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Permit
i it ti CITY TIGARD PLUMBING PERMIT I r, DEVELOPMENT SERVICES PERMIT #: PLM2005 00101 c�Jl 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/16/2005 PARCEL: 2S103CB -01701 SITE ADDRESS: 12280 SW JAMES ST ZONING: R -4.5 SUBDIVISION: WILLAMETTE LOT: 043 JURISDICTION: TIG Project Description: Line work to connecting existing residence to lateral. Septic tank must be pumped and filled or removed. 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: 35 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES SELNER, JOHN JOSEPH + MAXINE ELL Description Date Amount 12280 SW JAMES ST TIGARD, OR 97223 [PLUMB] Permit Fee 3/16/2005 $72.50 [TAX] 8% State Surcharl 3/16/2005 $5.80 Phone : Total $78.30 Contractor: HOLLENBACH + HURD INC 3000 SW 174TH AVE REQUIRED ITEMS AND REPORTS ALOHA, OR 97006 Phone : 591 - 5987 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 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 9 or 1-800-332-2344. Issued By: 1441A-4v: 1441A-4v: Permittee Signature: MY Call % �- 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. l Plumbing Permit A r to i.LhV E $ FOR OFFICE USE ONLY . City of Tigard Received Pemvt No. 13125 SW Hall Blvd., Tigard, OR 97223 , � Date/By: �/u / 4 '��. � j - � to/ �}} i 1 Plan Review l Phone: 503.639.4171 Fax: 503.598.1960f 3 1 �• 200 6 i/fNl v I II N Date/By: ." p� Other Permit N -� � �Q� �I�I N j : 24- Hour Inspection Line: 503.639.4175 �`f Date See Internet: www.ci.tigard.or.us CITY OF TIGARP,- _.._.. 1-" N tified/Method: , ` S Supplemental Information - ". . . "; Ydzz li3 " ;3v . T vr ,9, . , . _ �. F . E* CHEDU E . bra , a �� .fie. ,��; - " �,� m �- a,� -� - "�,., 'ra :��:,�. -�"�u" � ��° ., �,. �� _ � . . �- , ,. , � x �, , � > ❑ New construction ❑ Demolition For special information use checklist Description Qty. 1 Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ,, 1 .> GATEGOR„Alle: ONS1RL ,„#6N " , i ari a. l 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 El Master builder Each additional bath/kitchen 45.00 ❑ Other ,, ._ ar i ,,,„ Fire sprinkler ( sq. ft.) Page 2 < gt °d ,,W w,wT t ' gA4=1 s �� LOCRAT` „€ 1 �' - . : A . : ,Ygk � ,t, VX- a . ; , . z m ,.y. Site utilities Job site address: I 2,N.11 a 5. ui , ,.1 A m E S 5-T• Catch basin or area drain 16.60 City/State /ZIP: T, cur d iL h g7a -3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 0 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.: I ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: o ", y Absorption valve 16.60 " <,. DESCRIPTION Ort� ,. r '� � &, � tJar, . ,..: ...,,,a _.,.,r -t_ -„ >„,- _t, :,,, �Z,.�„..-1., : Backflow preventer Page 2 �,..) JA , �c_c -{ t 0 r y • Backwater valve . 16.60 Clothes washer 16.60 Dishwasher . 16.60 ; rj t - . .. u> "nr .Y: ;` 7 % t tit, . i ; " ,, , ,,>; �> ; , : ,,,:: t . Drinking fountain 16.60 �s �� `ice g> „�. :- . P ROPER + A T Y QW ( ER " - -' - 4 " r TEN " ANSI > : : e Ejectors /sump 16.60 Name: 0,041Yi { MAXI ►1AX1 eLKE Expansion tank 16.60 Address: I a a A o 5.u, . `)\ G S Sr. Fixture /sewer cap 16.60 City/State/ZIP: t c d t a r % eWl Floor drain /floor sink/hub 16.60 Phone: (5(7) 6e} 0 1'7 g 1 Fail( ) Garbage disposal 16.60 fr Ali' � A . wiladAT 1 °'� W a i A T PERSO Hose bib 16.60 s � . . . ;e. ''r 4 =' n �. '" " *,, ". 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 fV l ` a i, W, C®NTRICTORt N- `" `� ' ' ii , i ., , � ° , Water closet 16.60 Business name: 140 I I e ri 6/i- di *- Ii ur'd, tire Water heater 16.60 Address: Other: City/State /ZIP: °' _A 51 W W. a0 et ALb 00, Subtotal ` ) Minimum permit fee: $72.50 Phone: (5 31 - 59 5 7 Fax: (5o3 ) g t4 - ( 5 3 �, Residential backflow minimum permit fee: $36.25 '7a . J -0 CCB Lie.: e e /5 ( Igo -7 Plumb" g Lie. no.: Plan review (25% of permit fee) \ /� . E � ��/J Sta surch arge (8% of permit. fee) s- ' � Authorized signature: Z /jJ /615 TOTAL PERMIT FEE &ch. Printname: MJ�xtive E � 1 JC R Dte: 5/' , This permit application expires if a permit is not obtained within l • ^ 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i:\ Building \Permits\PLM- PermitApp.doe 12/03 440- 4616T(10 /02 /COM/wEB) 78.3 0 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: •;,X_. ,�aa..a•: , ,., ,,. Mi r • , y>2vnr3a;,r is ;r. ■ . - via,.. , maw; `"': ? x::i" «.'^%�v.;:z"� -,` .:..�; - n.�,5 "sna,:� ; „:?°,, .:._ _ :ee ea Total:. ; °: ';., * "' > eb Vh • li t ><e s ' ' y C) 0: t1 are Foolta a 0,17*It iFi0" 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 • Storm & Rain Drain - 1st 100' 55.00 'a'U ;at1OI1''' "'<.prlTlll FED:; $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 ,3s:` � gt (ea Tot 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 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: Are you capping, moving or replacing existing fixtures? 'If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Ur: Fr tnre Type t r , 7 - r' R lace a � � ��•, 5r��wr, ne Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall . -Drive Thru . Cuspidor/Water Aspirator - . . Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" -3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total -Bradley Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. - . • Swimming Pool Filter . Washer - Clothes Water Extractor Plan Review • Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: • is\ Building \Permits\PLM- PermitApp.doc 3/03 FROM :HOLLENBACH & HURD Inc FAX NO. :583 848 6832 Mar. 17 2885 12:32PM P2 ALOHA SANITARY SERVICE . INVOICE NO. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9371 503 - 644-2797 * 503 -648 -6254 * 503- 39 -5188 NAME: - / ",/le'zif-le • t "•-�'%-P. j h T . x ; /+ ,.7' ' , .• -- - - =5., . F ADDRESS: r' r' "- : / l'i CITY: i /J;fr Vot- - - STATE: r'9' ...►_.- ..._..,_._.. ZIP: �"'" HOME: ,....;24 _ IS ! WORK: etELL: iKi JOB SITE ; Af , ''. (' -'..>"--° - , ; t ''' '''Y , ,2-./ ..0► P C. 7 -- - • PAID BY CHARGI( CHECK ❑ • CASH ❑ CREDIT CARD El DATE 4 �"- F`� ... DRIVER 4._W 744 ,s AMOUNT PUMP SEPTIC TANK ❑ LINE OPENING 0-1110205'' 6 l O t ❑ INSPECTION FEE © SERVICE CALL ? ❑ LABOR, LOCATING, DIGGING, BACKFILL ❑ MATERIAL - •• THIS Is NOT A , TICI- $YSTEM INSPECTION REPORT - - TOTAL ^ �'� - - REMARK TYPE OF TANK: STEEL ❑ \' ONCRETE ❑ PC El HOMEMADE El HORIZONTAL ❑ Lg6TI TICAL ❑ RECTANGLE ❑ ❑ OTHER SIZE OF TANK: 350 ❑ 500 ❑ 50 El 1 ❑ 1250 ❑ 1500 ❑ 2000 Cl 3000 Li LID LOCATION INLET ❑ OUT ❑ , / MIDDLE ❑ ENTIRE TOP El TANK CONDITION: GOOD ❑ FAIR C POOR Li FITTINGS: BAFFLES CI � CONC r LI CAST IRON El PLASTIC ❑ NEEDS NEW LID? YES ❑ SIZy GROUND COVER OVER TANK ' COMMENTS ON CONDITION OF DRAINFI D ETC. I ,r:. � it �'" . �.�'.�. . r -A, J. -ei SIGNED BY DATE i ��..- "'c $ CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005^00101 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2005 Phone: (503) 639- 4171 wdolNipt • Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 3/17/2005 TIME: 7 :13AM PAGE: 121 SITE ADDRESS: 12280 SW JAMES ST CLASS OF WORK: SUBDIVISION: WILLAMETTE LOT #: 043 TYPE OF USE: PROJECT NAME: SELNER DESCRIPTION: Line work to connecting existing residence to lateral. Septic tank must be pumped and filled or removed. OWNER: SELNER, JOHN JOSEPH + MAXINE ELL, PHONE #: CONTRACTOR: HOLLENBACH + HURD INC PHONE #: 591.5987 Inspection Request Scheduled For: Date: 3/17/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 00197401 503 - 936"5733 N Corrections /Comments /Instructions: PASS ✓ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 7of FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: /(i N #PPLY Date: 3 )7 " Phone #: (503) 718- 27513