Permit CITY OF TIGARD PLUMBING PERMIT
' 2 :. COMMUNITY DEVELOPMENT Permit #: PLM2011 -00312
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/20/2011
Parcel: 2S103DC00818
Jurisdiction: Tigard
Site address: 11230 SW FAIRHAVEN ST
Project: HIDALGO Subdivision: VIRGINIA ACRES NO 2 Lot: 11
Project Description: 100 ft of sewer. Reimbursement district #30 fees paid 10/20/11.
Contractor: , CANTRELL EXCAVATING LLC Owner: HIDALGO, SALOME
16155 GILLIAM RD HIDALGO - BARRIOS, JESUS A
DALLAS, OR 97338 11230 SW FAIRHAVEN ST
TIGARD, OR 97223
PHONE. 503 - 638 -0800 PHONE'
FAX:
FEES
Quantity Description Date Amount
100 If Sewer Service 10/20/2011 $62.54
Specifics: 10 ea Minimum Fee Adjustment - 10/20/2011 $9.96
Plumbing
1 12% State Surcharge - 10/20/2011 $8.70
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or direct questions to OU by calling 503 232 1987 or :10 332.2344.
Issued By • • Permi ee `'• -cure:
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 ��jj,�
Building Fixtures � y� FOR
Re ceived OFFICE USE ONLY
ilq City of Tigard cv- Penult No 'I 1 3125 SW Hall Blvd., Tigard, �y ?. ! rLQ \ \ Date/By (0/27)//1 a /0/ ) / -0,- 1)...,_ Plan Review
D
Phone 503.718.2439 Fax 50` 98 196JJ � 0 9 y Other Permit No j ' ( I il 5-
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Ti.GARD Inspection Line 503 639.4175 O` ` Gt� � ,` Date Ready /By. Juns ® See Page 2 for
Internet. www tigard-or.gov
(* 1 �� Notified/Method F Supplemental information
TYPE OF WOR({ Q 1 .,`Cjv FEE* SCHEDULE
❑ Ne nstruction M. It ,: �litii For special information use checklist
• Description I Qty. I Ea I Total
Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
- and 2- family dwelling ❑ 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: (2.30 5( k `( henVe'f\ S� Catch basin or area drain 18 76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: --A \.i (A „_ ( 0 . c1 9_ Z.,ZS
Footing drain (no linear ft ) Page 2
Suite/bldg /apt. no. Project name: b k\ C:`,0 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18 76
Sanitary sewer (no. linear ft. ](,C) ) i Page 2 (p 5
Storm sewer (no linear ft • ) Page 2
Water service (no linear ft - ) Page 2
Subdivision: Lot no.. Fixture or item:
Tax map /parcel no.: Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25 02
Drinking fountain 25 02
Ejectors/sump 25 02
rgi PROPERTY OWNER I 0 TENANT Expansion tank 12.51
l Fixture /sewer cap 25 02
Name:
” `�CSt" 4 A, n ' `Ci lb5 ✓ 11��7`) a " 1-1‘Acac r' Floor drain/floor sink/hub 25.02
Address. } i /L�6 54 } ak f how -f /L Garbage disposal 25 02
City /State /ZIP: —1 l q r Xct C ° Z-Z ? Hose bib 25 02
Phone: (503 So v- 0 6 Fax: ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name:
Medical gas (value. $ ) Page 2
Contact name • Primer 12.51
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
Water closet 25 02
CONTRACTOR
Water heater 37 52
Business name: Cn l,N-t - «tI. cod, 56(yg �= X L Oc Waterpiping/DWV 5629
Address: ;5 m /�j Other. 25 02
City /State /ZIP _d // s o (2---- ``--��q 7.3 Subtotal
Phone: ( 7 3Q DKoo Fax • ( ) Minimum permit fee. $72 50 7
ll iKCB Lie i 1 6- C �/ D l Plumbing Lie. no.: Plan review (25 %ofpetrrtit fee) l
II `` , State surcharge (12% of permit fee) p t . "? Authorized signature: l V TOTAL PERMIT FEE O �, ) r) Date: I This permit application expires if a permit is not obtained within 180 days
Print name'
�, /Q e /-/z1) lC" ) Z C /7) II after it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board
I \Buddmg\Permlts\PLMU- PermriApp doc 10/01/09 440- 4616T(10 /02 /COM/WEB) V \ �' q ' ' ( & r
U '1--GO r �1 C) C� ��
PlumbinE 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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62 54
$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
P 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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixtdre Type for Replace/ Please check all that apply
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath - Tub /Shower
engineer.
- Jacuzzi /Whirlpool
Car Wash Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918- 780 -0040.
Cuspidor /Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher - Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 780 - 0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain /sink - 2"
3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal - Domestic food related
- Commercial food related
- industrial food related
Ice Mach fRefrig Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Lav /Bar non -food related
- Bradley
- Com/Sery /Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filler increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures
L: \Building \Permits \PLMF - PermitApp doc 08/04/2011 2
I
i
Community Devefopmern
T IGARD !
Reimbursement District Payment Worksheet
Planning /Engineering to complete:
Site Address I ( 2. •� S t' ct.t�(�.c ��-y1 C J •
Parcel No. ZS 10 3 h L 00 ''i 8
do
Reimbursement Distract No 3 8 Amount Due• $ (67 Coo
Date 1v / U/`/ By . h^".21, 4" kbz, eo
Qr.sd to 10 /2.8(I/
Not Amount due is as of date shown above 1
t'eferred Accounts:
Name
Phone Number
Legal
Amount paid $
Remaining to be paid, deferred am., t $
Buildin Division to com,s lete:
Reimbursement amount paid. $ 0(.1)
Received by L s �
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
1 \CURPLN \ Masters \RennburseWorksheet doc 2/23/07
JOB INVOICE
ORVALL T. CADE
BYER'S SEPTIC TANK SERVICE, INC.
P.O. BOX 549 -
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO DATE ORDERED
(503) 656 -3326 1 0- 27 - 1 1 -
ORDERTAKENBY DATE PROMISED A Al
Pirn,fo // - 003I1 graCP 10-77 ❑ PM
BILL TO PHONE
Gene Cantrel Scott- 312 -1363
ADDRESS MECHANIC
87
CITY HE
JOB NAME AND LOCATION ❑ coy WORM
11 230 SW Pal rhaven St. Ti g ❑ CONTRACT
DESCRIPTION OF WORK ExiRn
off 115th.
QUANT DESCRIPTION OF MATERIAL USED PRICE AMOUNT
Tank pumping 3y7). o D
>
HOURS LABOR AMOUNT TOTAL
MECHANICS @ MATERIALS
TOTAL
HELPERS LABOR
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work
SIGNATURE DATECOMPLETED TOTAL
•
`1