - Phone #: (503) 718- Scheduled .• r. Date Work Order # River City Environmental Inc. Complete Industrial P.O. Box 30087 503- 252 -6144 Waste Removal Portland, Oregon Septic Tank Cleaning 97294 Sump Line Cleaning ,) , ' \ / !' / Site Information Description ' Units Amount /4,,e l' r`r ,y g Instructions: Driver Notes /j' River City Environmental, Inc. is in no way responsible for damage to the septic tank or lids on the system. Terms: Net 10 days. 1.5% per month will be charged on past due accounts. (18% per annum). Terms and Conditions The customer agrees to.pay all invoices arising out of pumping services, and any other special services herein within 10 days. The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered, over and above the normal servicing schedule, on behalf of the customer. The customer agrees to assume responsibility damage to customers real or personal property arising from pumping services which take place on customers premises, where the drivers and vehicles of River City Environmental have been instructed to enter. This includes, but is not limited to driveways, trees, power lines or poles and building structures. If River City Environmental, Inc. finds it necessary to add liquid to the tank on jobsite, customer will be charged for the additional gallonage resulting from these condidtions. Customer agrees to reimburse River City Environmental, Inc. for ati Reasonable attorneys fees court costs and other expense incurred by said company to enforce collection or to serve their rights undertg,agree„ ant. Customer agrees to the above conditions. '. S \ Redeemable in Multnomah County Work Authorized by / ,� k Y _ . �\ Date /; / Driver Signature �: , % i \` `', Date . to (, L ' /c' Time;