Permit •
• �
F CITY OF TIGARD PLUMBING PERMIT
,r COMMUNITY DEVELOPMENT PERMIT #. PLM2008 - 00448
TIGARD DATE ISSUED. 12/9/2008
13125 SW Hall Blvd , Tigard, OR 97223 503.639 4171 PARCEL 2S103DC - 00822
SITE ADDRESS 11310 SW FAIRHAVEN ST ZONING R - 3 5
SUBDIVISION. VIRGINIA ACRES NO 2 LOT. 015 JURISDICTION' TIG
PROJECT CUMMINS
Project Description: Connecting existin house to sewer, septic tank to be pumped and filled Reimbursement # 38 Fees
paid 12/09/08
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
ROBERT CUMMINS
11310 SW FAIRHAVEN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/9/2008 $72 50
[TAX] 12% State Surch 12/9/2008 $8 70
Phone 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 rules or direct questions to OUN calling lin 503 246 6699 or 1 800 332 2344
Issued By � \x�0 L-54,/j Permittee Signatur: \ _
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 'V) 2 to 1 - GG .2
Building Fixtures CJ' et Foe"oFFICE USE OSIiY /x' L11'1
City of Tigard 1 . , ' a i t Pem'n No S ii as i •W 4t
q 13125 SW Hall Blvd, Tigard, OR 9722 "!an Rciew
111 11 2 - Phone 503 639 4171 Fax 503 598 1960 Other Permit No •
Inspection Line 503 639 4175 .∎ 4� �� Date /ey tuns SO o C
P Date Ready /By 0 See Page 2 for
TIGARD Internet www tigard -or gov O ` �� Notified/Method Supplemental Information
• TYPE OF WORK �\ FEE* SCHEDULE
❑ New construction ❑ Demolitio 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 (I) bath 24920
❑ I- and 2 -family dwelling ❑ Commercial /Industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi-family SFR (3) bath 399 00
Each additional bath/knchen 45 00
❑ Master builder ❑ Other
Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address / f 5!0 s� / 7;1 - //Z 4/ y-, v e Catch basin or area drain 16 60
City/State//1P j / c ," Z
A t , / _ 77 2
2 ., Drvwell, leach line, or trench drain 16 60
Suite/bldg /apt no l 1 Protect name 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 )lid ) Page 2
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
Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 6 W
Electors /sump 16 60
Name glJsAt7 ,---5y, H „' ..��a Expansion tank 16 60
Address / / 3 / O 5- ci 1,.'/2 h074/6y Fixture /sewer cap 16 60
City /State /ZIP 7 Ki 97 z z 3 Floor dram/floor sink/hub 1660
Phone (SUS .637 35p3 ti 64(5"-- o5-8/ Garbage disposal 1660
CC 1/ Hose bib 16 60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16 60
Business name
Interceptor /grease trap 16 60
Contact name Medical gas (ealue $ ) Page 2
Address Primer 16 60
City /State /LIP Roof drain (commercial) 16 60
_ Sink/basin/lavatory 16 60
Phone ( ) Fax ( ) 'I ub /shower /shower pan 16 60
E-mail Urinal 16 60
CONTRACTOR Water closet 16 60
Business name ? 4-.� � YQ aucti t r �, 1 v,_ C Water heater 16 60
Address o Other
l (� k k � � z Q 7�. Of Subtotal r Cn} /Start /LIP
l n \ Ci ll / v l0 Minimum permit fee $7250
Phone (SO) Soy • 2 A 4i Fax ( ) Residential backflow minimum permit fee $3625
CCB Lie Plumbing Lie no Plan review (25% of permit fee) —
State surcharge (12% of permit fee) O 70
Authorized signature
/ TO'I AL PERMIT I'LL 0 10
Print name r• 2 ) 3 r ] rg ...Li -ei . _;7 Date / 2r/e. This permit application expires if a permit is not obtained within
l _7/ 180 days after it has been accepted as complete.
'Yee methodology set by In-County Building Industry Service Board
I ABmldinglPenmislPLMI - PermitAppdoe 12/27/06 4404616T(10/02/COMRvFa) 2 1 / 2 0
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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 - 1" 100 55 00 0 to 2,000 Si I5 00
Footing drain - each additional 100 46 40 2,001 to 3,600 $160 00
3,601 to 7.200 5220 00
Sewer- 1st 100' 55 00 7201 and greater $309 00
Sewer - each additional 100 46 40
Water Service - 1st 100' 55 00
Medical Gas Systems:
Water Service - each additional oo 46 ao Valuation: Permit Fee:
Storm & Rain Drain - 1st 100 55 00
$1 00 to $5,000 00 Minimum fee $72 50
Storm & Rain Dram - 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
Fixture' or 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 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 duelling 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
specially requested inspections - per hour 72 50
Subtotal: $50,001 00 and up $742 00 for the first st $ $ 00
$50,000 00 and $I 20 for
each additional $100 00 or fraction thereof
Commercial 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 with water service 2 and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer
Previous Capped Added Exishna ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined nn OAR91 8
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 OAR9 1 8-780-0040
-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'
4
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach /Refrig Drams
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 - Collet
Urinal
Other Fixtures
BuddmgwPcmmts PermiApp doc 12/27/06
a;= •
CITY OF TIGARD it,
BUILDING DIVISION P MIT # PLM2008-00448
13125 SW Hall Blvd , Tigard, OR 97223 J DATE ISSUED. 1J9/2000
Phone (503) 639 -4171 I C I l V
Inspection Requests (24 Hrs) (503) 639 -4175
INSPECTION WORKSHEET FOR DATE 12/11/2008 TIME 7.00AMl PAGE. 13
SITE ADDRESS- 11310 SAN FAIRHAVEN ST CLASS OF WORK:
SUBDIVISION VIRGINIA ACRES NO 2 LOT # 015 TYPE OF USE
PROJECT NAME: CUMMINS
DESCRIPTION Connecting existin-house to sewer, septic lank to be pumped and filled. Reimbursement it 38 Fees
paid 12/09/08
OWNER CUMMINS, ROBERT PHONE #
CONTRACTOR LOVETT EXCAVATING INC PHONE # 503-504-2847
V IPs
Inspection Request Scheduled For: Date: 12/11/2008 Pour Time.
Code # Inspection Description Confirm # Contact # Mes -.ge
399 Plumbing final 078978-01 503-317-5358 Y
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Corrections /Comments /Instructions:
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• V PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL CALL
LF�\FOR / INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: " l/V V Date.) VI I / O p Phone # (503) 718 - °2-te
•
AJAILPLIMP !Ag; "TI1TK N SERIES
Daeicc Corp.
191
13023 NE Hwy. 99 #7
Vancouver, WA 98586
(360) 887 Purt. (503) 285.5838
CUSTOMER'S ORDER NO PHONE DATE
NAME fr
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I f �
ADDRESS _ ____
SOLD BY CASH COD CHARGE ON ACCT MDSE RETD PAID OUT
OTY DESCRIPTION PRICE AMOUNT
I` ' - - ------ - -/i .2-2 5__ 5(A) F /p " , -- }1 �:�: 1 ---- - 7 S
1-ec---i`
,
— Payoff tnis invoice- ----------'__-- -
NET 30 days A finance charge of 11/2 ter month
- (93Y6 per aru iifi anit he chafed an unpaid arir Pas
Cohteuon fees ?Abe be assessed r pe; c ssa TAX )a-- ?;
RECEIVED BY
TOTAL sC ; C) Y
All claims and returned goods MUST be accompanied by this bill
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