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Permit CITY TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00249 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6!5/2008 PARCEL: 2S102DC -00507 SITE ADDRESS: 09155 SW EDGEWOOD ST ZONING: R -4.5 SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG PROJECT: LARVIK Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #31. Fees paid 6/5/2008. 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: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KENNETH LARVIK NYOKA W, TRUSTEES Description Date Amount 9155 SW EDGEWOOD ST [PLUMB] Permit Fee 6/5/2008 $72.50 TIGARD, OR 97223 [TAX] 12% State Surch 6/5/2008 $8 70 Phone : 503- 620 -5546 Total $81.20 Contractor: CANTRELL & SONS CONTRACTING 6860 SW NORSE HALL RD TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 638 -0800 Reg #: LIC 97005 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 B :ij / - ermittee Signature: of � � 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 Bui`Iding 'Fixtures ) . FOR OFFICE USE ONLY" City of Tigar O CSCs41 �oo� Received / �� _ P No / L ill v 13125 SW Hall Blvd , Tigard, OR 97223 w\ Date By (p i , Phone 503 639 4171 Fax 503.598 1960 ,� \V 0 A� a , Other Permit No se;��rr S' ' • M ill Ins ' Inspection Line 503 639 4175 � . TfGARD p V �lJ 'pia a Ready /By lures See Page 2 for Internet. www tigard-or gov O V 1N N otified/Method Supplemental Information - ' TYP OF WORK ` s Vy )' ` . - - FEE* , SCHEDULE . " -, ❑ New construction 1:1 Demolition 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 249.20 X and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00 ID Accessory building CI Multi-family SFR (3) bath 399 00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: . Fire sprinkler ( sq ft) Page 2 - ' ; e ' JOB.. A ND' LOCATIO . , _ :, . Site utilities Job site address: 9 / J f-s g 1,0 cI 3 e i. co oc] 5-I- Catch basin or area drain 16 60 City /State /ZIP: ; 9 Ai , c..)' \ 7 a _ 3 Drywell, leach line, or trench drain 16 60 Suite/bldg. /apt. no.: Project name: .y; Footing drain (no. linear ft.. _) Page 2 "` Manufactured home utilities 110 00 Cross street/directions to job site: Manholes 16 60 Rain drain connector 16 60 Sanitary sewer (no linear ft . ( Page 2 55).N Storm sewer (no linear ft : ) Page 2 Subdivision: Lot no.: Water service (no linear ft : ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16 60 DESCRIPTION_ OF ,WORK', %•* ' _ Backflow preventer Page 2 Rd) 6 k `1 vv J e ) t .5 n/ 1 h 0 ws - tc, c; ly Backwater valve 16.60 S < W Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16 60 ,. `' PROPERY OW TNER .' ' ' ' ❑TENANT , '" " -, Effectors /sump 16 60 Name: K e N Iva I\ I.. C7a>r ,,,,k_ Expansion tank 16 60 Address: 1 /55 S -C.: J 9 et,cOc9 q S / Fixture /sewer cap 16.60 City /State /ZIP: I ., et I, d oR q --)-9- 3 Floor drain/floor sink/hub 16 60 Garbage disposal 16 60 Phone: (SC)3) 6. - -L C., Fax: ( ) 16 60 ,_' , , . ::' `- ,: , ' :- , . � e = CONTACT P ERS ON• Hose i Ice maker 16 60 Business name: 5i-' _� 410 6 ✓ -- 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 , ., , . _ CONTRACTO,, , ;) „ , , . • Water closet 16.60 Business name: CIA b e / '�i S ;VS Water heater 16 60 Address: �o��/��,\6V rse- � ear!. Other G7C_J City /State /ZIP: Subtotal � I I U� ����� � Minimum permit fee. $72.50 Phone: (5 ) .—CJ�f U Fax ( ) Residential backflow minimum permit fee. $36.25 7 v cb CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) 70 Authorized signature: ��,,, ti TOTAL PERMIT FEE Q r Print name: k t h (_CI teU ; k Date: 6 /5/c 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 1 \Buitdmg \ Permits \PLMF- PermitApp doe 12/27/06 440- 4616T(10/02/COM/WEB) V • ` _ 14 VW `_ ^ /6, av Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information r • Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. " Fee (ea) Total ` 'Square Footage: Permit Fee: - Footing drain - 1 s' 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 Storm &Ram Drain - 1st 100' 55 00 Valuation: Permit Fee: . $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 �1%tl1l`e Or`)tem 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: $50,001 00 and up $742 00 for the first $50,000 00 and $1 20 for each additional $100 00 or fraction thereof Commercial Fixture Work: Plan Review for Plumbing Installations w ., 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*. 111 Any new commercial building with water service 2" and Q uantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type:. a 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 ' ISOmetric'or Riser Diagram' - 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 \Budding\Permns \PLM- PermttApp doc 12/27/06 CITY OF TIGARD ., BUILDING A • PERMIT #: P1M2008 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2008 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 „,--A-g. - 7 - l..... INSPECTION WORKSHEET FOR DATE: 8/5/2008 TIME: 7:00AM PAGE: 20 SITE ADDRESS: 09155 SW EDGEWOOD ST CLASS OF WORK: SUBDIVISION: EDGE:WOOD LOT #: 0 TYPE OF USE: PROJECT NAME: LARVIK DESCRIPTION: Connecting existing house to sewer. Septic lank to be pumped and filled. Reimbursement #31. Fees paid 6/5/2008. OWNER: LARVIK, KENNETH PHONE #: 503-620-5546 CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503,638..0000 Inspection Request Scheduled For: Date: 8/5/2000 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 073738-01 503-620-5546 N Corrections/Comments/Instructions: R A ,, ‘ e c _,!, e . r1 t - - A- \.„,....,Lt_ X PASS 0 PARTIAL APPROVAL El CANCEL El NO ACCESS El FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: 01114 ( I) k) (3_........— Date: 51 ,s1 rfn Phone #: (503) 718- cob - ' 11111111111111111111111 `�' _ � • Septic � I C � ■ ®■ ®� Date 07/22/08 Scheduled 07/25/08 p Work Order # W078268 08:00:00 fi ‘ ` t Ri ver CLi1ty E Vk�l�Ol�l l l �'I�( tai Jac" 503- 252 -6144 Complete Industrial P.O. Box 30087 Salem 503 - 363 - 2464 Vancouver 360- 896 -5256 Waste Removal y Septic Tank Cleaning Portland, OR 97294 www.rivercit usa.com Sump Line Cleaning OR CCB# 147355 WA CCB# RIVERCR981BT ,Y � S�te�yy,information � 1 Ken Larvik Ken Larvik 9155 SW Edgewood St 9155 SW Edgewood St Tigard Tigard, QR 97223 Contact: Ken 503 - 620 -5546 Hm 503 - 721 -6148 WK PO# e.G �. . © ®sariptiQofWor . .. 9 J nitsand;P ric�e �. Septic Service ���, ,� r ,;` <� �� Septage Overage ,.t;: {': :.RC Notes COD, Lid exposed, pumping for decomission, See Ken at 8:OOAM Friday, 503 - 620 -5546 • , Y tai; _ . . • Total Charges River City Environmental, Inc. is in no way responsible for damage to any vehicles, personal or real property. Terms: Net 10 days. 1.5% per month will be charged on past due accounts (18% per annum). Terms and Conditions The Right to Lien The customer agrees to pay all invoices arising out of services, and any other special services herein within 10 days The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered, over and above the normal servicing schedule, on behalf of the customer The customer agrees to assume responsibility damage to customer's real or personal property arising from services which take place on customers premises, where the drivers and vehicles of River City Environmental have been instructed to enter This includes, but is not limited to driveways, trees, power lines or poles and building structures If River City Environmental, Inc finds it necessary to add liquid to the tank on jobsite, customer will be charged for the additional gallonage resulting from these condidtions Customer agrees to reimburse River City Environmental, Inc for all reasonable attorney's fees court costs and other expense incurred by said company to enforce collection or to serve their rights under this agreement If this work order is not contested in writing within 10 days the full amount is considered due and payable Customer agrees to the above conditions A fax on the work order is considered an original Redeemable in Multnomah County { Check # Visa MC Amex Card ,# Exp Date Vcode Work Authorized by _.. _ 1 - °'l Date / Service Tech #1 ' Service Tech #2 Date / / 1 / Time / A 1r I r ^I ' I�.7i it till I y +Rn F yI:�II f' ',f Q. .. '1' ^. .+`( f ry .;� r