Loading...
Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00184 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/2/2005 PARCEL: 2S103BC -02100 SITE ADDRESS: 12235 SW ALBERTA AVE ZONING: R -4.5 SUBDIVISION: CANOGA PARK LOT: 005 JURISDICTION: TIG Project Description: Connect existing house to new sewer service. Plumbing is to be reversed and septic tank is to be pumped, filled and inspected. Reimbursement District fee paid on 3/21/05. 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: 1 TUB /SHOWERS: SEWER LINE: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES SITZMAN, DEANE D /ANNA L Description Date Amount 12235 SW ALBERT ST TIGARD, OR 97223 [PLUMB] Permit Fee 5/2/2005 $105.00 [TAX] 8% State Surchari 5/2/2005 $8.40 Phone : 503 - 590 - 1974 Total $113.40 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 calling 5 - 246 -6_• • or 1 -:0O .32 -2344. Issued � iLL : 1i Permittee Signature: y 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 c,95^ Plumbing it Ali g erm ppcation .. - FO OFFICE USE ONLY City of Tigard ' ' 0 Received / / Permit N .: ' 13125 SW Hall Blvd., Tigard, OR 97223 < Date/By. , Di, o �s�a Plan Review Phone: 503.639.4171 Fax: 503.598.1960 i ^^ -- - +� p /� - I f Date/By. Other Permit N See Page Y_ hA� �Cj 24- Hour Ins ection Line: 503.639.4175 , J I s Date Da te Read B Juris: vvPa ������ "''""''`^^^^^`������JJJJJJ !! ww.ci.tigard.or.us W y Y' Supplemental See Pa e z for . Internet: w Notified/Method: Supplemental _ _ *, information z��` ry" �„ y' a.:�� =��^`"��; ?: �:i,:`�� was ca�rrt. � 'z � ' ° �Ti'.'r ° � - Ys; 7 ; ^ .� �,� r: �t :, r; .. '1. 41 .2 1 r l � V ,.OF W x « 't WOfiri t�� r ' i ,'Tr.' ,g, ,. .r x a° ;.e ;a;,ii ra l »:.: r•:,:•; », _',. . df ...: i.04. "; k :I „ gi p t £ 5 �c fi +x i ; t ,f ift.. #.� .' t. . - .43�xrti �� �'ta�ta,.; �,ec�.. r,:,�lit` �'14%, ��..�' �y�r -e:,1 ����� �` &J;E , �SCHEI)�JL; : Er' ,y; -•'' rc» r .lat.w.,a � 4 a, I ��, �..;..> e€> wt�? xrara�'�naa_b�ai��:k;.�ww:�. n ....� .. For special inform anon use checklist. ❑ New construction ❑ Demolition ❑ Addition/alteration/replacement g Other: c Description I Qty. Ea. I Total +£xtr sew, �Op� New 1- 2- family dwellings (includes 100 ft. for each utility connection) .. ;;1•.. �irS:l f f ,f GAT,E`G.; RY.•0 O1YS RitfrnTXO . 1 Fea'i' "`' 1`i :. t: .5, '�x:a:...., iatS x�re�. rx+ a. �s«:: �: �. s: ��x5�� �u: �,. �• �. r,: �;��cawa >rl..t','�m'��75`��.�,. �'` "• 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 • ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: ,z c r!�1wX'e,ti`iya .=ia'ffte r'r.w ,� t r r„r; r'.z N ;r r Fire sprinkler ( sq. ft.) Page 2 ? S it 033, �'r'Mr, f -s r k'O1tM/ eTsIe- , elT;TO „A.xol a r i r' i: fi�; u�� �+.± t?+ �{�_��'rr�.r�.ru5;x F..t,�ui�FY. �u7 ?�T��'.�'ua^s;�. r � r : + �5'K�'t�,�"�-�;� g �sr,es;;rc; �.�.�";- .s "�s.�, >?'t` .��`- �t "'�.'. 91, Site utilities Job site address: lAA3 3 S y/ A /b 74 T7 Catch basin or area drain 16.60 City/State /ZIP: r7 - 1 Nd (9ir 7 42 7 2, Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: G Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: We � 6f 2e0 Manholes 1 6.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: 76 ) Page 2 5 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item „s' 7t= R :,:; s,_ <, =�;r., Absorption valve 16.60 ,.l1 011 %' -*3f l . +il# %� � -jSC.. ... tN jO.V CORY{ itIa , ta ~ ar- a :,xr..., cv;.:..si=,.u�,;.t.KS4s.. s zz+ �sefa ,siri.L. +'u� "u�.`a,'~k :taa�".� Bacicflow rev r p et ter Page 2 Hook e2rci .s ri k J S f k ot h ji Ri- � tuier Backwater valve 16.60 • / Clothes washer 16 60 Dishwasher 16.60 '~"�:I,''�;:� �� .F•..;h,:- �,;,�4r,.,.,.e�r �:.�kt»=`�?,��r^`., ..�� a�� .�,.zks..r,��,.��:. ,:r Drinking fountain 16.60 "1 rrliAi':.?,i 'P,ROI? I TI OW1V'ER s C 1 %; # ' , +;i. ',, ..>i . - ,tvar: ;.aFar,..�.'. -�� a.,^ 9cs> �. c,-- ,:r�.c"ee`�'�:cr;�- ',`��`' <�:i� �L j. � a TE/�'t�:I�;r S` • , Ejec tors /su 16.60 Name: b'S A o p em e S// 24Io1N Expansion tank 16.60 Address: log 73 ' c U4 4/1 ertia S7 Fixture /sewer cap 16.60 City/State /ZIP: 777 ar 0 Pe, 9 72.23 Floor drain/floor sink/hub 16.60 Phone: SS ) "yo / g - 7 U Fax: ( ) Garbage disposal 16 60 . eF t : ' -iii "fib i:;Y.a t#£'"` x`, F:4.�:i'kfr_�»Ux..i < � ' ^ € t... y l�:u,•�... -. y . �, � ,.xK M a �.� :�t aat °�,.•4.., 'sw.s.�: Hose i Atigf _ ;� A 3' a t' ,. � ,J»<•a: Wi s bib 16.60 a "< : ; ,...,, : t1ti . -. sEL GAN:T ar ' t;� ` ®; COI.PTyACT t SwON .c« >�cy4 ''' . ` wrx ... .. ' �; , °� ->s ���•i3 ., saY. w a.:. , "".<,•, „ �t' x 4x sY * x .; , v. "'t«. k' ..tP.� =;M+� , Bak, b t p f0 � b1 Jh c., Ice maker 16 60 Business name: / Interceptor /grease trap 16.60 I r l/ I Contact name: G P_.0 'NJ P /Ai aD [ ' Medical gas (value: $ ) Page 2 Address: -76 � 1 S to / ,1 / !f Aek Primer 16 60 h . 2 a ( City/State /ZIP: pd Jf (OtAe 72-223 Roof drain (commercial) 16.60 �r��_ , 7 G? (r 3) 5 Sink basin /lavatory 16.60 Phone: (Sb ) ! Fax:: D 7 3S Tub /shower /shower pan 16.60 E -mail: .: =' . " ?i u3` y ; ; .«c; r5 ». %Iaas °asr y; <• Urinal 16.60 �� + 11i W_ p t :? c, Uf a. .., . i , ' r t z a` m. - m.p''' ^`' '' ^ - ig n � ^a` +Ss ' . i ,, .,. M , 1 -. is * . , 4fr.,.1 ?1 .: >. ` 4 ., CONTRACT R c 11µ 7 t . x t , ' A w t i` 1 ->z. � . a..r .rt:;r,��:irm rg� a< � � .�. ,� ..�.�?: �t�u.r, ,a�?t�'1 °�r� Water closet 16.60 Business name: W ater heater e Ag �J by' e 16.60 Address: Other: eered+3,2 / r �4 f( 50 - I City/State/ZIP: Subtotal Phone: Minimum permit fee: $72.50 a e ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 C06'., i CCB Lie.: ° 3 p a7 b 7 Plumbing Lic. no.: ,26- 8(p 119:2 Plan review (25% of permit fee) Authorized signature: / 44 ��Q� h " . c 44 t/ ,it State surcharge (8% of permit fee) g 0 1 p/°� � T OTAL PERMIT FEE 113, Print name: �yeao� € / /5a� +' [ A1� -. Date:7_A, 05 This permit application expires if a permit is not obtained N.' • 180 days after it has been accepted as compler -- *Fee methodology set by Tri -County Building industry Sc i.\B lding\Pcrnua\PLMF- PcnnitApp.doc 12/03 440- 4616T(l0 /02 /COMJWE13) Plumbing Permit Application - City of Tigard ' _ Page 2 - Supplemental Information Fee Schedule: Residential Fire Su . . ression S stems: ,x ix� .1 r..! V 4 :J3iICP� °:S "t'3°yi+} "n, �u? Y" yN,,:�.y,. : ii �` t.:, . k ''�i« m i t m itl�Y , . :, t` r a 5 Slt@ Uti11tiTeS t ` ' it w f Q, : �: e ra „ To` i11 � ���:, , ���� � . �; ���m, €�,a:�:r;gay.;tP 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' 3,601 to 7,200 $220.00 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 Fra, r 1 �:, ...,•,,.;,,;, , ,,,. ;.,,,,,, 55.00 »k y Yua a ., yPe . Storm 8,4 Rain Drain - 1st 100' "�:r-Y.t t.- -.. . $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 w' raj �# c� s� : . ,<,.. , . 3 Ftureor. gteini' "' `fr -F3'` r' " t �' °S1QY t ee;(e zr I?otalit additional $100.00 or fraction thereof, to and tt:W � tE� ,3'1 2 °l Y y n3` ;signs: 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 * . 5..irx'�`�' Rr�+`r'J:`:•a E u "�r,1 'M" ti6� -' { • 4 ' �n : z s Fiy�toP� aM a wd y n5wu:sd'„ ,t iTAN ; 91,, t ``, :OltatilaW .;1 tt e � Ntal.,ort1]era Fis user jt V ra : ..' 414,1g Se r l sego 1, o 5 „ ro t4 ....' =�ir_ � , r..,., 6 iewtem atkat %is'pped Comments regarding fixture work: Baptistry/Font .ts 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 �ammeaI *Note: If the fixture work under this permit results in an 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 • Bradley Quantity Total 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 t ' Urinal - Plan review is required if fixture quantity total is >9. Other Fixtures: i'1Bu Iding\Permits\PLM -Pcm itApp doc 3/03 12/30/2005 09:54 5032450735 BABBITT PLUMBING PAGE 02 . ,.ii..siimm....m.i.wbme.........uwosawwuwu... L ".....m....wouumgimem.wgwm...mgmmumoiie ' I, • ALOHA SANITARY SERVICE INVAICE NO. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9628 503444.2797. 503 - 648 -6254 . 503 -639 -5188 NAME: Akti \ tA_Y u ,. plc ..._... . 1. .., P 1 . .5 2 `y ADDRKss; 1- . CITY; _ for; C.A t.1( STATE; NOME:_ WORK: 2 4 -J2iq CELL: - 3 k Z f i 73 w Jos SITE; __11_,Z a ._.a — 0 r `t% coo. . J P,O.0: . _.....,.._.� -- _._ � � , ,....._. - . _..� PAID ay CHARGE ❑ CHIC CASH D CREDIT CARD " DATE V - I! DRIVER I, AMOUNT PUMP SEPTIC TANK IIIRM _____,__ Q LINE OPENING miniE ❑ INSPECTION FEE MINE ❑ SERVICE CALL U LABOR, LOCATING, DIGGING BACKFIC.L U MATERIAL, EM �-- Mtn i = - - THIS IN NOT A SEPTIC SYSTEM INSPECTION REPORT . TOTAL $ TOO - - REMARKS - - --- ._ TYPE 0 TA: STEED, O C ON CR ETE U PL.AST1 HOMEMADE ❑ HORIZONTAL n VERTICAL 0 A. ANGLE © D OTHER SIZE OF TANK: 00 Q! 730 ❑ 100 ❑ 1250 O 1500 0 2000 ❑ 3000 ❑ LIG LOCATION: r INLET ® • • , • MIDDLE U ENTIRE Top TANK CONDITION: ' GOOD U R U Room 0 • • FITTINGS: - - 4 CONCRETE ❑ K NON U PLASTIC U Nr cos NEW LID? YES 0 Size GROUND COVER OVER TANK COMMENTS ON CONDITION or GRAINFIELD ETC. SIGRID By DATE ,. .....a • E abed 86GL 2 YLINYS Y}iO'IY .dL• 500Z'6Z oga CITY OF TIGARI- , BUILDING DIVISION PERMIT #: PLM2005 -00184 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2/2005 Phone: (503) 639 -4171 Oman- dg l,, , �I i ;I Inspection Requests (24 Hrs.): (503) 639 -4175 -'I 1,. INSPECTION WORKSHEET FOR DATE: 5/9/2005 TIME: 7 :10AM PAGE: 31 SITE ADDRESS: 12235 SW ALBERTA AVE CLASS OF WORK: SUBDIVISION: CANOGA PARK LOT #: 006 TYPE OF USE: PROJECT NAME: SITZMAN DESCRIPTION: Connect existing house to new sewer service. Plumbing is to be reversed and septic tank is to be pumped, filled and inspected. Reimbursement District fee paid on 3/21/05. OWNER: SITZMAN, DEANE D /ANNA L, PHONE #: 503-590.1974 CONTRACTOR: BABBITT PLUMBING INC PHONE #: 503-244-5279 Inspection Request Scheduled For: Date: 5/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 006390-01 503- 244 -5279 N • Corrections /Comments /Instructions: Af. i — • /-/ AO C. OI GI I et It" ,,f c --- te-l 41 ./l /4- ❑ PASS Er. . -ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL II CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: if Th ‘a Date: t- Phone #: (503) 718-