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Permit CITY TIGARD SEWER CONNECTION PERMIT Er PERMIT #: SWR2007 -00096 COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/25/2007 PARCEL: 2 S 103 DA -01600 SITE ADDRESS: 10755 SW DERRY DELL CT ZONING: R -3.5 SUBDIVISION: DERRY DELL PLAT 2 LOT: 016 JURISDICTION: TIG PROJECT: COUSINEAU Project Description: Connect existing house to sewer lateral. TENANT NAME: CWS NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS: 1.0 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Owner: FEES STEVEN COUSINEAU 10755 SW DERRY DELL CT Description Date Amount TIGARD, OR 97223 [SWUSA] Sewer Connection Fee 4/25/2007 $2700.00 [SWINSP] Sewer Inspection Fee 4/25/2007 $35.00 Phone: 503- 443 -3687 Total $2,735.00 Contractor: REQUIRED ITEMS AND REPORTS Contact #: Reg #: This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issue by: ' I Permittee Signature: lJ I ' �� - _ • . 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. • IMIll CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00163 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/25/2007 PARCEL: 2 S 103 DA -01600 SITE ADDRESS: 10755 SW DERRY DELL CT ZONING: R -3.5 SUBDIVISION: DERRY DELL PLAT 2 LOT: 016 JURISDICTION: TIG PROJECT: COUSINEAU Project Description: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. 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: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES • STEVEN COUSINEAU 10755 SW DERRY DELL CT Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 4/25/2007 $72.50 [TAX] 8% State Surcha 4/25/2007 $5.80 Phone : 503- 443 -3687 Total $78.30 Contractor: THE EXCAVATORS LLC PO BOX 690 YAMHILL, OR 97148 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 649 - 5354 Reg #: LIC 152333 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 0001 -0010 through OAR 952 - 0001 -0100 You may obtain copies of these ru s questions to OUNC by calling 503 246.6699 or 1.800 332.2344. 0 ` I in\ Iss d By: , i . 4 • Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application r , 'a' * z ,, t * i a T 1. 4 H x a' t r a. e iy 3 x ,,? yn 4,1,4 . �. Site Utilities m, i 3 X 1' , .9 , + 0,12 Ori ,,,:..:..•-•,,,,:,:.!-.,., IC L USE UNL'1 + x' s r P Y .t;X ■r - 4 ... , �. s a ,'l;': �; i ran ,, �+"t . A '!.."ii? w,44:k - ,$.. . City of Tigard Received P N-- II 13125 SW Hail Blvd., Tigard, OR 97223 Plan Y °�`� 0 o G � ^ � 7 / � Date/By Other Permit No /� 1 ` 111 .7 Phone 503 639.4171 Fax 503.598.1960 y nn••,oru��� , r Inspection Line: 503.639.4175 Date Read /B 1 ® See Page 2 for T1 G: AKD, Internet: www.tigard or.gov Notified/Method Supplemental Information t � t- ,_ ': , � .,,'. TY F °4W RK', '>7a ^4'w0't;" ; ., r i,r s. -c'�' :4-','a.:, :r . w, ' ;; -5,', , t' ,. �Fy ryM, 9 , _� �,�'.t. �'E .;8 REDUCE, - , ,ate,, �. - Air• ".�- :Lys, q �h _ , .rr �. , ��l'',.tnti'Za'_ � - PE -0 's.' 0_ r r �� - � , : t4 -,.pa u. ��, �e -4d. : -.a 3,' �.. w . 4 _, .., � � .. j ❑ New construction ❑ Demolition For special information use checklist. • Description 1 Qty. 1 Ea. 1 Total ❑ Addition /alteration/replacement ❑ Other New 1- 2- family dwellings (includes 100 ft. for each utility connection) 3 : * `":'' ' "' '''' a CATEGORY, OF . CONSTRUCTION" `` * w;' - '' r ' ' ' 4'''Fi''-' S FR (1) b ath 249.20 ❑ 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: ,:`' �.. .:• F< .,. ,..•.,•.,; : _ Fire sprinkler ( sq ft ) Page 2 s JOB=SITF INFORMATR V VN: ° `"�: } "' 3' #'"� `t=�.i 4�� �x. ';�sw� , ; •k�.•,, _...,- � , . , ONE .A1V,D', LOGA'i']UN,,;�ys��•�a *W �' �'':`"in ° � �� - � ' � •� __ ��' Site utilities Job site address: 0 7 SS .5 Niq D e . rr ' e \ C--'t , Catch basin or area drain 16.60 City /State/ZIP: V 3 c, A 0 Q -7 23 Drywell, leach line, or trench drain 16.60 j0_01.10.-i ` 1 e Pr � Footing drain (no. linear ft.: _) Page 2 Suite/bldg./apt. no.: Project name: r�l Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 P C .f r< 2 c i 9 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) / Page 2 53 • C) Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no : Water service (no. linear ft.: _) Page 2 Tax map /parcel no.: Fixture or item 1; 't'�,�,' +r - y „r ;: .. > . ,.�r »^ rz..- e• n*�•• ;--.: rxra ,caw.,:;. nra•,F.""Y - a ,- Absorption valve 16.60 " -'?z r .� a > `i;.' , wm � fi D TION: ?' w 'S°'SAI °- � l ' + ri ; I r�`.t ,i,F; . .••;�.,,A x ," „f _ .., ,r , O t,x,.p,,w s - g.,, -R - �� l,`JI i > �r • ��• � � i Back p Page 2 % %��S _ / 0 � /�/ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 • "i ..∎ , ' PROPERTY ti it ; ` „ ; " : 41.2, - Ely Drinking fountain 16.60 ',w. ,*`'�:a.. ^.• , , ,,�.:.,•.i..°, -, , 4, ,, ,.. a,., ... ;..kAi:.:, "`= v, ` 4,iu -1-zi- " a '' s ® • . ?T AT!IT�;, :i , I Ejectors/sump 16.60 Name: SS'- p_J!,o C2 .,"),,,Si vt Expansion tank 16.60 Address: i n 7 $ S s 1M 0 r r r b e l l CI.. Fixture/sewer cap 16.60 City/State/ZIP: � ' i5 car � © � � 7 +^ / 2 Z `3 Floor drain/floor sink/hub 16.60 Phone: (L d3) Ti 3 - 3G $ 7 Fax: ( ) Garbage disposal 16.60 is "'� : `,y,,, .x' ., , :' �. �, :=-. ?- : . ^', ss:.,° , -..-, , " SO 'r9 + 1 �' �?;' �.ti�`�P c ®t. AP,PLIC ��«:'- - : t , f��. ❑t"CON7`ACT.,� `��-- �.rd3, Hose bib 16.60 : �.� �. �a�,..�.� �,b _. �_.„ � a�,{,t;,� "�• � , �, . , PER IVr �„ a.�; " �` � 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:( ) Fax..( ) Sink/basin/lavatory 16.60 E -mail: Tub /shower/shower pan 16.60 ,{ ?tl " t wJ a , �. , m Urinal 16.60 i , ?m +-& CONTRA TO ` " 4 o „t ',o,' ,.,,,, ,i- 6 6 g'4 � "� #h <"se. �Y'4�.xSl` ,na;. �, : rw. �•> �r.; b, o'. u-. �A1a�zr.. �. x' �v." �y' d�' �A`''" �i"*. ,.` "�.''� Water closet 1 0 Business name: - ru e t X cc ✓ u tai($ L L C Water heater 16.60 Address: Po • 6 ( Other: City/State/ZIP: 'ctw.c OK 0 1 - 7 11-1 Subtotal � Minimum permit fee: $72.50 ''7 o° 750 Phone: ( 03 70 - 7_,70 Fax: ( ) (p f� �v D i� Residential backflow minimum permit fee: $36.25 ( CCB Lic.: i 5 Z 33 Plumbing Lic. no.: Plan review (25% of permit fee) .... Authorized signature: Q State surcharge (8% of permit fee) S,QO L� ��- TOTAL PERMIT FEE 78 , Print name: S ��� P+vA.c+CI ` � 1 �,e;� D ate:2c A 41 2 04 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. l :\BuiidrngWeanitsWLMU- PermitApp doe 06/26706 440-4616Tt10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: , iSite tdlltti 044 ._ ; ; -. Qt i a' Fee.(e'a) T a t uu. 2 Ota e., � "ce.,": =`M,,: �� ° 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 S 5 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 Permit -F e e: 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 , (e r a v`' Totals' additional $100.00 or fraction thereof to and . F1xtUre �:� 'x,„ �,.�;: �y t y . Fee� •�a� � � ' 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 $100.00 or fraction thereof Fixture Work: �•_. ; �;- �: Plan '�Iteviev%�foi-$`Plp`i>nliii g;�Installation "s ��,�_�.`. 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 eater, except systems ;; ,-'�,, �� :7,4 ; N�r ,• QaaofifY= tiy,(Flature).WorkPerformed•� greater, designed and stamped by licensed p Fuirire.TYPe =.. � z r "� n- Replace ^ engineer. o s -= - 'Cepped'r 0Added� `�l?aistin U , a ❑ 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 ❑ My 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 Y .xy ��*��"�." ��+tws,P• .�.� , r - .:'�sv.�� - ,,t�. e,�.h�'�s��.a. Pa i .� ..:.: a .D'agramk�•a,w Drinking Fountain � �`� , "''1'�SOmeti7lC�Ul'�R1S I' 1 •'ss 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: 'Biuldmg PennitstPLM- PertnnApp doc 09/22/06 CITY OF TIGARD - - BUILDING DIVISION PERMIT #: PLIv42007 -00163 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4125/2007 Phone: (503) 639 -4171 �lNu(' Inspection Requests (24 Hrs.): (503) 639 -4175 �_!!+�,� f- IL INSPECTION WORKSHEET FOR DATE: 5/22/2007 TIME: 7:01AM PAGE: 45 SITE ADDRESS: 10755 SW DERRY DELL CT CLASS OF WORK: SUBDIVISION: DERRY DELL PLAT 2 LOT #: 016 TYPE OF USE: PROJECT NAME: COUSINEAU DESCRIPTION: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. OWNER: COUSINEAU, STEVEN PHONE #: 503 - 443-3667 CONTRACTOR: THE EXCAVATORS LLC PHONE #: 503 - 649 -5351 Inspection Request Scheduled For: Date: 5/2/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 047513-01 503-317-6694 Y Corrections /Comments /Instructions: W " /7 -lam , s" PASS I I PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS I FAIL I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: �7"b 1 13� Date: S) [b Phone #: (503) 718-