Permit CITY TIGARD PLUMBING PERMIT
, u . r 0 , DEVELOPMENT SERVICES PERMIT #: PLM2005 -00183
e �'l l 13125 SW Hall Blvd., Tigard, OR 9 503 - 639 -4171 DATE ISSUED: 5/2/2005
PARCEL: 2S 103BC -03300
SITE ADDRESS: 12300 SW ALBERTA AVE ZONING: R -4.5
SUBDIVISION: CANOGA PARK LOT: 007 JURISDICTION: TIG
Project Description: Connect existing house to newly installed lateral. 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:
TUB /SHOWERS: SEWER LINE: 90 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft •
Owner: FEES
OLIVER, CHARLES A /BETH M Description Date Amount
12300 SW ALBERTA ST
TIGARD, OR 97223 [PLUMB] Permit Fee 5/2/2005 $72.50
[TAX] 8% State Surchaq 5/2/2005 $5.80
Phone : 503 590 - 7095 Total $78.30
Contractor:
BABBITT PLUMBING INC
7611 SW ALDEN ST REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97222
Phone : 503- 244 -5279
Reg #: L1C 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 503- -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: ) a 4.
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 o5
Plumbing Permit Applicatio
' -. FOR OFFICE, USE ONLY .- , , { .; ` • City of Tigard ,� Received �` �,' ' 85
! 3 : 2 5 S ' , 1 ' H II Blvd., Tigard, OR 97223 D Dale /By: r ' Pemti! t e QQl
nom:. 503.639.4171 Fax 503.598.1960 �� d Plan Review - --
��' T ' b' ( � 1 Date Re Other Permit No "� or . t�9C
24- Hour Inspection Line' 503.63.598.1 �] �� ekt)5 a5 J
nie net: ttww.ci.tigard.or.us �/ (41.111411
's= r =. Date Ready /By: )ufi • � B See Page 2 Cori
NotifedA4ethod:
: its.) tj ?�A. ;'jlJ''+� 'y4':t+;; ,� trnl {,h:,'+,;.7tM yt�+ / � Supplemental Information
.... ::�' f ' �`y ``��..A, 6 ,tu ���,,ppi��Sy:( trill 'r•.y.�'.j�:. >r, "�J ".hly2 s�, : .,�',0 *:•Yt }• at: ?i
4 4+ • �',r 'p %lf� '' �j 7 $c * nl° . ,. i l , . .,^ : ? ±:G y :m =,: ,
r+,. .: �tT, !$::!';4G�tC �`{�;..'4 §., ..",�.• „ r::�l� .n .: 'T �;t i � „u•{ '�.I, - +��y „� -, t`i�:!: �.. ;6Y, :.�'p �.0 . ,. # "�.a
'�� •, r . ,_ t . ,,t i�. ��,a, r.�t�..,:tss. aFo x�.,.,..., �.,, �I:`� ir:'wr to �J� ia: ' . .,..:.= "�?;E'� . ? S.CH�.�TJL' E,.
❑ Ness construction ❑ Demolition For special information use check /Lrt.
❑ �dditiot/3!teratiottlre lacement r � Description Ea Total P t' Other' Sew, K Qty.
L. :.t; ; eC;' °;a% Yt,>.i,;,v`;•.; :;,r.;F;t °,:;., rH ?. „,- �0 New 1 - 2 - family dwellings (includes 100 ft for each utility ronne..�o.
' ^ 9C*l.`[:1... St^.•41r+ r.' L•.'` .2'..tt �.7t ^�'� "7e ?•9.' ���
.::c...,, ,. .,,. .;u,w: �. svty. t. Y> zrinnr��i +w''if�4��;`is',,;t,.: %t .'..:'SG::.p,lrst SFR ( bath 249. 20 I 1
i : - and 2- family dwelling ❑ Commercial /Industrial SFR (2) bath 350 00 1
1 IT Accessory building ❑ Multi - family SFR (3) bath 399.00
^,5.00
1E1 Master builder Each additional bath /kitchen ❑ Other:
, >r.�. °v:r,ur. ": ps, o -; ia , 14,ti ) itr,a4�� r ,, r:rt. m, r Lvxrr ;,r ;:.. ,:.� /�; Fire sprinkler sq. ft
'jj' ,?,�. .( . ,0JOB',AIT. ;,, 'F: TY" ' � t Q r I ' t ,a,r t.�_. � j I.. P ( 9 ) Page 2
: ;i. , 1LJ 1 fi R I t e � •At.:
:S'•• „ ++ nk rt G:i..e ?i;slf';f3 k s:,,1,X N ti't attG'�`s�':`:r i Site utiliti
Job site address /02 3 n(
I A/ . 00 S Ar ,6 -f c74,
_ Catch basin or area drain 16.60
City /State /ZIP:
7/�ia N 0 ( ,•>e ,Z 23 Drywell, leach line, or trench drain 16.60 I
I Su :tefoldg. /apt no.: d I Project name: Footing drain (no. linear ft . ) I Page 2
i
Cross street/directions to job site: Manufactured home utilities I 00
We �� CP-I f
`°�� Manholes 16 60
Rain drain connector r 16 60 i r_— Sanitary sewer (no linear ft.:4) I P:tue 2 55-
I
Storm sewer (no. linear I't.• ) Pale 2
Subdivision: I Water service (no. linear ft.: I I 2
Lot no.: ( ) Pair 2
Tae map /parcel no.. Fixture or item
Absorption valve
;:.'`' `if >`.'D
�i7� �.i •y,_- �::, I x.66 I
,. OT+.::' • w,,,, `�
:.t.
_ - r w , •• ���:....... �.. rr.: �., a., �u. .. ?::( ixt;�:� t Bacl<tlow prev
enter , f / w,y r: enter P;:ge?
C I o0� e2-C/ 5 / /Hi p/./0 - 7c) ft..f,.;e.r Backwater valve
6.60
Clothes Clothes washer 16.60
•
Dishwasher !6.60 I
. 'PROPER °TY' i ii:v ;473 r4? rr
ill3iik,:::.w:. °r, :trs;, ..._,t.i Drinking fountain i,A,.Gn.t, —.
. .,H•,: .,,1, -. V- 2.4i4'i{�F'` 1,MiIiN11•i11();",� „m: •4 .F;.r` .,: C: 48' y',i , !� 6 C+U
. • � ,:.7 :.:x'�y :.., .r .�. , Ts , _ +.v_..�<v? �r?�.'vL`'_' — - --
Name: r Ejectors /su mp 6.60
k kt CAU 0 / i v' � V' Expansion tank 16.60
j Address: /2306 S - 4 illb v�� a. Si I
� P + Fixture /sewer cap U0
I City /Stale /ZIP: llr/.Jt e9 N„ qi 2�Z3 Floor drain /floorsink/tub 16.60
Phone: (�3) S'iaV./�' gs— Fax: ( ) Garbage disposal I6 6,,,
f ::r +t *h iii '��i •: i:.' clu rrr i
f,° .. .. a,; '`G; d/ ,.. rosrr. .,s ct Hose
' . ` t i ��P>,EL�'��Ttlsx;, ,�� i� N?�,�;(-�< ' �7' .t et::;:.tr +,.:ia�; bib I 1
�
`,;.i. '. :: -`,. � :-r,'br y Hi.. �a, ` A w� J.i , , r r I I 0.0�
!. ate:r„ t.F w,,> <i y, ,r 4-ya k Ice maker
B usinessname: -tea P b It- p(U � D 11 /k 16 60 I
I Co lI I 1 r Medical
Interceptor/grease hap If, 6„
Contact /' , `(JEs D
1 l t/ 1{ i
7 [ Medical gas (value $ ) Page
.Address: - 76 /7 s••
5 f ,f /�P s! r Primer 6 60
L`ti
Citr /State'ZIP: �� � � ��� I �11�� ��� Roof drain (commercial) 6
� Phone: (C� 3 ) ), t�•�- `J a ? q ('/ Fax: : (5`0.3) r;#57:_. D 7 35 Sink basin /lavatory I 0 60
F. „(I_ / Tub /shower /shower pan I6 60
;. r ., : , .� _;. t .a: ;:; ti : a �u . F , y , Unnal • 1660 1
w , ' 0 `�.,,, T . C ST; „ <'t : r i x:• ; 4 .,M '- —
:. ..: : °:: :�.:... +.,.. u„:, x?, e ,- x:,.r ir... �.:,� -s: ° '° Water closet I 16.60
Business name ^�,! Water heater 5c4/1Q f4 S a+ hvE? I 16.60 I Address. Other:
. City /StateJZIP:
Subtotal
?
Phone. ( ) Fax Minimum permit lee 572 50 .70:7 '57-Y
-
( ) Residential backflow minimum permit fee 536.25
I CCB Lie.: 30a6q Plumbing Lic. no : X 86' ex, - Plan review (25% of permit Br)
Authorized signature: 6 4 Adeb.6 V/ 5-6 State surcharge (8% of permit ice) 1 C80
r
TOTAL P!'IL1q IT FEE 7F � v
i Print name_ �ec,rC, , ,. L j, / . /t I Date: Date �acy._U5' This permit application expires if :t permit is not obiaiined
v ! 180 days after it has been accepted as conipier!!
*Fee methodology set by Ti - County Building industry S
. ..e::c:r.eP c ::, :s'•P LAtF- Pcrmii App doc 12/03 440 - 46161'(10 /02 /C'OM/WEti)
Plumbing_Permit.A plication Cit Tigard
, A t,� yj;o,f.Ti ar .
Page "2 .
ement$1Iformatio' �'
S as•..,. ;. n;a�G.'.G' ux it,;' 1v�, �,fi ,,, :., .
•
• Fee S'cnedule:
c ..� , , , d Residen al F re Su • . ression'S stems:
k'rsr �' :.. git',2 4 "^ , <j ,t,, '�f 4054'x/ 04.0 �rmitiv +w , 19J 1 e.. V . e, r ti }:7 l q , .� : :it -
• ,,,dgZ @9+i!a[' k .R._ hi'i! rI l J 1 T A li i , , t � K t. { y L ,•' u ll .,,t'/ I U Q �",.li .' ... .. " e
71 l h.l ,c _.1.:., tl a r. t! t,4 . z .3r '''1�
Footing drain • I" 100'
55.00" 0 t� 2,000 $115.00
•
Footing drain - each' additional 100' " "46:40' . 2,001 . to ' 3 ;600 •• : ' $160.00
Sewer - 1st 100' 55.00 - 3,60T Yo 7 ;200 ' ' '' '- $220.00
•
Sewer -each additional 100' , 7,201 and greater $309.00
46.40
�' o$''':i'
Water Service - 1st 100' , ,.. - 55.00' '
Medical Gas S stems
Water Service - each additional 100' 46.40 .. , }r , a y ,
#cvt liiV O i i � i Y ' �y� ti '' . trafAeE ad - ;•
Storm &Rain Drain 1st 100' ,' 55.00' r 1 ,, I ', fi?4 t ; - ,.
.'-ow i
Storm & Dram -each additional 100 $1.00 to $5;000 :00 Minimum fee $72.50
46 40 55,001.00 t� $10,000.00 $72.50 for -the first $5,000.00 and $1.52 for each
4'7.! _ t. 5 �Oi i r �r t q r r iaia.t t pii„Sj°' ti I Q'� to ar ,.
° +" l w�td, +Ci;itli� .
k �vte +ty ° ; i lzt� r4�`.�3 ^ft,r , ' ' additional $100.00 or fraction thereof, to and
Commercial Back Flow Prevention Device 46.40 including $10,000.00.
$10,001.00 to .$25,000.00 5148:50'fo> 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 I . $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1 .45 for
Inspection of existing plumbing or 1' ; 1 - - each additional $100.00 or fraction thereof, to
specially requested inspections - per hour '2,50 arid including $50,000.00.
oura.. .. $50,001'.00 and up $72.00 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 existiing:'fixtures? If
"yes ", please indicate -work performed by fixture. 'Failure to • .
accurate! re . ort fixtures could result in increased sewer fees *. •
, lt! yE't• �"l {� -TC,l t
Comments �+, t t� �' 1 7 [ 1. -
f
��, l , tt r ad ° d r+ I r'1t_.Jlta"' ti' b b ,l tri '�bi 1.
9i+ r n� + .� l �� ��4t�1`11 u
1l, {�41 tlti / , rt4nc yp+tl ,,� r x + ,•r
144 1 k l[FI ,Bf -, .. Cllr lq. I . �b'�ti tl ylti .� + f : . l t. } }M,�
c Y, r k! rt t f lit ar t tl� / t A g ri } , � ti 4
.. s'' 1: 5�.' YI: J. f' t��_ 1 ,.(;3.'L;�dt,r.i�fellut.' #�t {�° �., ,� :.r i'ti';k;�� }f,�i n ts regarding fixture work:
• Baptistry/Font
Bath . -Tub /Shower.
- Jacuzzi/Whirlpool
Car Wash . Stall 1 +, ; t , .. . ... ,. - ... ..-
-Each ir; i ; ..
-Drive 'Ihru a: • - 1-
Cuspidor/Water Aspirator -- • • . ' '"'_° " .. •
Dishwasher - Commercial - - • -
- Domestic .
Drinking Fountain .. ;; . •
Eye Wash 1 .. .,.._...
Floor Drain/sink - 2" ... . ._
` i -.
Car Wash Drain " -- "
G
• arbage ' - Domestic . " ... -.... . • • _. .. ` 1;
Disposal - Commercial " " ' ;�, ,, • Industrial *Note: If the fixture work this results in an
Ice Mach. /Refrig. Drains ' ' " increase sewer EDUs, a sewer per w ill be issued and
Oil Separator (Gas Station) fees assessed for the sewer.increase must be paid before the
' Rec. Vehicle Dump Station pluinbing,permit,can ;be:issued.
Shower -Gang
-Stall :,, •,..,,4 ,
Sink Bar/Lavato _ " a.'i... :.,
- Bradley ry Quantity Total
Commercial , „ Isometric or riser diagram is required if fixture quantity
- Service , ,.. total is >9. .
Swimming Pool, Filter • •
Washer - Clothes .. •
Water Extractor
Water Closet - Toilet _ •-
Plan Review,
Plan r
Urinal .._ review is required if fixture, quantity total is >9. •
Other Fixtures:
i lauilding \Permits \PLM•PermitApp.doc 3/03
I
I
A LOHA SANITARY SERVICE
INVOICE NO.
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9 6 1 0
503 -644 - 2797 * 503 - 648 -6254 503- 639 -5188
F ,
NAME: 1 �'; y, N' ',a.,.
ADDRESS: ?. .. a 0 6 i,; }. iV . ,
;' "- _a RA "• . .
3
CITY: d ry ' , •'i 2. 0 STATE: ZIP:
HOME:
'' < /,, 1,y
WORK: CELL: ir:''S �
JOB SITE: i }r , ` P.O.#: %. ,:,/.;' '
i' (1
^ el % V
PAID BY CHARGE ❑ id !), CHECK CASH ❑ CREDIT CARD ❑
DATE } - .�A� ; . 2, 6:1.5 DRIVER 'V41 ' ,.. 74 Z ! AMOUNT
44 ,•,t
Cr PUMP SEPTIC TANK ✓ ou
❑ LINE OPENING • 1
Y
❑ INSPECTION FEE I
i
❑ SERVICE CALL i
❑ LABOR, LOCATING, DIGGING, BACKFILL e
❑ MATERIAL ?
TOTAL $ � , 7) ._.
- - THIS IS NOT A SEPTIC SYSTEM INSPECTION REPORT — - a
y ' , t .1 "' - REMARKS - -
TYPE OF TANK: 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 ❑
i
TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑ ,,/
FITTINGS: BAFFLES ❑ ' ❑ CAST ❑ PLASTIC ❑
NEEDS NEW LID? YES ❑ SIZE"" -.., --- "'
GROUND COVER OVER TANK .
COMMENTS ON CONDITION OF DRAINFIELD ETC.
I
SIGNED BY DATE
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00183
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2/2005
Phone: (503) 639-4171
kir 1,it
Inspection Requests (24 Hrs.): (503) 639-4175 ,...
INSPECTION WORKSHEET FOR DATE: 5/4/2005 TIME: 7:01AM PAGE: 39
I ,
SITE ADDRESS: 12300 SW ALBERTA AVE CLASS OF WORK:
SUBDIVISION: CANOGA PARK LOT #: 007 TYPE OF USE: •
PROJECT NAME: OLIVER
DESCRIPTION: Connect existing house to newly installed lateral. Septic tank is to be pumped, filled and inspected.
Reimbursement District fee paid on 3/21/05.
OWNER: OLIVER, CHARLES A/BETH M, PHONE #: 503-690-7095
CONTRACTOR: BABBITT PLUMBING INC PHONE #: 503-24-6279
Inspection Request Scheduled For: Date: 6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer 006086-01 603-2446279 N
Corrections /Comments/ Instructions:
FI II •Se Pav1 CA el OtAt.--(14,-*" 1
t
P st.e-ti ia• t •
X PASS Li PARTIAL APPROVAL 0 CANCEL 7 NO ACCESS
7 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: 07)L-44./i t tl , A-g— Date: 57 War. Phone #: (503) 718-