Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00096
cr�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/14/2005
PARCEL: 2S103BD -02700
SITE ADDRESS: 11940 SW CARMEN ST ZONING: R -4.5
SUBDIVISION: CARMEN PARK LOT: 004 JURISDICTION: TIG
Project Description: Connect existing house to sewer service, less than 100'. Septic tank is to be pumped, filled and
inspected.
CLASS OF WORK: NEW 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BIEHL, PHILIP D + LINDA M Description Date Amount
11940 SW CARMEN ST
TIGARD, OR 97223 [PLUMB] Permit Fee 3/14/2005 $72.50
[TAX] 8% State Surcban 3/14/2005 $5.80
Phone : 503 - 590 - 7445 Total $78.30
Contractor:
HOLLENBACH + HURD INC
3000 SW 174TH AVE REQUIRED ITEMS AND REPORTS
ALOHA, OR 97006
Phone : 591 - 5987
Reg #: LIC 121807
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 - ' • through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct estions to OUNC by
calli n 03-246-6. or -40k 32 -2344.
Issu By: % / ��fj ✓ 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.
t t'
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard
Date/ Received . I `1 Q Permit No.: 0 6/49e05 „�i� 9/�
. 13125 SW Hall Blvd., Tigard, OR 97223 y' v�(!J !Y
Plan Review �
Phone: 503.639.4171 Fax: 503.598.1960 /lt4 'I # Date/By: Other Permit No` l S `/ _ .
24- Hour Inspection Line: 503.639.4175 , rA Date Ready/13y: hurls H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method:
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j y Noti ethod� � Supplementallnformation
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`fiFEE SCHEDUT;E' "
'❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
la ;�:, �y =:� „�, a,�3.:.;x»�y � � a..+r".�€��.:eF..��;;,q�. >� �..,, .
�. ' " A OI X�O ONSTRI� �O 1 y ; SFR (1) bath 249.20
■ and 2-family dwelling ■ Commercial/industrial SFR (2) bath 350.00
■ • . ■ SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Fire sprinkler ( sq. ft.) Page 2
A 0' 8 1 0 0 Site utilit
Job - " - Catch basin or area drain 16.60
1' , Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: , e. t
Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 1 10.00
street/directions Cross to job
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.te) Page 2 s
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 •1 tl 5 • ®' Backflow preventer Page 2
i ft ' Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1 6.60
' �,i P t7PER e4 ER 1R g til TeE � till Drinking fountain 16.60
._- .3, ...�� Es, maw_ ,.- .,,p,41,; , Ejectors /sump 16.60
Name: Pi ll 1' ( 6),_,G,,(
Expansion tank 16.60
Address: , , ,c) G W 6 t .4 „,.., 4 , 1 � frt 41,6 Fixture /sewer cap 16.60
City/State/ZIP: 7 ll ✓• 4 I OR cf 7 22 3 Floor drain/floor sink/hub 16.60
Phone: (S 5' D 7 i L r Fax: ( ) Garbage disposal 16.60
,� �-� � y � �� ° • >7.e��a ��� a.
g r "■ PI-IGA T �a ' GO1V' Curti ERS®N
.. 'i .i , W,: -° 4. __ t7 a � a,� . Hose bib 16.60
_ 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:
,E s,= „ ' ° - '� Y.rY Urinal 16.60
�t �� 'r, ra - s 6 v {, ; ARACTO t t r < M : r.
]� W a t er c l ose t 16.60
Business name: r l/,,� 6 6.. it, V`. ( ] ,,,. , ( Wate r heater 16.60
Address: Other:
City/State /ZIP:
Subtotal
Minimum permit fee: $72.50 / 50
/
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: /� State surcharge (8% of permit fee) S• $�
TOTAL PERMIT FEE •7R 3 D
Print name: pit f -1 e t • j ( Date: 3 //,, //,, 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 12/03 440- 4616T(10 /02/COMJWEB)
Plumbing Permit Application - City of Tigard "
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
PP Y
�. ¢, ` r - Qty. ;, =.(e ,Tot r .
• IgiteUtilitig �, S uar Foota e. : -. Perlis t =Fee
Footing drain - 1 n 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
100' Water Service - 1st 100 55.00
Medical Gas Systems:
Water Service - each additional 100' 46.40 a . P K M : _ ; �.
a , er m l< tF ee , ` r �,
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
n lr i . m„ ,, „i,a x ;< "tea : -§ h ; ,_. i �_. i
3 '� ,;,< �� 1 'ea �'w�I' otal °, "' additional $100.00 or fraction thereof, to and
1xtU e�Or;lte3 6 - �_ 41�'ce.: ,_ :: mss 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 * .
Qua Eby (Fixture) Work l'ertormecl
11*.4,tureType -" �� 1 Replaee�- �=
Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whiripool
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.
Swiinming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet _ Plan review is required if fixture quantity total is >9.
Urihal
Other Fixtures:
i:\ Building \Pemtits\PLM- PermitApp.doc 3/03
Mar. 16 2005 07: 53AM P2
FAX NO. : 503 848 6832
FROM :HOLLENBACH'g HURD Inc
—... —,,, ...me■milMV_,._, .eq..■...,,,1■1■Iplmwmil.,„...1i11■11.1■11.■;d■-•
ALOHA SANITARY SERVICE
INVOICE NO. .::
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9454
503-644-2797 * 503-648-6254 * 503-639-5188
...._.-_- , . .
NAME: - & riLe3V1,() tiet __
Z'.....___
ADDRESS:
CITY: _
STATE: ZIP:
.._
HOME:
WORK: CELL: , 421 :0 1 tr - l.r;T:P,9
-
JOB SITE: ' ''' ,''' ' ''. ‘111 .--"' '.. • . , .':',. ".-- 0
,
-,____. :___ ____. _ . __ . --,-_..-_.....__....---...._,"— • -- -
PAID BY CHARGE A CHECK 0 CASH 0 CREDIT CARD CI
DATE 4r- 4./ DRIVER '7404 *mil AMOUNT
2t 0 00: t ." I .zlei
_ PUMP SEPTIC TANK
______
CI LINE OPENING
1:1 INSPECTION FEE
0 SERVICE CALL
LI LABOR, LOCATING, DIGGING, BACKFILL
_
LI MATERIAL
• Sp?ir ,/,-(aer
____...
TOTAL
- - THIS IS NOT A SEPTIC SYSTEM INSPECTION REPORT - -
. .__
._ . . .. ..
.. . .. .. -
_. ..
' ' REMARKS _ _
TYPE OF TANK: STEEL CI CONCRETE 0 PLASTIC LI HOMEMADE 0
HORIZONTAL 0 VERTICAL 0 RECTANGLE D 0 OTHER
SIZE OF TANK: 350 0 500 LI 750 C3,...1-000 d 1500 D 2000 D 3000 0
------
LID LOCATION: INLET ID OUTIIT LI MIDDLE U ENTIRE TOP O
.....--'-
. TANK CONDITION: GOOD CI ....-----' FAIR ID Poon LI
FITTINGS: BA,FECE 0 CONCRETE LI CAST IRON D PLASTIC D
NEEDS NEW LID? ""I U SIZE
GROUND COVER OVER TANK
COMMENTS ON CONDITION OF DRAINFIELO ETC.
..•
. . ... ._ .._.
. _ .. . .
..._
SIGNED BY
DATE 0/ ,<C.,, ,d,' '-'
CITY OF TIGARD OOP"' .0
BUILDING DIVISION PERMIT #: PLM2006.00096
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/14/2005
Phone: (503) 639 -4171 Ai
Inspection Requests (24 Hrs.): (503) 639 -4175 ,, ' x __..
INSPECTION WORKSHEET FOR DATE: 3/16/2006 TIME: 7:13AM PAGE: 24
SITE ADDRESS: 11940 SW CARMEN ST CLASS OF WORK:
SUBDIVISION: CARMEN PARK LOT #: 004 TYPE OF USE:
PROJECT NAME: BIEHL
DESCRIPTION: Connect existing house to sewer service, less than 100'. Septic tank is to be pumped, filled and
inspected.
OWNER: BIEHL, PHILIP D + LINDA M, PHONE #: 603. 690-7445
CONTRACTOR: HOL.LENI3ACH + HURD INC PHONE #: 691-6987
Inspection Request Scheduled For: Date: 3/15/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
5055 Sanitary sewer 001758 -01 503 -936 -5733 Y
Corrections /Comments /Instructions:
/ n A
• ..,____.,=.-, c—t,..., -.—...,- w— — -,,s,
Aril r. A
.. ...
r`t.,PASS PARTIAL APPROVAL n CANCEL I I NO ACCESS
❑ FAIL J I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
n
Inspector: l/ J Dat-: ) Phone #: (503) 718-
,.