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Permit C ITY OF TIGARD PLUMBING PERMIT iri COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00102 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/9!2007 PARCEL: 2S 102CD -02701 SITE ADDRESS: 09765 SW O'MARA ST ZONING: R-4.5 SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 028 JURISDICTION: TIG PROJECT: SHEHORN Project Description: Line work to connect sewer to lateral. Septic to be pumped and filled or removed. CLASS OF WORK: NEW 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: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES SHEHORN, STEPHEN LEE 9765 SW O'MARA Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 3/9/2007 $72.50 [TAX] 8% State Surcha 3/9/2007 $5.80 Phone : 503- 620 -4963 Total $78.30 Contractor: A- AFFORDABLE SEPTIC SERVICE PO BOX 1130 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 969 -9548 FAX 503 -570 -0779 Reg #: LIC 158246 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: Permittee Signature: 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. V Ptu, iibin2 Permit Aiirilicati 'II _ l'' soli calks 113E ONI.l � . , �J � __ i, : ' 1 ' Received City of Tigard DriwBr..3 /`1/07 t P snit t'l 11. 2007 -42, (4,2- 4 13125 SW Hall Blvd., Tigard, OR 97223 Han cw Phone: 503.639.4171 Fax: $##y9809$0 2007 DateBy. Other Permit No.: Inspection Line: 503.639.41 T I C; n R D Date Ready/By: lutn: El See Page 2 for Internet: www.tigard-or.gpv \� r ` ` i; L A Notified/Method SupplemmtalInformation Ej tiro vi ses FEE* SCHEDULE n For special information use checklist ❑ New construction ❑Demolitio �� Description I Qty. I Ea. I Total U� Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 Cal- 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: 974, S 5, ��,,„ , `s'/ Catch basin or area drain 16.60 City/State/ZIP: T4/4„� 4/e � �!'7 2 2 3 Drywell, lead line, or trench drain 16.60 Suite/bldg. /apt. no.: I Pro name: Footing drain (no. linear ft.: ) Page 2 / J � e _ © �� Manufactured home utilities 110.00 Cross street/directions to job site: L[ �� Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: Y7) g :;) Page 2 Storm sewer (no. linear ft.: Page 2 Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2 Tax map/parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF W 7t WORK // Back flow preventer Page 2 Roeths�r/2� - ,X /i1/0 - rS ..., e 6 ' 7pn.s? eei / 4 Backwater valve 16.60 A ct hce..i _ Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 �( Ejectors/sump 16.60 Name: 3 /lam � e / Expansion tank 16.60 Address: r $- </..). / /)qp -e. �r / a Fixture/sewer cap 16.60 City/State/ZIP: /B..4o/ "Pi2 9 72.1.3 Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 Cl APPLICANT ID 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: ( ) I Fax:: ( ) Sink/basin/hwatory 16.60 Tub/shower/shower pan 16.60 E-mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: /,Q .1 ,D.4-ff' ` 5b721 C cc e:eU / //� Water heater 16.60 Address: a EdX 030 Other: Subtotal City/State/ZIP: i 9 ih, „ „ /, % I '7070 3.) [ O S 2 - / 92 Q Fax: (0 7 570 - 47 7 Minimum permit fee: $72.50 Phone: Q ) Re backflow minimum t fee: $36.25 CCB Lic.: / 5-g c., Plumbing Lic. no.: Plan review (25 %ofpermit fee) e State surcharge (8% of permit fee) Authorized signature: U , i�� TOTAL PERMIT FEE D Print name: /...z' ri r ORS Date: 3 - q' _ p 7 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. IA&dWingTermia\Pt1N -Perm itApp.doc 0626106 440-4616T( I CV02/COMAVEB) 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 - I 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 Valuation: Permit Fee: $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 Q ty. Fee (ea) Total additional $100.00 or fraction thereat to and Fixture or Item 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 $3625) 27.55 and including $25,000.00. Rain Drain, single family dwelling 6525 $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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Qua odtx by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Fabliau ❑ . New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780-0040. Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. - Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash • ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink -2" that meet the qualifications above. -3" -4 " Car Wash Drain Comments regarding fixture work: Garbage - Domestic Disposal -Commercial -Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall *Note: If the fixture work under this permit results in an Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and - Bradley fees assessed for the sewer increase must be paid before the -Commercial -Service plumbing permit can be issued. Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal - Other Fixtures: i: \&dtdma\Pamzu \PLM- Permiwpp.doc 09/22/06 A-AFFORDABtE - ri SEPTIC SERVICE P.O.BOX 1130 WILSONVILLE, OR 97070 (503) 682.1929 FAX (503) 570 -0779 CUSTOMERS ORDER NO. PHONE DATE 3 - 13 7 NAME /t ADDE6S� A 71S 11 s s �� ali, / ' , 722 SOLD : Y CASHr C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT _ I QTY. DESCRIPTION . PRICE AMOUNT fl/— .4 ,, ,/6/) - . /4 1h 7 ''z TAX RECEIVED BY TOTAL All claims and ; chimed oo�s MUST be ac companied by this bill. ^ rn �1I Leo THAINK YOU CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007 -00102 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2007 Phone: (503) 639 -4171 A�, j t Inspection Requests (24 Hrs.): (503) 639 -4175 ,, ` :_.. INSPECTION WORKSHEET FOR DATE: 3 /1412007 TIME: 7:00AM PAGE: 19 SITE ADDRESS: 09765 SW O'MARA ST CLASS OF WORK: SUBDIVISION: FREW1NGS ORCHARD TRACTS LOT #: 028 TYPE OF USE: PROJECT NAME: SHEHORN DESCRIPTION: Line work to connect sewer to lateral. Septic to be pumped and filled or removed. OWNER: SHEHORN, STEPHEN LEE, PHONE #: 503-620-4963 CONTRACTOR: A- AFFORDABLE SEPTIC SERVICE PHONE #: 503.969 -9548 Inspection Request Scheduled For: Date: 3/14/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 044810 -01 503 - 969 -9548 Y Corrections /Comments /Instructions: / 1 �/ A ArgfrillaillIMMIIIMF,i4dAit r 1 A/ / . , i:' / siF • - PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED h Ins ector: n \ Date: \ V 0 Phone #: (503) 718 - P 1 I 1 � � )