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Permit t. ... C ITY OF TIGARD PLUMBING PERMIT !PI z COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00265 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/12/2008 PARCEL: 25101 DC -02900 SITE ADDRESS: 07595 SW CHERRY ST ZONING: R -3.5 SUBDIVISION: ROLLING HILLS PLAT 2 LOT: 047 JURISDICTION: TIG PROJECT: CHICK Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #44. Fees paid 6/12/2008. 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: 75 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES MARIBETH CHICK 11575 SW PACIFIC HWY #120 Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 6/12/2008 $72.50 [TAX] 12% State Surch 6/12/2008 $8.70 Phone : 503- 639 -7362 Total $81.20 Contractor: BRIAN CLOPTON EXCAVATING INC PO BOX 509 q WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 682 -0420 Reg #: LIC 50337 PLM 3 -517PB • 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 503.246.6699 or 1.800.332.2344. Issued y ! Permittee Signature: 0.746) Q C .,,...„ 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. Plumbing Permit Application Building Fixtures FOR OFFICE USE. ONLY , " City of Tigard Received DDate/By: .4 // .4 // () 0 g / / Permit No.: / ti P kifira.... -I . a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review G j Phone: 503.639.4171 Fax: 503 • . 00, O Other Permit No` JE �r " D a t eBy: ��� �"" yF Inspection Line: 503.639.4175 ` e Q� T I G A R D l. 0 Date Ready /By: luris. 65 See Page 2 for Internet: www.tigard or.gov � 1 Notified/Method: 73,70 Supplemental Information ' .' . ` :- . .TYPE OF WORK. S : 'G N. .. FEE * SCHEDULE' use `' _ " ❑ New construction ❑ D,i } t GO For special i njormrma f ion use check 3,� Description Qty. I Ea. Total ❑ Addition/alteration/replacement O Y` e.py) t, New 1 - 2- family dwellings (includes 100 ft. for each utility connection) ' CATEGORY'.OF"'- CONSTRUCTION '- , , SFR (1) bath 249.20 Tr(- 2- family dwelling El 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: 5 x� JOB' STI'E I*6RMAT ION AND LOCATION -t , Fire sprinkler ( sq. ft.) Page 2 Site utilities Job site address: 7 si ) cheer LI Catch basin or area drain 16.60 City /State /ZIP: �R q 1p 7io2 Drywell, leach line, or trench drain 16.60 t Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no:: Project name: /It C �, i�k � --/J Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: 75) ( . Page 2 . 5 - 5 - ; lie Storm sewer (no. linear ft.: _) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 . ^ ., a ik . DESCRIPTION OF,,`WORK ` ' -, . ' _ _ Backflow preventer Page 2 „ee, -r 17(X5,- -e-e ) Backwater valve 16.60 Clothes washer 16.60 ,., Dishwasher 16.60 :' °,IBPROPERTY OWNER- : 1 Drinking fountain 16.60 r �,- -• , ` ❑,TENANT- Ejectors /sump 16.60 Name: / f'/ bt✓th /q . Ch I e _rC Expansion tank 16.60 _ Address: /X575 . S ) ' b2 / ,s d Fixture /sewer cap 16.60 City /State /ZIP: 04 9 102 Floor drain/floor sink/hub 16.60 Phone: (5:93) 6' _ 7 - 669 _/5 Garbage disposal 16.6 Hose bib 16.60 ' B; APPLICANT' '❑ CONTACT _PERSON. ' Ice maker 16.60 Business name: e ,,� .,:7b,9 dd 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 CONTRACT .. ` Water closet 16.60 Business name: 1 t k A2 Z o - /1 Water heater 16.60 Address: P f Other: Y" )X C, �, ) Subtotal City /State /ZIP: N Lic. "/(.4 ( k ` Q7() !v ! Minimum permit fee: $72.50 Phone: (5 G0 - )-.-() t---( Fax: ( ) Residential backflow minimum permit fee: $36.25 - 7a,.'57) CCB Lic.: S-j 3 3 7 Plumbing Lic. no.: 3 -57 7 Plan review (25% of permit fee) State surcharge (12% of permit fee) r. 76 Authorized signature: _ Q �/� TOTAL PERMIT FEE - Print name: »�i; b e X) A9 ( /C Date: �o // Qg ' 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. 1:\ Building \Permits\PLMI'- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: S><te Qty F Total, uare Permit Sq Foota Footing drain - 1s 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 Perinit } 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 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: v Plait Review for.Pluinbing Installations: Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quantity by(Fixture) Work Performed ' greater, except systems designed and stamped by licensed Fixture Type - . Replace ; engineer. Previous Capped ` Added, Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918 -780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic - • Drinking Fountain v :, C "R i ser Diag am, .... ' ' Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain • Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 12/27/06 x /`• k� 1F . .lam/ k i LE SEPTIC SERVICE RO.BOX 1130 WILSONVILLE, OR 97070 a - (503) 6824929 FAX ( 3) 6704779 CUSTOMER'S. ORDER NO. PHONE - DATE ADDRESS „ 7-5/5 51J GHE y T.L ,#I2P> 6 e __ _ SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT _ QTY. DESCRIPTION PRICE AMOUNT • / a ©v 6-L 5Z 5E 2 j12 t6'" 3 Z oO - s ti TAX RECEIVED BY TOTAL 32.5 c as • All claims and returned goods MUST be accompanied by this bill . /A To Reorder. THANK YOU 800-225-6380 or ntbs.com . . 1111 ro g Community 1 evelopment T i vA Kn Reimbursement District Payment Worksheet Planning /Engineering to complete: Site Address: ( 5 ct `z� � -(64 tf S1 Parcel No.: r, 01 w, 0 j UY Reimbursement District No.: 4 Amount Due: $ C6" /44--/L01) Date: lam' B S TEE 4 I Note: Amount due is as of date shown above. Deferred Accounts: Name l q(,,v'r l 1171 Phone Number: Legal: Amount paid: $ 006 Remaining to be paid; deferred amount: $ 41- Building Division to complete: Reimbursement amount paid: $ CD Cup, Received by: ,' ' ' drop Return completed worksheet with copy of receipt to planning /engineering permit technician. Planning /Engineering to complete: Enter "paid" parcel tag. Enter "deferral" parcel tag, if applicable. Route copy of receipt and parcel information printout to Finance Department. ]. \cURPLN \Masters \ReimburseWorksheet.doc 2/23/07 CITY OF TIGARD ,.. BUILDING DIVISION PERMIT #: PLM2009-00265 13125 SW Hall Blvd., Tigard, OR 97223 .. DATE ISSUED: 6/12/2009 Phone: (503) 639-4171 , ...0 4, 001 1 ri Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6116/20013 TIME: 7:00AM PAGE: 7 SITE ADDRESS: 07595 SW CHERRY ST CLASS OF WORK: SUBDIVISION: ROLLING HILLS PLAT 2 , LOT #: 047 TYPE OF USE: PROJECT NAME: CHICK DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #44. Fees paid 6/12120013. OWNER: CHICK, MARIBETH PHONE #: 503-639-7362 CONTRACTOR: BRIAN CLOPTON -EXCAVATING INC PHONE #: 503-682-0420 Inspection Request Scheduled For: Date: 6/1612009 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 071427-01 503-849-7607 N Corrections/Comments/Instructions: e . , , -\\\.4 _se, Re—, h X PASS 0 PARTIAL APPROVAL 0 CANCEL fl NO ACCESS 0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718-