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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00185 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 5/2/2005 PARCEL: 2S103BC -03100 SITE ADDRESS: 12240 SW ALBERTA AVE ZONING: R -4.5 SUBDIVISION: CANOGA PARK LOT: 005 JURISDICTION: TIG Project Description: Sewer connection 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: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES MICHAEL CONN Description Date Amount 12240 SW ALBERTA TIGARD, OR 97223 [PLUMB] Permit Fee 5/2/2005 $72.50 [TAX] 8% State Surchar1 5/2/2005 $5.80 Phone : 503 -590 -6566 Total $78.30 Contractor: BABBITT PLUMBING INC 7611 SW ALDEN ST REQUIRED ITEMS AND REPORTS PORTLAND, OR 97222 Phone : 503 244 - 5279 Reg #: LIC 30869 PLM 26 - 86PB 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 calli 503 -2 699 or 1- 800 - 332 -2344. Iss d By: Permittee Signature: ) &AI( 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 Plumbi Permit Application `' ,. , FOR OFFICE USE ONLY City of Tigard D � Received Permit No.: ' 13125 SW Hall Blvd., Tigard, OR 97223 �� Date/By: S Q� \\,,,„2,905-4-,;04,- Plan Review n _ 6 � Y Phone: 503.639.4171 Fax: 503.598.1960 �� /� � u w Other permit No.: /( DO (/ 24- Hour Inspection Line: 503.639.4175 � ' . u -III •'��' . Date 4, Date/By: R d/B c r AL Ready/By: Juris: p Se e Page 2 for Internet: www.ci.tigard.or.us �" g c Notified/Method: l Supplemental Information �� i �'�.� =i . " a ��x'` : �� i `r:� �'`z� , :w .3. :.::s" �:zc 'xa: . E�;<�*: c�m,�:�',.� .�r�', _..� : _ ' ��` €.. TY t :t- '., , - �Ve x fi Fx _ �,,, ..; ;? , a) , O)R WORK . _ �,,,,r, t,.•it ,w . ss- W xs ..:r =� °`' °;; rte ....- r ;, r � <a� � .. ..:��.:�:.c^'- ..sS. ,..ar.s:. _. : �, ` „r:..,�'.'s: z.� +s :� 5�. r � v3 t x� F�E- �SCj1(�.�Ee�- .�as.�'' � � �� n�"aiv�..,�Sr -x: rS'� -d :�£ xz: a "u =,`.Gcc�.,:',�rs.::�,� � . - ..a,€md �w < x � . � ,' , ❑ New construction ❑ Demolition For special information use checklist. '�// L Description Qty. I Ea. Total ❑ Addition/alteration/replacement ® Other: Sew fv' /'100/C 1, New 1- 2- family dwellings (includes 100 ft. for each utility connection) ;€`n"�m, '`. ::'` Y '.n „ r?#5st&e;a,`i':..::-•s. .is;t,`i_.: f h Y i ) "- r i .. tr r ,<,,.C±` fealiY ® C0 SL12`UC61,a "N x;- , s SFR(1)bath 249.20 rg 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: r _. r... Fires sprinkler _ °',�?,� .fit � ;�:- �;� >=" � � < r 1:� P r ( sq. ft.) Page 2 �'�J�OB ST! E r"O Mc)<'1'IQ1�A�1�(D� ®CA O `." ', § .- . ,r. . ". k.;. ,, .. r � ,,1 ..ri, a'.N _<' .t Site utilities Job site address: /A94710 S, C(/ Al ber'f c sl f Catch basin or area drain 16.60 City/State /ZIP: -1' l I5 ;1 v- � 0 r , Q Pf 2.2....? Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: j,�/ f 7-/24- Manufactured home utilities 1 10.00 6+ /o 0 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft. ) Page 2gc- J Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item �� °x r a� ;r O r,• Absorption valve 16.60 ' � € 1 P ; lTION O F W ` �1. .r .r ;: �A,, s �_ >,A.� ', . t a R _. . s$ , ., Backflowpreventer Page 2 17p0 e kt C! / ' b/ u l�'1 D'Li ' '1(5 S eW?_(/` Backwater valve, 16.60 ll a Clothes washer:- 16.60 Dishwasher 16.60 l W " P,. , ' Drinking fountain 16.60 s 5 PROP -at i, O WNER"i � ` � I TENANT4 k: -..:., k Ejectors /sump 1 6.60 Name: RiC LIof Cryii / �[ Expansion tank 16.60 Address: izt 5 , . ✓� eN /` A/J S/ Fixture /sewer cap 16.60 City/State /ZIP: `�-'' 1 0, 9 7, 2, 23 �t'��Jtn .. Floor drain/floor sink/hub 16.60 Phone: (Sd3 ) 67® „ , ; ;5 ,; Fax: ( ) Garbage disposal 16.60 h � �' . 1fA�APPfi T TI,;e ° ~ 700 �PE r� Hose bib 16.60 *�%�'' .... �:$e.s^.��.c 3 1,4,11} mh 16.60 Business name: so b d > DI ii L it f Ice maker - 1 /, J U k" AC / Interceptor /grease trap 16.60 Contact name: (_eo N P A } J b >ir Medical gas (value: $ ) Pa e 2 Address: '7 /_ if S A / ' 44 s Y, {{ tt Primer 16.60 City/State /ZIP: p r -f d ©a e. 722,3 Roof drain (commercial) 16.60 _ Phone: (96 3) 'd C _, Sa 7 t Fax:: (6 3) �1 ,,5 _ 0 , -3S- Sink /basin lavatory 16.60 E -mail: 1 0 � Tub /shower /shower pan 16.60 � _... r Urinal , 2 . „�a ° _,�-;., ,.: « i TKPV= W,.5 _. t . ,: K r a 16.60 A4 :0 '. >,. a,, ,`: ` CONTRACT `+ , . h,o t ��.�_'�; � - ,r��°.. ��;��r- ���_._ ��?,� V t� Water closet 16.60 Business name: Water heater 16.60 Address: Other: City/State/ZIP: Subtotal Minimum permit f 0 0 Phone: ( ) Fax: ( ) Residential backflow minimum permit ee: $36.25 �pt' S CCB Lic.: 3o g6, l Pllu Lic. no.: :26 - 'g PB Plan review (25% of permit fee) rc��V fl Mlt.�a State surcharge (8% of permit fee) 5 . 60 Authorized signature: if TOTAL PERMIT FEE n Print name: OpiP N A Q [ r i .{� Date: ZQ_ OS Thi per mit application expires if a permit is not obtained " V IJD /1 180 days after it has been accepted as completr • *Fee methodology set by Tri-County Building Industry Se i:\ Buildin g\Permits\PLMF- PermitApp.doc 12/03 440- 46t6T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard P Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ' t �e 'ea ' Total r ` S t e``r tih ties ( q o .. �Pe m it Free .. . . 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 a " ;? :; -_ ...,,, •R - Storm & Rain Drain _ 1st 100' 55.00 a1uatlO.II „ s ,• i PernutF . ...m,. $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 Waiti�•3 �x Z• additional $100.00 or fraction thereof, to and r �Orx•IteirW V Qt " ' C OX 06161 '� �s 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: 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 * . :. : ,. , 3&-i•,:. < - _ d , it "' � ; r;;a :s iag iiWi (F r?ur>e) . ,orb hitta-r_.med, _ Frxt 11ype t ( � R ep l ac e q � s�ea ' Comments regarding fixture work: Baptistr /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 Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and 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 Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. 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: is\ Building \Permits\PLM- PermitApp.doc 3/03 12/30/2005 09:54 5032450735 BABBITT PLUMBING PAGE 03 _ _ _ _ ALOHA SANITARY SERVICE INVOICE N0. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9627 503 444 -2797 * 503- 648 -6254 • 503- 639 -5188 _ ........... . NAME: 4S' 1 - 1 LI1PtOL CK )IS 4(,A - ^� p er. ADDRE : l II � . , 4O� , � • _ _ Orr i Q Irl / ,qt,.■ STATE: 6 611, -. - _ 2iP: q7 Z e 3 Home: WORK: '\- S� 1 CELL: - 3 1 Z M iJ Jos SITE: 6 1 , c vt. . p.�..: • PAID BY CHARGE 0 A • CHEC CASH 0 CREDIT CARD 0 DATE A � . _ e /t DRIVER L 4 944 '' ( AMOUNT 111111ry Val 0 LINE OPENING 0 INSPECTION Fu n mil ein 0 SERVICE CALL man t3 LABOR, LOCATING, DIGGING, BACKFILL 0 MATERIAL 1111111=111 THIS is NOT A SEPTIC SYSTE M INSPECTION REPORT , A TOTAL - - REMARKS - TYPE OF AIVK: STEEL CI CONCRETE D PLASTIC U HOMEMADE 'i HORIZONTAL ❑ VERTICAL ❑ RECTANGLE U U OT J SIZE OP TANK: 350 0 I 01 750 0 1000 ❑ 1 250 0 •00 0 2000 0 3000 LID LOCATION: INLET U Ou CI Mom 0 ENTIRE To Q TANK CONDITION: GOOD C] FAIR D Poo PI "Irr7NoR: BAFFLES ® CONCRETE 0 IRON C7 PLASTIC Q NEEDS NEW LID? YES 0 SIZE GROUND COVER OVER TANK COMMENTS ON CONDITION . • : ELD Etc. Sion ey pin • Z abed 26sL M78 -£O5 AVYLINVS VHOTV dL :EO 5OOZ'6Z owe r . CITY OF TIGARl BUILDING DIVISION PERMIT #: PLM2005 ��� 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: PL 2005 i Phone: (503) 639 -4171 �M� �il Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: PAGE: 5111/2005 TIME: 7:12AM 21 SITE ADDRESS: CLASS OF WORK: 122 SW ALBERTA AVE SUBDIVISION: c , N O rA PARK LOT #: 005 TYPE OF USE: PROJECT NAME: C A NN DESCRIPTION: Sewer connection OWNER: CONN MICHAEL PHONE #: 503 -590 -6566 CONTRACTOR: BABBITT PLUMBING INC . PHONE #. 503- 244 -5279 Inspection Request Scheduled For: Date: 511112005 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 006609-01 503 - 2445279 N Corrections /Comments /Instructions: . Ad , Z. . . A / C i / _ ■ /;AC/AIAMP i j,P4SS g!t PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1- M-4 Date: // -(/ Phone #: (503) 718-