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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00103 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/12/2007 PARCEL: 2 S 103 DA -05000 SITE ADDRESS: 10605 SW COOK LN ZONING: R -3.5 SUBDIVISION: FANTASY HILL LOT: 009 JURISDICTION: TIG PROJECT: HERZANDEZ Project Description: New sewer connection. 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES • CARLOS HERNANDEZ 10605 SW COOK LN Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 3/12/2007 $72.50 [TAX] 8% State Surcha 3/12/2007 $5.80 Phone : 503- 680 -6264 Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Contact # : Reg #: 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 By: .— Z(L Permittee Signature: 15 _— 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 RECEIVED" t R , , :1.01 0 N ICE " d City of Tigard u��,�o� �L �� ..1 ' %r � I ,, ' r v s. Received 7 /� V 7 , V C.) Permit No1��� r� /�f % �� % Q 3 a 13125 SW Hall Blvd., Tigard, OR 97223 MAR 2007 Plan Review 1 v, t+ J Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.. g Date/By. S x17 mod Inspection Line: 503.639.4175 CITY OF Ti w� T 1 G A - 16) ��D Date ReadyBy. Je ri+: ®S ee Page 2 for ,, 4, Internet: www.tigard or.gov Notified/Method .: <. LDI� n 5 Supplemental Information AI Supplem� ,:a : .� ��- x,' - .,.r.a ''•; ::,4 "'dh "-B a^ a;,.. a - a-4 elf ,,`: °� - ,. _ .� -t:,,:,..: w :*'r'a,. �: x I � ti "` i��a "t '� �.�, ,a,., ? I FEE s . :�; �'^ ..,: nr< _ _ .. *.�a` .- x..,. .. „J `_s. f. • .. .:x�i�. rL "� � ""° , �,yU. � Rti,. ,r ... Y.r+:�a La ... ,_:nSL�. k" :; - da �S; aR. h�' �"., ,,7T -�e �n . ..r_ _. . - tl ?',s � ''�- """ •N�v .a,:a, ❑ New construction ❑ Demolition For special information use checklist. Description 1 Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft for each utility connection) z;- °; :;. , 4 ° r , 0'i 1 ,;CATEGORY STRU OF CONCTION,p i� r g triy ' ., SFR (1) bath 24920 ❑ 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: `e�: 4r , .- . M ; u » : . s .. ,.,-4---. * Fire sprinkler ( sq. ft.) Page 2 *st ; + ' °dOB;;SI'TE'�INFORMAftON ANDt LOCATIO } r .� v J +'^ ' Site utilities i'l:ta:il st. ... X5i'ef�. ^ap'.LP"FY d. ...e a� . _ =Yk'.4';;� .. c.... .� -� '.f�3.,i.. -vt� � .� . .: •t�t��.t",�1_�ntM�9. �� h ^r{,. Job site address: % o CO 5 s cJ coo 4 ` , Catch basin or area drain 16.60 City /State/ZIP: 't / A o k Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: V Project name: 50 v - co �;e </ rep Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Lt) A L Ja Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 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 f ` "4.x41 ..:' , "� to ; ' * rDESCRIPTT N ", . 5il A , l � ' g 1 ..., , rP + -1 --. eY _,,,, :' .. ,', . O r OF� "VVURK ' `t" � ,� ' : 7, - 1 , . , - :, x , " ` »a h« v ;#'= u `L�.... : •:,t ^.. i.... _�r ., war . _,,._way »M... a�� a a ,nah _-. M.'' ,_ °nt�: .».?'i Backflow preventer Page 2 C G9 A�J e <4 .5 -e d -1-.. 7 4 . C / 'J' y Backwater valve 16.60 / Clothes washer 16.60 Dishwasher 16.60 't. -'. nr ; ':ts f #, . , , ,s 3 u .., - `" ;+.� PROP.EI , 4 , i ^ V ro TE a : F „�.,� �. �._ �, � �.. ; +'�.�. a, , �` s, �'� z (]�- ANT; + �.,. �": Drinking fountain 16.60 „ a a -. r �.,.- .�"_. _-,� , .. _� #: � r "' Ejectors sump 16.60 Name: `' t1 /(' 5 f 1 , air) Expansion tank 16.60 Address: in K O, j ` . Set (c, c7 /c < it) Fixture /sewer cap 16.60 City / State/ZIP: 1 A ) 4_ O r , Floor drain/floor sink/hub 16.60 w Phone: . )3 �' c3 G" 6 4' Fax: ( ) Garbage disposal 16.60 tv �' M1 : r, ';-,.:, ;' '0 APP r. _ LICA ., . N. T.. ;sry T g vnM . g *) ;= , „ - ©_ TA . CTrPERSO .- Qt- . ,.. . .. -,,, . Hose bib 16.60 • � :ai _ --- '' 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 Phone: Sink/basin/lavatory 16.60 ( ) Fax::( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 ''k ,„,,, n`r a m i, ".:.i',.'; . '„;,',.:':,,,',".-X;;"`..:.. =; b' CO1VTRACTOR'' ,' ra.'d .r" � '.;r � " ,. - �t� ;' '' ;:.: 'w :: z''' _ .. r ,= ' '", ° , ; a: ': . Water closet 16.60 Business name: Water heater 16.60 Address: Other: City /State/ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: n Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: !� c ,(/) i State surcharge (8% of permit fee) YY �\ TOTAL PERMIT FEE Print name: A y (d S r. ; „, j , Date` ?�, 2 „ 07 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 \Penn its \PLM- PermitApp.doc 06/26/06 4404616T(I0/02/COM/WEB) Plumbing Permit Application - City of Tigard ' Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: S1teUt111hCS s Fe e' ea *T-- 1= + , Qty ff : �t Square I+'bgtage ., "er • , ;5 , � '.;. � ., 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 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 q rm �aa x Storm & Rain Drain - 1st 100' 55.00 i aluat on: 4 elrmit' ,ee: = l , . .w^, $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 "" _ ri additional $100.00 or fraction thereof to and :F1XtU i'e, .. 0 l, i,:4; „ y . , 4 . a .' n e e a " , �tedlt "" a ' " R Qh Fe ( y, frTotitl 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: tPlankReviewfolrPlumliiigInstallations 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 greater, except systems designed and stamped by licensed '.z uanti b 'a u� .W k; ;" "Q� Y'(Fi t e) or Per•fo�med ". �re .,T., ` o ; , .,.: , engineer. �:Fiztures+T." . ": r �r i ,r h � � Re ce � =;h er ,- ° ::l.-," 5 Pravi s ; Gappea�,4 , Aiiaed = ! = "Extsttn ❑ 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,: ... . r,h Drinking Fountain z+0ffietr1C" OT'R15ed' &DIAIl'm gnu.a 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 Comments regarding fixture work: Garbage - Domestic Disposal - Commercial -Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang - Stall *Note: If the fixture work under this permit results in an Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and Bradley fees assessed for the sewer increase must be paid before the - Commercial Service plumbing permit can be issued. Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is\ Building \Permits\PLM- PermitApp.doc 09/22/06 Gates Creek Construction,LLC ' " Invoice CCB #127502 DEO #37712 MODERN SEPTIC SYSTEMS Date Invoice # 39370 SW Hartley Road 2/16/2008 675 Gaston, 503-985-7450 7119 -8595 RECEIVED BILL TO MAR 12 2& Carlos Patino CITY OF TIGARD 10605 SW Cook Lane BUILDING DIVISION Tigard, OR. 503- 680 -6264 /. T-- 0 (d 3 DESCRIPTION AMOUNT VERIFY SEPTIC TANK DECOMMIISSION @ 10605 SW COOK LANE, TIGARD OR. ioo.00 INSPECTION RESULTS: Septic tank was found empty indicating it was pumped A pile of crushed rock was found along side of septic tank Owner is now filing the tank with crushed rock INSPECTED BY1c.Q) ` 2/19/2008 Bill Billingsley s ft) v l �' Modern Septic Systems is a trade name used by Gales Creek Construction L L C Total $100.00 ` CITY ������M�������� ~- ' ��wo m ��n nn���mnm�� ^ ` BUILDING DIVISION PERMIT #: PLM2007-00103 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/12/2007 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 AO- IL INSPECTION WORKSHEET FOR DATE: 11M9/2007 TIME: 7:01AK4 PAGE: 16 SITE ADDRESS: 1U6DGEW COOK LN CLASS OF WORK: SUBDIVISION: FANTASY HILL LOT #: 009 TYPE OF USE: PROJECT NAME: MERZANDEZ DESCRIPTION: New ewer connection. OWNER: HERNANDEZ, CARLOS PHONE #: 503'680-6261 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/1E/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 355 k8ivc.iOopociiun 050920-01 603-G80-6364 Y Corrections/Comments/Instructions: Nw It CO • \ z� ---` \k ~ \ � K, ^ ^ a L� ^�'� �� z` �� -T- • r PASS gPARTIALAPPROVAL El CANCEL [1]N[>ACCESS El FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: Date: / >q 1 r17 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007- 01103 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3,112!2007 Phone: (503) 639 -4171 ei Inspection Requests (24 Hrs.): (503) 639 -4175 I . INSPECTION WORKSHEET FOR DATE: 11/16/200 TIME: 7:01AM PAGE: 641 SITE ADDRESS: 10605 SW COOK LN CLASS OF WORK: SUBDIVISION: FANTASY HILL LOT #: 009 TYPE OF USE: PROJECT NAME: HERZANDFJ DESCRIPTION: New sewer connection. OWNER: HERNANDEZ, CARLOS PHONE #: 503-6M-6264 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/16/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 395 Min. inspection 059792 -01 503 -680 -6264 Y Corrections /Comments/ Instructions: b` t 1 t t I AS S c P i 100 i +^) a ;_i dDi d--at Ca, ,,■ 'Pav Il PASS j, PARTIAL APPROVAL , ❑ CANCEL I ( NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C r i N V ri n " A M - , . 2 — ' Date: )') / / 0 0 Phone #: (503) 718-