Permit CITY TIGARD PLUMBING PERMIT
,.,1111°, DEVELOPMENT Tigard, -639 -4171 DATE ISSUED: 12/28/
PARCEL: 2S 103CC -01300
SITE ADDRESS: 11925 SW GAARDE ST ZONING: R -4.5
SUBDIVISION: COLONIAL VIEW LOT: 008 JURISDICTION: TIG
Project Description: Abandon septic & connect to sewer.
CLASS OF WORK: OTR 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: 200 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JON FRANCE Description Date Amount
11925 SW GAARDE ST
TIGARD, OR 97223 [PLUMB] Permit Fee 12/28/200`. $101.40
[TAX] 8% State Surcharl 12/28/200. $8.11
Phone : Total $109.51
Contractor:
HOLLENBACH + HURD INC
3000 SW 174TH AVE REQUIRED ITEMS AND REPORTS
ALOHA, OR 97006
Contact # : PRI 503 -591 -5987
FAX 503- 848 -6832
Reg #: LIC 121807
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 • ay . ATTENTION: Ore. on law
requires you to follow rules adopted by the Oregon Utility Notification Center. Tho-- rul. s are set f• h in 'IA
952- 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rule- or • irect ques ons OU C by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Zj I �� Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that bus' ess day.
This permit card shall be kept in a conspicuous place on the job site • it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Bthlding Fixtures
y Plumbing Permit A "r FOR OFFICE USE ONLY
City of Tigard Received 1 Permit No.. /�
Tigard, OR 97223 D � y ��/' �� ��� � �� `o 7 �
13125 SW Hall Blvd.,
Phone: 503.639.4171 Fax: 503.598.1960 D c 2005 Plan Review Other Permit No.:
�t i ti1p�4i '1111' Date/By.
24- Hour Inspection Line: 503.639.4175 a 1 Date Ready/By: rOOS ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGA
i� ii��1 {��v��R� Notified/Method: �)I Supplemental Information •
TYP� F9K FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
'ILAddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
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: //Y �� 5' 14-9 r A j ' Catch basin or area drain 16.60
City /State /ZIP: .-....1.--
s/� ,41,6.. ` Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
V 9 ---C� / • 1 //S / 4-e Rain drain connector 16.60
Sanitary sewer (no. linear ft..00) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I 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
4 ) 3---/,,074, c , Backwater valve 16.60
�ddt"` 3 &?J Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ❑ TENANT
�_ Ejectors sump 16.60
Name: � �/Z A,J .. Expansion tank 16.60
Address: // ',,,2_,..5 ‘ .e.- 1✓ , ' Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink /hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
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 Water closet 16.60
Business name: j�if//�/9 Lt- / / �ci Water heater 16.60
Address: Cr y49 Ai j A9 pr^ lt Other:
City /State /ZIP: / ' 47 k 9 262 Subtotal
Minimum permit fee: $72.50
Phone: (5 ) .5y / j 7 Fax: ( ) Residential backflow minimum permit fee: $36.25 / /� • " / O
CCB Lic.: / /9 , Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ''', / i
Authorized signature: A'S / q,5-/ -- TOTAL PERMIT FEE
Print name: /-1 J,, rp� Are, ,f_c Date: /2 -7i d2 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- PernitApp.doc 06/05 440-4616T(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 [hereof 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 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 I3 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4'
Car Wash Drain Isometric or Riser Diagram
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 ermit results in an
Water Extractor p
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.
is\ Building \Permits\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION t,
PERMIT #: m42005_00699
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/28/2005
Phone: (503) 639-4171 anzontl
Inspection Requests (24 Hrs.): (503) 639-4175 -dj,
INSPECTION WORKSHEET FOR DATE: 12/30/2005 TIME: 6:59AM PAGE: 47
SITE ADDRESS: 11925 SW GAARDE ST CLASS OF WORK:
SUBDIVISION: COLONIAL VIEW LOT #: 008 TYPE OF USE:
PROJECT NAME: FRANCE
DESCRIPTION: New sewer connection.
OWNER: FRANCE, JON PHONE #:
CONTRACTOR: HOLLENI3ACH + HURD INC PHONE #: 503-591-5987
Inspection Request Scheduled For: Date: 12/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 024213.01 503-936
Corrections/Comments/Instructions:
1\1 CcA(
„.:40
PASS
114 RTIAL APPROVAL El CANCEL NO ACCESS
El FAIL NLSALL FOR INSPECTION ADDITIONAL FEES ASSESSED .
Inspector:. • 06) (13___
Date: _ 1 1 /0 Phone #: (503) 718-
► - . i
CITY OF TIGARD
, BUILDING DIVISION PERMIT #: PLM2005.006 9 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 120312005
Phone: (503) 639 -4171 _ l( l
Inspection Requests (24 Hrs.): (503) 639 -4175 ''' �..
INSPECTION WORKSHEET FOR DATE: 1/3/2006 TIME: 7:01AM PAGE: 3
. I
SITE ADDRESS: 11925 SW GAARDE ST • C LASS OF WORK:
SUBDIVISION: COLONIAL VIEW LOT #: 008 TYPE OF USE:
PROJECT NAME: FRANCE
DESCRIPTION: New sewer connection.
OWNER: FRANCE, JON PHONE #:
CONTRACTOR: HOLLENBACH + HUM.? INC PHONE #: 503 --591 -5987
Inspection Request Scheduled For: Date: 1/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer 024301 -01 5*3- 836-5133 N
Corrections /Comments /Instructions:
-c1144 ,
K / , ,
�►��
J/ /Wit
/,'
/
._���._
,./ .„ , :._ ' 7 ,-
(/ r )is (..-
ASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: f?'Y)4 Date: ' 1,? Phone #: (503) 718-