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Permit ,! CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2012 -00002 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2012 Parcel: 2S103CB02100 Jurisdiction: Tigard Site address: 12190 SW JAMES ST Project: Wilson Partition Subdivision: Lot: 0 Project Description: Connect existing house to sewer service. Contractor: BIG MOOSE DEVELOPMENT INC Owner: STEVE WILSON PO BOX 2208 BIG MOOSE DEVELOPMENT BEAVERTON, OR 97075 9450 SW JAMIESON RD BEAVERTON, OR 97005 P PHONE: 503 - 522 -0426 PHONE: 503 - 522 -0426 FAX: FEES Quantity Description Date Amount 100 If Sewer Service 01/04/2012 $62.54 Specifics: 1 12% State Surcharge - 01/04/2012 $8.70 Plumbing 10 ea Minimum Fee Adjustment - 01/04/2012 $9.96 Type of Use: SF 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, o " • k is suspended for more the 180 days. ATTENTION: Oregon law requires ou to follow the rules adopted by the Oregon Utility otification Cen e . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -01 -0090. You may obtain a copy of the rules or • rect questions to OUNC b n• 50 .1987 or 1.800.332.2344. I-,ued By: r Perm ittee Signature: 1 , Call 503.639.4175 by 7:00 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 Building Fixtures FOR OFFICE USE ONLY. City of Tigard Received ��� Permi N o.: G� /+ /a III �� 13125 SW Hall Blvd., Tigard, OR 97223 Dan Review : / / IN ,,v Plan R Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: ev T l G A R D Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 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 312.70 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building El Multi- family Each additional bath/kitchen 25.02 ❑ Master builder El Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ` , \ 0 b s„) Q - A/1 o) S� Catch basin or area drain 18.76 City/State/ZIP: 1 414t-VC---- _ V Drywell, leach line, or trench drain 18.76 Ci ty 1 ( ��o 1 6 n " t 4 1 - Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: c �lwtlj cJ t Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 --t-- is j I ,"1" Rain drain connector 18.76 Sanitary sewer (no. linear ft. /00) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ' Clothes Clothes washer 25.02 S&3 CA- [ tLU P 6r e )a . N ( ' f "/ '"" Dishwasher 25.02 Drinking fountain 25.02 f Ejectors /sump 25.02 t PROPERTY OWNER I 'El TENANT Expansion tank 12.51 Name: <i b intAS 7 ii li �r't L. Fixture /sewer cap 25.02 c ��� V Floor drain/floor sink/hub 25.02 f Address: o �== a.U� lJ Garbage disposal 25.02 City /State /ZIP E N� � r , (54Q Hose bib 25.02 Phone: (95 ) cdd _ 6 `-1 p. �? 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 (L 01,u, v_ I F V(LL 0„ _, f l �• Wat er tin W V 56.29 ' PP � Address: I Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) [_ Fax: ( ) Minimum permit fee: $72.50 7,2 •° Plan review (25% of permit fee) CCB Lie.: )9 Oa 0 1 9 )? Plumbing Lic. no.: State surcharge (12% of permit fee) $ • 7U Authorized signature: ��+ TOTAL PERMIT FEE Slg Print name: 1 This permit application expires if a permit is not obtained within 180 days (,.� \ �- Date:' 1 � �� after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. l.\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 - Is' 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' 62.54 Valuation: Permit Fee: $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 ❑ Isometric diagram is required for new buildings Garbage - Domestic - non - food c or riser g ram re q g 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/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes 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:\Buil ding \Permits\PLMF - PermitApp.doc 02/24/2011 2 EXISTING SYSTEM DECOMMISSIONING PL M,? G1 6),(2) The street address for the property is / 2/ J iA7 • ; 3 $ )_ . . 0 By my signature, I certify that the existing (select one or more of the following) [ eptic tank [ ] Seepage Pit [ ] Cesspool was decommissioned in accordance with established standards of the Department of Environmental Quality (DEQ). The DEQ standards require the selected items to be: A) pumped by a licensed sewage disposal pumping service to remove all septage; B) filled with reject sand, bar run Gravel or other material acceptable to the County, OR the tank must be removed and properly disposed. 4 The septage was pumped by ;(,./5 � �l (Company Name of the pumping business) � �� .-- � 1 � • Date: i �— Signature: �, . �• • T1 GA RD SAND & GRAVEL, LLC. M TONQUIN AND STAFFORD QUARRIES •, . P.O. BOX 4810 • TUALATIN, OREGON 97062 . . PHONE (503) 692 -1800 . TICKET NO.: 1 686383 SOLD TO: MISC .VISA /MC DATE: 1/1/2712 � �c,� / T IME: �� w � G i I�UI� �OC� JOBNO.: JOB: TRUCK NO.: M I SC 1 20006 ' DELIVER TO: BLUE. LAKE / JAMEA ST ORDER NO.: I {VG 1 154 . f IbARD BLUE LAKE CLA NCY 511.1,;5--4 / n -672 1 . WEIGHT ` ' - QUANTITY - . • , .: AM , � OUNTSi.. GROSS `' TARE ` , NET ` ' ' TONS CUBIC YARDS MATER N IAL DESCRIPTIO � ° UNIT , „ T PRICE TOTAL • 53240 23800 27441 - 14e 72 11.32 314" — 0 $211.5. • $211.50 13.35 Net Metric Tons Job Total: $211.:50 D I RECEIVED BY: .A—.) u \/ �—_ n � f I C V WE MAKE DELIVERIES INSIDE THE CURB,LINE AND ON THE LOT AT THE CUSTOMERS RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR DAMAGE RESULTING FROM SUCH DELIVERIES. ALL CLAIMS FOR SHORTAGES MUST BE MADE IN WRITING WITHIN 5 DAYS FROM DATE OF DELIVERY. FREE UNLOADING TIME • • OF 10 MINUTES FOR A SINGLE TRUCK AND 20 MINUTES FOR A TRUCK AND TRAILER IS ALLOWED. EXCESS TIME WILL BE CHARGED AT EXISTING RATES. • CUSTOMER COPY