Permit C ITY OF TIGARD PLUMBING PERMIT
•i PERMIT #• PLM2008 -00298
COMMUNITY DEVELOPMENT
TIGARD 13125 5W Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED' 7/14/2008
PARCEL' 2S103DC -00821
SITE ADDRESS• 11290 SW FAIRHAVEN ST ZONING: R -3 5
SUBDIVISION: VIRGINIA ACRES NO 2 LOT. 014 JURISDICTION: TIG
PROJECT. HAMILTON
Project Description. Connect existing house to sewer service, septic tank is to be pumped and filled Reimbursement
District #38 fee paid this date
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: 100 ft
WATER CLOSETS: WATER LINE• ft
DISHWASHERS: RAIN DRAIN. ft
Owner FEES
LARRY & MA HAMILTON
11290 SW FAIRHAVEN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/14/2008 $72 50
[TAX] 12% State Surch 7/14/2008 $8 70
Phone: 503- 639 -1214 Total $81.20
Contractor.
LOVETT EXCAVATING INC
PO BOX 86280
PORTLAND, OR 97286 REQUIRED ITEMS AND REPORTS
Contact # . PRI 503 -504 -2847
FAX 503- 288 -1630
Reg #: LIC 125507
PLM 26 -773PB
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 r - • • -ct questions to OUNC by calling 503 246 6699 or 1 800 332 2344
Issu• • By: Q - I itaguaft, Permittee Signature. x /17404\4 .k - t711Th-
Call 503.639 4175 by 7:00 a m. for an inspection that business y
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 1 I I FOR oI FicE USE ONLY
Received City of Tigard Date /B 1 Permit No g /4-19 00 g--602? fo
13125 S W 1 fall Blvd , Tigard, OR 9722 Plan Review I
_ Phone 503 639 4171 Fax 503 598 1960 DateBy Other Permit No11-)e2,208---00 (i p
-- TIGARD. Inspection Line 503 639 4175 Date Ready /By in. RI See Page 2 for
Internet www tigard -or gov Nolrtied/Method , Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ 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 24920
❑ I- and 2- family dwelling ❑ Commercial /mdustnal SFR (2) bath 350 00
❑ Accessory building ❑ Multi -family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other,
Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address /12 ,-c..O 1 /L)4 t 13 r— Catch basin or area drain 16 60
City /State /ZIP --TT& 4- 2- D 2 972-2 3 Drywell, leach line, or trench drain 16 60
Suite/bldg /apt no I Project name (I . H 1 L ^, Footing dram (no linear ft Page 2
' WT Tp Manufactured home utilities 110 00
Cross street/directions to lob site
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft /005 Page 2 55 a'
Storm sewer (no linear ft ) Page 2
Subdivision I Lot no
Water service (no linear ft ) Page 2
Fixture or item
7 ax map /parcel no
Absorption valve 16 60
\ \
DESCRIPTION OF WORK Backdow prevcnter Page 2
l J f71J0 FA 1 Ex 15T/ IV�n ?fRS£ TU ai fA)Ple, Backwater valve 1660
Clothes washer 16 60
Dishwasher 16 60
L PROPERTY OWNER I ❑ TENANT Drinking fountain 16 60
Ejectors/sump 60
Name V x' 'LL. fMt.
A/ � 4).4 i Lib 3 Expansion tank 16 60
Address I. a-4' Q dL A ) 1%fr t ID MU e fJ CT • Fixture /sewer cap 16 60
Qty/State /ZIP to tr•i c'2_ 9 7? - ? Floor drain/floor sink/hub 16 60 -
Phone (+ )t) 3?-/?Iii Fax ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON lose bib 6 60
Ice maker 16 60
Business name Interceptor /grease trap 16 60
Contact name Medical gas (value $ ) Page 2
Address Primer 16 60
Qty /State/ZIP Roof drain (commercial) 16 60
Phone ( ) I Fax ( ) Sink/basin/lavatory 16 60
Tub /shower /shower pan 16 60
E-mail Urinal 16 60
CONTRACTOR Water closet 16 60
Business name �O f l l Ex e4J Rue_ Water heater 1660
Address f=p -jpK VDAg0 n Other
city/state /ZIP Po - TL6!sip Dn � 4 72 Subtotal
�/1�ry {jyj 2 Minimum permit fee $72 50 q
Phone @,) 534 - cO O 41 Fax (7r3) p - / ! CP o Residential backflow minimum permit fee $36 25 70/ "
CCB Lie t 9. Plumbing Lie no A6 .. 773 fl Plan review (25% of permit fee) --(
Authorized signature/ Z 7/1/ It State surcharge (12% of permit fee) g'.. 70
►, .e TOTAL PERMIT FEE u'l, 20
Print name Man d v ( F ain i (t o') t Date 7 p[771 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 i Building iPermas\PLMRPerrniApp doe 12/27/06 440 -4616Tt 1 0102 /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 - I" 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
Valuation: Permit Fee:
Storm & Rain Dram - Is[ 100' 55 00 $1 0010 $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 tor each
Fixture dr Item Qty. Fee (ea) Total additional $100 00 or fraction thereof, to and
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 Backtlow 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
Inspection of existing plumbing or each additional $100 00 or fraction thereof to
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
Fixture Work: Plan Review for Plumbing Installations
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 wuh water service 2' and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: 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
- lacuin /Whirlpool ❑ Any multipurpose fire sprinkler system
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040
-Drive I hru
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"
Car Wash Drain
Garbage - Domestic _ Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach /Refng 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 -1 octet _
Urinal
Other Fixtures
i 1nulldingWernns'PLM- PcrmitApp doe 12/27/06
AALLPUMP SANITATION SERVICES
Da** Corp.
191
13023 NE }lbw. 99 07
Vancouver, WA 98686
(360) 387-2969 Port. (603) 235-5838
"CUSTOMER'S ORDER NO PHONE - DATE, "N
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NAME
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NET 30 days A finance thaw of 11/230 per month
(3.893 perannerna beTcha ciraffneaf bit/alas — - I
TAX r-t
Collection aral ba assessed if necessay.
RECEIVED BY
TOTAL n crin
All claims and returned goods MUST be accompanied by this bill
M Rat
3870 erhanir9(ou
CITY OF TIGARD ,1
BUILDING' DIVISION PERMIT # PLM2008- 00298
13125 SW Hall Blvd , Tigard, OR 97223 DATE ISSUED* 7/14/2008
Phone. (503) 639 -4171 �^I
Inspection Requests (24 Hrs )• (503) 639 -4175 .2'u °7 I II
INSPECTION WORKSHEET FOR DATE' 8/1212008 TIME 7:00AM PAGE 8
SITE ADDRESS. CLASS OF WORK
SUBDIVISION:
11290 SW FAIRHAVEN ST LOT #• TYPE OF USE
PROJECT NAME VIRGINIA ACRES NO. 2 014
HAMILTON
DESCRIPTION
Conned existing house to sewer service, septic tank is to be pumped and filled Reimbursement
District #38 fee paid this date.
OWNER. HAMILTON, LARRY & MARY JO PHONE # 503-639-1214
CONTRACTOR LOVE! I EXCAVATING INC PHONE # 503. 504 -2847
Inspection Request Scheduled For. Date. 8/1'2,2008 Pour Time
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 074076 -01 603- 317 -5358 Y
Corrections /Comments / Instructions
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PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l wf a c\ ,,,,_ Date' T"\ 0 ` ?, Phone # (503) 718-