Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00519
13125 SW Hall Blvd., Tigard, OR 97 1 223 503 - 639 -417 DATE ISSUED: 10/5/2005
PARCEL: 2S 103AC -01100
SITE ADDRESS: 11465 SW FONNER ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Line work to connect to sewer. Septic system to be pumped and filled or removed.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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
THOMAS PHELAN Description Date Amount
806 OFFICERS ROW
VANCOUVER, WA 98661 [PLUMB] Permit Fee 10/5/2005 $72.50
[TAX] 8% State Surcharl 10/5/2005 $5.80
Phone : 360 - 993 - 2275 Total $78.30
Contractor:
SOVEREIGN HOMES
806 OFFICES ROW REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98661
Phone : 503- 816 -7536
Reg #: LIC 110180
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 503-246-6,t9 or - 800 - 332 -2344 i
Issued By: . � _ _ . Permittee Signature: ,(A N( Li 4jA/ )t/r/L-elt—
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.
Pu: ding Fixtures •
g � VI
Plumbing Permit A E hfOR ochlcr. 'ONLY-'
City of Tigard OCT
Plan ��}}
�°T ® 2005 Received Date /By l/ / O5 21te Permit N. / .1�9
13125 SW Hall Blvd., Tigard, OR 97223 `s 1 Revie)y C J
•
Phone: 503.639.4171 Fax: 503.598.1960 /Ain * l i\ Date /By Other Permit 3/5
24- Hour Inspection Line: 503.639.417C1TY OF TIGARD ■ I� '•f I Date Ready /By: °k El See Pa�ge for
[ [J
''Internet. www.ci.tigard.or us BUILDING DIVISIO Noufied/Method: Supplemental Information
TYPE OF WORK FEE* S EDULE
• ❑ New construction ❑ Demolition For special information use checklist.
Description I Sty. 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
❑ 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:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION` AND "LOCATION - Site utilities
Job site address: 5 � Al � ` Catch basin or area drain 16.60
City /State /ZIP: / J,,.(t .- 0 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: (�J I Project 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 - ) JO 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 Back flow preventer Page 2
Backwater valve 16.60
/ Clothes washer 16.60
• 1 TI � ((( 1 n/ C�/ Dishwasher 16.60
Drinking fountain 16 60
T. PROPERTY OWNER ❑ TENANT e
� ji Ejectors /sump 16.60
Name: 0 Iir ( t Expansion tank 16.60
Address: r �i/� 5 C'Q i-4- LZ) T / Fixture /sewer cap 16 60
City /State /ZIP• \Q, (1 0 L.ti.ve)2. V-A 9 X" IQ ( • Floor drain /floor sink/hub 16.60
Phone: (&,„t) ' 43_ �2_ 7& Fax ( ) Garbage disposal 16 60
Hose bib 16.60
- ❑ APPLICANT ❑ CONTACT PERSON •
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
Tub /shower /shower pan 16.60
E -mail Urinal 16.60
CONTRACTOR I Water closet 16.60
Business name: 0 )1- j.--e l 6- 1--lll U m a `s Water heater 16.60
Address: /� (� /-' Other:
��i �' (� K.S (C� ��� Subtotal
City /State /ZIP: V ii (79 L L V e e F ' ( � (C j
i Minimum permit fee: $72 50
Phone: ECO ) (0 " �6.3 Fax: ( ) Residential backflow minimum permit fee: $36.25
rs
CCB Lic. ! 1D/00 l � s Pluml)ng Lic. no. l ! A$�05 Plan review (25% of permit fee)
Authorized signature: (, Dl / State surcharge TOTAL of permit fee)
// /�A �`' I • TOTAL FERMI "I' FEE
Print name: \jam( I? ,ciA 2yrr -? -- Date < 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.
i \ Building \Permits\PLMF- PermitApp doe 06/05 440-461 6T( 10/02/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 - 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 ,
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 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
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 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
specially requested inspections - per hour 72.50 and including $50,000.00
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 Complex Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath -Tub /Shower ❑ Medical gas and vacuum systems for health care facilities-
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink -2" Submit 2 sets of plans with any of the above.
-3"
.
Car Wash Drain ‘ Isometric or Riser Di agra m ,
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
-Industrial .
Ice Mach /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal - • fees assessed for the sewer increase must be paid before the
Other Fixtures plumbing permit can be issued.
i \Bu lding\Perm ts\PLM- PermitApp doc 07/05/05
11/04/2005 16:44 5039251290 FLYING H PAGE 03/04
•
Scheduipd 10/27105 Date 10/27/05 . -... A
Work Order # W032C69
River City Environmental, Inc. Complete industrial
P.O. Box 30087 503- 252 -6144 Waste Removal
Portland, Oregon OR CCB# 147355 WA CCB# R!VERCE981BT Septic Tank Cleaning
97294 Sump
Line Cleaning
Flying H Construction Site Information
PO Box 2533 PO#
Wilsonville, OR 97070
503- 678 -4224 11465 SW Fonner, Tigard, OR
Description Units Amount
Septic Service f ��! G ;70.3T_,
• ,' 2e
Instructions: Driver Notes
Resident Name: Valda Summers
The tank is in the back yard. There are orange
flags marking the tank. Leave receipt on -site.
There is a tree stump you can attach the work
order receipt to. Use a rock to hold it if you need
to. • -
� � // rt R F� 1! ,.l fir' '. ; s / (P,
River City Environmental, Inc. Is in no way responsible for damage to the septic tank or lids on the systrrin.
Terms: Net 10 days. 1.6% 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 pumping 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 to customer.
The customer agrees to assume responsibility damage to customer's real or personal property arising from pumping services which take place
on customer's 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 jobafte, 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 trils agreement.
Customer agrees to the above condltlons Red in Multnomah County
Work Authorized by l7 Cc, Data/ 1 0 '! mss'
Driver Signature DateT T ime
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rtri 7 ,. " - rte t n [� 1 fp 77i
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CERTIFICATION OF EXISTING SYSTEM
ABANDONMENT
I I Y '
SEPTIC PERMIT NC., " ��
1'16- i�"6 l �-
T i S, R r 1 i" Section 0 lA�; Tax Lot(s) C V°®
I certify that the existing septic tan / drywell / cesspool (circle one or more)
was properly abandoned to 'a - standards. The sewage contents were �� �
removed by pylt cfr. <> ti®D`
(Company Name) "?\‘Y'
a licensed sewage disposal pumping service. The unit was then backfilled with , ° mac
rock or nd a d the building sewer promptly capped or removed. 0 J` �o
Signature L g CAii<re Date
• Attach a copy of the pumping receipt.
• Remit completed form to:
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E TIGARD INVOICE
•® SAND & GRAVEL, LLC INVOICE :NO. 81796
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P.O. RO)t 4610 • TUALATIIN, OR 97062 INVOICE DATE 10/31/0
PHONE (503) 692 -1800 JOB Na ORDER NO.
SPECIALIZING IN MEETING YOUR AGGREGATE NEEDS - ,
DELIVERIES•CRUSHED A OCK•FILL MATERIALS•9AN P•PECORATIVE ROCK F L¥ 1Z 0 5 0 0 4
F 7 F0 NER
609 _
_ fl.yi rg H Co1'Y,$ +ruct on
cu PO BoK 2.533"
1-i
Wi tsonvi 1. ie, CIR 97070
J L _J T(; TOI JIN QUARRY, 21455 S.W.120 Ave.
Ll _� GR= GRESHAM 190 QUARRY, 1900 S.E. 190 Ave.
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TERMS: 2 10th -11ET 30
DATE PRODUCT CUBIC YARDS
CUBIC QUANTITY SOURC up UNIT PRICE
TONS TOTAL
10/28105 F I L L SANS 1 3 9 1 TQ X 9 •00T0N 125.19
TICKETS 1446=4'65 - - - - -- _v. -- - - - - -- _ - , < ._ ". _ :. -_ ,_
Total 125.19
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S- 00519
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10 /5/2005
Phone: (503) 639 -4171 ,1 �Npu�ii�yf�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 7:16AM PAGE: 30
SITE ADDRESS: 11465 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PHELAN
DESCRIPTION: Line, work to connect to sewer. Septic system to be pumped and filled or removed.
OWNER: PHELAN, THOMAS PHONE #: 360 -993 -2275
CONTRACTOR: SOVEREIGN HOMES PHONE #: 503 -816 -7536
Inspection Request Scheduled For: Date: 10/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitaty sewer 019528-01 503 - 780 -4916 Y
Corrections/Comments/Instructions:
13tH; i I .. SQ 1 A\ G 3 � - ti � .. s r - -�— °� �ti.s LA
f (A.,,.? Sc k • e i II t T. {Pro ►�vu- ti ci: w 1 . � v'u� c , � �
Sc 1 c.
b)
( vS) I
n PASS 1g PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: J— ki—t, Date: ! O /Q-7) 0S -: Phone #: (503) 718-
1
r
CITY OF TIGARD •-I'
BUILDING DIVISION PERMIT #: PLM2006 -00519
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/6/2005
Phone: (503) 639 - 4171 .i � 1 uhp�ii�6l�j�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ' Vii-_
INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7 :08AM PAGE: 31
SITE ADDRESS: 11465 SW FONNER ST CLASS OF WORK:
SUBDIVISION. LOT #: TYPE OF USE:
PROJECT NAME: PHELAN
DESCRIPTION: Line work to connect to sewer. Septic system to be pumped and filled or removed.
OWNER: PHELAN, THOMAS PHONE #: 360.993 -2275
CONTRACTOR: SOVEREIGN HOMES PHONE #: 503-816-7536
Inspection Request Scheduled For: Date: 10;01/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 019008-01 503783 -1810 Y
Corrections /Comments/ Instructions:
P ecA--1 ✓1 TO e IA (Ocn , _- y a �- ei I 1,4
Id (1--
•
PASS PARTIAL APPROVAL 7 CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector:da I>s-A-A i 1 Date: /o j21� o . . Phone #: (503) 718-