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Permit CITY OF TIGARD PLUMBING PERMIT 111 11 ' COMMUNITY DEVELOPMENT P ermit #: PLM2011 -00291 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 09/21/2011 Parcel: 2S 111 BD00303 Jurisdiction: Tigard Site address: 9900 SW INEZ ST Project: Powers Subdivision: PEMBROOK HEIGHTS Lot: 3 Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled or removed. Contractor: OWNER Owner: POWERS, RICHARD & JEAN 9900 SW INEZ STREET TIGARD, OR 97224 PHONE: PHONE: 503 - 639 -5776 FAX: FEES Quantity Description Date Amount 200 If Sewer Service 09/21/2011 $100 06 Specifics: 1 12% State Surcharge - 09/21/2011 $12.01 Plumbing Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $112 07 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility 'cation • er Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or d'r ct questions to OU .y - • g 503 232 1987 or 1.800 332 2344. • Iss ed By: / Permittee Sign. ure: **P. Call 503.639.4175 by 7:00 a.m. for the next available inspe '•n date. 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 114 City of Tigard Date/By. 9 0 2 / Zr� Permit No . IL ��9 �� 13125 SW Hall Blvd., Tigard,OR 97223 y' at Plan Review J Phone: 503 718.2439 Fax. 503.598.1960 DateBy Other Pent No a: 12 - • .106` T I G AR D Inspection Line 503.639 4175 Date Ready/By Juris ® See Page 2 for . Internet: www.tigard -or gov Notified/Method Supplemental Information TYPE OF WORK FEE* SCHEDULE 1:1 New construction ❑ Demolition For special information use check list Description Qty 1 Ea I Total ❑ Addition /alteration/replacement !1 Other: New 1 - 2 - family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 l,1- and 2- family dwelling 1=I Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500 32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (— sq ft ) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: q C 0 C3 S ‘.. ..0 ) 5 ST Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18 76 City /State /ZIP: Mi G C_lra n 6).y Footing drain (no. linear ft ) Page 2 Suite/bldg. /apt. no.: I Project name: 6 G Q €0 !J Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 `0 a Rain drain connector 18.76 g �yypp g� Sanitary sewer (no linear ft _) Page 2 /0' Storm sewer (no linear ft.. ) Page 2 Water service (no. linear ft.. ) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31 27 DESCRIPTION OF WORK Backwater valve 12.51 ' Clothes washer 25.02 Ca cl v �p r o cr S Q mss'' Dishwasher 25 02 Drinking fountain 25 02 Ejectors /sump 25 02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12 51 Fixture /sewer cap 25.02 C Name VC_1J •1 v e S — PC'DtA) - k_ f Floor drain /floor sink/hub 25 02 Address: CI C/10,0,.. 0,) .1..)-5 Z 5 Y Garbage disposal 25.02 , City /State /ZIP: ` k .G c t 0 q Hose bib 25.02 Phone: (61...\3 ) 6 9 _ 5 rm 6 Fax: ( ) Ice maker 12 51 ❑ APPLICANT t ❑ CONTACT PERSON Interceptor /grease trap 25 02 Business name: Medical gas (value $ ) Page 2 Primer 12 51 Contact name: Roof drain (commercial) 12 51 Address: Sink/basin/lavatory 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 CONTRACTOR Water closet 25.02 rL Water heater 37.52 Business name: ��,� �/ Water piping/DWV 56.29 Address: Other 25.02 City /State /ZIP: Subtotal (l am- c4 oo�^, AA Phone: ( ) Fax: ( ) Minimum permit fee $72 50 CCB Lie.: �l Plu g Lie, no.: Plan review (25% of permit fee) / State surcharge (12% of permit fee) f�� e Authorized signature: `/ 6/7/ Yt � egel.../"��-a_ TOTAL PERMIT FEE / / A.c9 7 Print name: J ?ff /r[ ej fj e f oe.efecS Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tn -County Building Industry Service Board I \Building\Permits\PLMU- PermitApp doc 10/01/09 440- 4616T(10/02/COM /WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site 'Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 100' 50 03 0 to 2,000 $121 90 Footing drain - each additional 100' 37 52 2,001 to 3,600 $169 69 3,601 to 7,200 $233 20 Sewer - 1st 100' 62.54 7,201 and greater $327 54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62 54 Medical Gas Systems: Water Service - each additional 100' 37 52 Storm & Rain Drain - 1st 100' 62 54 Valuation: Permit Fee: $1 00 to $5,000 00 Minimum fee $72 50 Storm & Rain Drain - each additional 100' 37 52 $5,001.00 to $10,000 00 $72.50 for the first $5,000 00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to and including $10,000 00 Inspection of existing plumbing or for $10,001 00 to $25,000 00 $148 50 for the first $10,000 00 and $1.54 for which no fee is specifically indicated 90 00/hr each additional $100 00 or fraction thereof, to (minimum charge — 1/2 hour) and including $25,000.00 Inspections outside of normal business 90.00/hr $25,001.00 to $50,000 00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge — 2 hours) each additional $100 00 or fraction thereof, to Reinspection Fees 90 00/hr and including $50,000 00 Additional plan review for revisions 90 00/hr $50,001 00 and up $742.00 for the first $50,000 00 and $1 20 for (minimum charge 1/2 hour) each additional $100.00 or fraction thereof Subtotal: • Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate q y g' Baptistry/Font Please check all that apply Bath Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi /Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918 780 - 0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. 3" Isometric or Riser Diagram Car Wash Dram ❑ Isometric or riser diagram is required for new buildings - Domestic —non -food s g q g Disposal - Domestic —food related that meet the qualifications above. - Commercial —food related - Industrial -food related Ice Mach. /Refrig Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec Vehicle Dump Station Shower -Gang -Stall Sink/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an . Washer - Clothes Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures I:\ Building \Permits \PLMF- PermitApp.doc 02/24/2011 2 ' ,h,, , {f_ L 4 :- ,, ,i'st y .. :,j,,,,,,. 0 • f•' ♦ . . _' , • . •?. ;,-N+' 11$ , , . - . .. , r. ; _ - &A .... . �') ` 'h r J. .:( • l'.:? ' f• . �' ro i ate': \� . � _ �'• -." : _ .J ..�a� ..�' y. . /ALOHA SANITARY SERVICE INVOICE NO. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 1 63:01 503 - 644 -2797 * 503- 648 -6254 • 503 - 846 -1951 (FAx) wwvf.alohasanitary.•cop • Email: info @alohasanitary.com NAME: L j e i t . q <--, � ADDRESS: � / C2� �) r a/. A'T�3 CITY: o �/, i,� ZIP: HOME: 43? — 5776/ W ORK: CELL: JOB SITE: P.O. #: iici'oe Ci PAID BY CHARGE ❑ CHECK: VL: CASH ❑ CREDIT CARD ❑ DATE /OM /TIME DRIVER : ) J" TANK 74,144 / AMOUNT PUMP SEPTIC TANK 376 an ❑ INSPECTION FEE ❑ SERVICE CALL ' ❑ LABOR, LOCATING, DIGGING, BACKFILL / i L -- - OTAL 3 O - THIS IS NOT A SEPTIC SYSTE INSPECTION REPORT - - , * r �[ TYPE OF TANK: STEEL CONCRETE L�J P LAS I ❑ HOMEMADE ❑ HORIZONTAL ❑ VERTICAL ❑ R CTANGLE ❑ GI SIZE OF TANK: 350 ❑ 500 ❑ 750 © 100074 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑ LID LOCATION: INLET ❑ OUTLET ❑ MIDDLE ❑ ENTIRE TOP ❑ TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑ FITTINGS: BAFFLES ❑ CONCRET ❑ CAST IRON ❑ PLASTIC ❑ GROUND COVER OVER TANK COMMENTS A/25 /r1/4/ i ---- / r A - - ?LTV 28 11 042.9 1 Customer Signature ?goo S' X oCZ 5-7.--. DATE /g -/ 7_ z//