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Permit CI TY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00422 � JII 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/1/2005 PARCEL: 2S 102 C D -02604 SITE ADDRESS: 09610 SW HILLVIEW CT ZONING: R -4.5 SUBDIVISION: TWALITY HILL LOT: 004 JURISDICTION: TIG Project Description: New sewer connection. 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: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES MINDY SHELDON Description Date Amount 9610 SW HILLVIEW CT TIGARD, OR 97223 [PLUMB] Permit Fee 9/1/2005 $72.50 [TAX] 8% State Surchari 9/1/2005 $5.80 Phone : 503 620 - 8878 Total $78.30 Contractor: ARTS EXCAVATION LLC 6580 SE HAZEL AVE REQUIRED ITEMS AND REPORTS PORTLAND, OR 97206 Phone : 503 473 - 1800 Reg #: L1C 156488 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 -6699 or 1- 800 - 332 -2344. Issued By: PermitteeSignature: 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. 'Building Fixtures Plumbing Permit Ap - FOR OFFICE USE ONL City f Tigard a u I U [ u l / F i Received \ �y� �J g Date/By. ` -/ (1. Permit No3.. V`� `07, r/5"Qto 9 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 . ' 71165 41, 'P., F f �I.: Date/By. Other Permit No� ( � '�,4.�'r 24- Hour Inspection Line: 503.639.4175 C! ,,• Date Ready/By: ru "s ® See Page 2 for Internet: www.ci.tigard.or.us r � nr ^ ^ ^^ Notified/Method: ' S'K' Supplemental Information rte' So `ki FEE* SCHEDULE • ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. ( 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: G l ' G U 5 W t1 \.1/4).2_,-d C ! . Catch basin or area drain 16.60 City /State /ZIP: '---% 9 2:2_3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: 1 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.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: j 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 Drinking fountain 16.60 ' ( et PROPERTY OWNER ❑ TENANT Ejectors /sump 16.60 Name: `�Q, S a ka ` Expansion tank 16.60 • Address: 0 0 VV I Lo C.4) Fixture /sewer cap 16.60 City /State /ZIP: Floor drain /floor sink/ 16.60 t= � � 7 2 Z - - . ( (�3) , 20- pr (3) I, 70 C E Garbage disposal 16.60 Phone: V ° G Fax: i5 I Hose bib iERPPLICANT ❑ CONTACT PERSON Ice maker 16.60 Business name: Interceptor/grease trap 16.60 Contact name:2 a- C`L'Cf Lie._ 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:w g SQ 1 �s Water heater 16.60 Address: 6 S y SE o . -- 1 n . ., y - Other: City /State /ZIP: .l� r r \� CI R 9 72.0 6 Subtotal \ , Minimum permit fee: $72.50 Phone: ( J3) y -7 3 _t e0(3 Fax: (J7 3) 2 'c/ „ - , •7 36 Residential backflow minimum permit fee: $36.25 CCB Lie.: (s 6 y R sK Plumbing Lic. no.: 3- 996_?, Plan review (25% of permit fee) • State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: 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. is \Building\ Permits\ PLMF- PemtitApp doe 06/05 440-4616T(10/02JCOM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ;;Site°Utilities ''. - - . - Qt " Fee(ea) Total Square. Footage: 'Permit. Fee: .. ' . . Footing drain - l 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 Commercial Back Flow Prevention Device 46.40 including 148. i0g for the first $ $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 iristalled for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more . -Domestic dwelling units. Drinking Fountain ' ❑ Any NFPA l3 -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 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 und 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. i:\ Building \Permits\PLM- PermitApp.doc 07/06/05 CITY OF TIGARD a BUILDING DIVISION ;A�r ,p. \- PERMIT #: PLM2005 -�22 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1/2005 Phone: (503) 639 -4171 a 9100 l m Inspection Requests (24 Hrs.): (503) 639-4175 'I i INSPECTION WORKSHEET FOR DATE: 9/612005 TIME: 7:08AM PAGE: 21 SITE ADDRESS: 09610 SW HILLVIEW CT CLASS OF WORK: 1 SUBDIVISION: TWALITY HILL LOT #: 004 TYPE OF USE: PROJECT NAME: SHELDON DESCRIPTION: New sewer connection. OWNER: SHELDON, MINDY PHONE #: 503 - 620.8878 CONTRACTOR: ARTS EXCAVATION LLC PHONE #: 6Q3.473 -1800 Inspection Request Scheduled For: Date: 9f6f2OO5 Pour. Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 014975-01 503473-1800 Y Corrections /Comments/ Instructions: A I - - ■ , - / / / 7C_ / 40, W p / . /PASS PARTIAL APPROVAL El CANCEL n NO ACCESS U AIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 72 .�� Date: Phone #: (503) 718- CITY OF TIGARD PLUMBING PERMIT ;,'. I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00422 ,�lz; DATE ISSUED: 9/1/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102CD 02604 SITE ADDRESS: 09610 SW HILLVIEW CT ZONING: R -4.5 SUBDIVISION: TWALITY HILL LOT: 004 JURISDICTION: TIG Project Description: New sewer connection. 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: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES MINDY SHELDON Description Date Amount 9610 SW HILLVIEW CT TIGARD, OR 97223 [PLUMB] Permit Fee 9/1/2005 $72.50 [TAX] 8% State Surcharl 9/1/2005 $5.80 Phone : 503 - 620 - 8878 Total $78.30 1 gel. Contractor: ARTS EXCAVATION LLC 6580 SE HAZEL AVE REQUIRED ITEMS AND REPORTS PORTLAND, OR 97206 o Phone : 503 � e 1 r V1 '1 O Reg #: LIC 156488 . 1. ‹ I c I A 0 . i i it 05 ' , -\--07 1 e 1 r ' W # 0‘ , .„ is 1 This permit is issued subject to the regulations li t'ned in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done 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 -6699 or 1- 800 - 332 -2344. `� Issued By: r ; �, Permittee Signature: ��_'�� j / 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. ti t T. Inspections Required for: PLM2005 -00422 ✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground /slab cover 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service 205 Footing 120 Electrical rough -in 805 MFG - Structure grading /footing 125 Wall cover 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab 140 Sign installation 310 Crawl drain 145 A/C or heating unit circuit 225 Post/beam structural 150 Hot tub /spa /pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors 199 Electrical final 240 Exterior sheathing 245 Firewall • 250 Roof nailing ELR - Restricted Energy Permit 255 Wtr proofing basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing 810 MFG Structure set-up MEC - Mechanical Permit 280 Insulation 605 Post/beam mechanical +<, 285 Drywall nailing 610 Gas line 287 Suspended ceiling 615 Mechanical rough -in a 295 Misc. inspection: 620 Hydronic piping '4y., 899 MFG - Structure final 625 Duct work • 498 Grading 630 Fire damper final 299 Final inspection 635 Smoke detector shutdown • 640 Exhaust hood 695 Misc. inspection: 699 Mechanical final BUP - Fire Protection System Permit • 905 Sprinkler underfloor /slab PLM - Plumbing Permit 910 Sprinkler rough -in 305 Plumbing underslab 915 Fire alarm rough -in 310 Crawl drain . 6 ,. 920 Suppression trip test 315 Post/beam plumbing • 995 Misc. inspection: 320 Plumbing rough -in o. 998 Alarm final 325 RP/backflow preventer 999 Sprinkler final 330 Water service 335 Rain drain 340 Storm drain SIT - Site Work Permit • X 505 Sanitary sewer 405 Excavation 345 Culvert/catch basin 410 Fill 350 Septic tank 415 Grading 395 Misc. inspection: 205 Footing X 399 Plumbing final 210 Foundation walls 215 Footing drain 420 Sprinkler supply lines SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final - 595 Misc. inspection: 499 Final inspection 599 Final inspection I: \Building \IVR\InspCard- AOP.doc 06/17/2005