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Permit - CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00360 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/02/2011 Parcel: 2S103BA00201 Jurisdiction: Tigard Site address: 11545 SW WALNUT ST Project: NIHILL Subdivision: LERON HEIGHTS NO.2 Lot: 28 Project Description: 30 ft. of sanitary sewer. Contractor: GREG SCHROEDER ENTERPRISES INC Owner: NIHILL, GERALD T & DEANNA LYN 9812 SE WICHITA AVE 11545 SW WALNUT ST MILWAUKIE, OR 97222 TIGARD, OR 97223 PHONE: 503 - 654 -4734 PHONE: FAX: 503 - 652 -2333 FEES Quantity Description Date Amount 30 If Sewer Service 12/02/2011 $62.54 Specifics: 1 12% State Surcharge - 12/02/2011 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment - 12/02/2011 $9.96 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may —obta copy of._the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ■11111ft, Issued By: �/� ermittee Signa -- Call 503.6 • .y :00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application otc) (( - c)of Site Utilities �� FOR OFFICE USE ONLY R eceived City of Tigard q 13125 SW Hall Blvd., Tigard, OR 97 Date/By: r f 2 hi 8 / , - Permit No.: `� � O ,\ Phone: 503.718.2439 Fax: 503._ E '` 1.h . q, r1. Plan Revie Other Permit No.: DateBy: Inspection Line: 503.639.4175 TIG ARD A � ` Date Read B Y Ju ris: la See Page 2 for O` Ready /By: www.tigard - or.gov �� C C ` Al, `� � Notified/Method. 1 p Supplemental Information TYPE OF WORK '' c* \-$' FEE* SCHEDULE ' ❑ New construction ❑ De ,Rj.Ii For special information use checklist. �1�� Description f Qty. E a. Total El Addition/alteration /replacement ❑ Oth`a New 1 dwellings (includes 100 ft. for each utility connection CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 IQ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: // 5 s 5 cif 44/4 -t_ jL/c S r Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: '7 1;0_4,4,1 , p k 4 i' 1 z -3 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: 3 p) t Page 2,-5-0 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 . DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 / ni s r:+ /! S,a AI 5 *A.. L-1 n ; + i'.-. e ,...--,5 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 13 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture /sewer ca p 25.02 Name: TE let h, l .t f M •;.( Floor drain/floorsink/hub 25.02 Address: i / 5-9 > S_ J.J L:J4. (A, .7 - 1 Garbage disposal 25.02 City /State /ZIP: Tr .. -4 ,l G_: c 1 - 7 z Z ' Hose bib 25.02 Phone: (7z 3 ) 66 L- 4,'4. Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: G' S 4 . , it. C , 1 Water piping/DWV 56.29 Address: (--- e i 2 S - c_ O (c. L4 - t 4 AJi:e Other: 25.02 City /State /ZIP: 111 1, 41A.... , I. s L `t 7'2 Z ■ Subtotal GA ,ems Minimum permit fee: $72.50 ' - 73- 50 Phone: (S -4 13 r- Fax: ( Sr" ) 6S 'L - L333 CCB Lic.: j 7 �' 3 G 4 4 Plumbing Lic. no.: ,3 - Sgt ptj Plan review (25% of permit fee) - / State surcharge (12% of permit fee) 3-,70 Authorized signature: . 1� � TOTAL PERMIT FEE rl, Print name: , ! D a t e: This permit application expires if a permit is not obtained within 180 days �. 6- J� N G L i7 c� / Z ' 2 ' �C I after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I.\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 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' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm & Rain Drain - 1st 100' Valuation: Permit Fee: 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi /Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor /Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" Isometric or Riser Diagram Car Wash Drain g Garbage Domestic non - food CI Isometric or riser diagram is required for new buildings Disposal - Domestic - food related that meet the qualifications above. - Commercial -food related - Industrial -food related Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink/Lay - Non -food related - Bradley - Commercial- food related - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I: \ Building \Permits\PLMU- PermitApp.doc 2 II Site Utilities — Plumbing Permit Application Plan Submittal Requirements TIGARD A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. 1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn to scale) labeled with: A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number ❑ zoning ❑ applicant name ❑ phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads with project location. 2. PLUMBING PLANS - Two (2) complete sets, civil only. All details listed below shall be incorporated into the plumbing plans: A. Storm drainage plan showing: 1) Finish elevations throughout the developed site. 2) Grade breaks determining area serving each catch basin. 3) Location of catch basins. 4) Pipe size. 5) Type of material. 6) Slope of piping. 7) Manholes and field drains. 8) Cleanouts provided for each 100 feet or fraction thereof. 9) Roof drain laterals specifying cleanouts at each upper terminal. 10) Location of existing or proposed connection to a public sewer line. B. Utilities plan showing: 1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes and cleanouts provided as required for storm. 2) Size and location of domestic water piping and drainage. 3) Proposed location of connection to a public water or sanitary sewer line. I:\ Building \Permits\PLMF - PermitApp.doc 12/30/05 JOB INVOICE y � SOX 549 (MGM d v Y OREGON 97 0 5 CUSTOMERS ORDER NO. DATE ORDER ' i '' �4. �766�\.. dd���dWWll// B g� C s S �+, 6 rr p) YY � L� p� dd � CN n . NN ` LL aS . �{ EEr�7 �� �0..Y ! Y � 'J 97045 � � � ! ! ( 1 E "s """' as o O ��1 Tppp AKEN BV DATE PROfMS Er A M • Pt - r ❑ P.M. 11i{ BILL TO - PHONE i . (-.V >c.- i . ADDRESS - • `�` ___ MECHANIC • CITY CJ` HELPER j r ,JOB NAME ANDILCATION JOL• (Y �i%'J#�., � _ ' 7� '•1 _. •:.; ./ � ' w. • -'- // Y j$� w i(] DAY WORK I DESCRIPTION OF WORK ❑ CONTRACT a ❑ EXTRA QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT 7 P1��0 / /.- a O.5C C� "In ( " tin ,t,• :? t • Z% a,,• • _ • • • = i 1. . sat' - .t .. K - . }�' } HOURS . . LABOR AMOUNT • - TOTAL MECHANICS © MATERIALS _..... HELPERS @ TOTAL LABOR a. I hereby ackndwledge the satisfactory TOTAL LABOR TAX completion of the above described work. - SIGNATURE DATE COMPLETED -� TOTAL PORTLAND Ik0AD AND.DRIVEVVAY COMPANY INC. Invoice 10500 S.E. Jennifer Street Clackamas, OR 97015 Date Invoice # Phone: (503) 650-5006 FAX: (503) 650-8022 12/07/20n. --- `-- CCB# 2271 Bill To //515 . • A • • • k94=EEF . ; /, ) P.O. Number Project • Quantity Description Price Each Amount • zs.tiv 1.e.t OhINt 33;i3 • Signature ' . TOTAL SEE FOR TERMS AND CONDITIONS • • • . • . •_. . •._ _ . _