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Permit
CITY OF TIGARD PLUMBING PERMIT q COMMUNITY DEVELOPMENT Penult #: PLM2012 -00186 T t G A A L) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/09/2012 Parcel: 2S 111 CCO2300 Jurisdiction: Tigard Site address: 10385 SW CENTURY OAK DR Project: Coffield Subdivision: SUMMERFIELD Lot: 20 Project Description: (20) linear ft. sanitary sewer Contractor: APOLLO DRAIN & ROOTER SERVICE Owner: COFFIELD, FRANCIS 2208 NW BIRDSDALE #8 10385 SW CENTURY OAK DR GRESHAM, OR 97030 TIGARD, OR 97224 PHONE: 503 - 239 -8801 PHONE: FAX: 503 - 669 -9568 FEES Quantity Description Date Amount 20 If Sewer Service 07/09/2012 $62.54 Specifics: 1 12% State Surcharge 07/09/2012 $8.70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 07/09/2012 $9.96 Plumbing Class of Work: OTR 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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: J "`,.! Permittee Signature: . 7jI /j P /1 / Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be r 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. Jul. 6. 2012 5:26PM Apollo Drain ' No. 2393 P. 2 Plumbing Permit Applie D Site Utilities volt 01 use: mix • City of Tigard JUL 0 9 2012 golf ? (4 /« Sof' Permit No.pbti 281a.. 0O18G n 13125 SW Hall Blvd., Tigard, OR 97223 Phut Review . Phone: 503.718.2439 Fax: T1OI TIGARD Dm/B othu Permit No•: L IC;AttU Inspection Line: 503.639.4 v 0 DIVISION Dare Re re Internet: WWW.ligard -or.g0 Notified/Melhtd: 44 S plementa Information : :•,. : : :', :�, s,:.•::.:,::: _ _ ._' 1 { li.l , ."- w;; : -, E -x : ..- 5557 -. ...r . 3 . .e . . ��.,. ....-_..._.. �_ :, : :_ . - - - ........._..:v_„- ..,.,, 1 ...., ,�...� . �.�: � : : ::1'.� . :: 555.. 75x5... �. ,.........__........ _ 3... ....._.... .. :�! -•. ,....� „- 5555 - -55x : :-.; 7.541_ -.. ,.1 , 1 , 555-' ...._... -�,..i4 . - i,`7, , i♦:. :r•1:.�4i.: :��:, +•`•' ,,,. • .. _........... 555 .....,::::,..:,: � �,r.• M-1. ,555. , ... 5 555._. � - - - - - - - .. ,.•, 1, .. :..,, :• :. :- •:a:. •: :FEEL :�'SCEYED -3:,+ . 1... {.:,1.;;.,_;: � : ,5 r : : :l. =: 1 . N {.;�_'r� : - : �. TXPE o�•�woax.-- . � . :: .,:::,:::,. �' : :�' : :: J: . , - : -- ,u� � .. -. 5555 -- - -- -- - - •� ,- ... -. -- ���• �,�,..,..._._..,,_. ..._.�..... ' 1 , e , n•::>`: r,.. l._ ..; :.._ ._.._._.._..... �... : ._ . . :� _ _ - :'r::i 1 �In�i.: n'•- ... ...__........... � . ... .. ... ... .. ... 5555 5555. .-.: ... -. ... 5555.. ..:: ' : :.� ........ .,._ 5555.. _ 5755 . 5555.. ... ...: ,,. .�. 5,555. _ ... ❑ New construction ❑ Demolition For special irrjornrrrlio'i use checklist ['( Addition/alteration/replacement ❑ Other: Ne Description l Total - 2- family dwellings (includes 100 R. for each utilityconnection) ; ;* �;nli;{ i�-' : _ -__ <: _; _ �•.�..{ , 1 . = � : {� ( of ` VJ tig � ; t_r ig "ti:: r;i Y #., i5l SFR 1 2.70 :,rlh.�,1 : :1 } J•._ - _ ; �T.. "1,.. .T_. .f `�.1'. ..'. TYW1 .1 1 �.`# 1 t � .� :I' . 1. I � ( ) bath 31 -•� : • :�' : : : : :. /..i, 1 ,•••r.�� :l IIMY.r ■� M`I+i ry.� �f r i•'.� 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. • 18.76 or area drain �i:: .._ : �iY �� :�„ :'u. •i, : -{�' � : :. :.� : :';._ : : : :.- : : : :'. :'. 57 7::. �: � ��:, ��:,: � � .•: �: �: �.: J�'_���'•,- ','uy_Y i ��� � -' :-�. r�_ __ ..:....:.. •- �.:: t:)t _ Ril i rl •, 4 1 _ - : _ - sue utilities: .�. :..c� : :r :. - � :a' :: :......t r.rr .a•. .1 „. 5 555`• .... ?e.. .. _.. .. 4a '> s ; 3::_•e - � r... � -� � �• ` •• basin or site address: �i�I�I� �� I, gg,J� Catch basi Drywall, leach line, or trench drain 18.76 City /State/ZIP :TI r I • q 12 4 t Footing drain (no. linear 11.: ) Page 2 Suite/bldg. /apt. no.: I 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 fl.: X.) Page 2 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 r'r.•'ly y3 yl'.•`i' '`l;'•S �4� J -_ _ _ y ..'• - ..1),:- , trn.•nrr.:.. .N ,:': i-tr •..T 3^ } -;4 �' t Backwater vain 12.51 - ?!- :', ,-.a..� k"I ill . :.. ° =• PSC .IQ O YQ C : ,, :: r:._= _ s 4.M fit: � -�. _ :.� g� �1= ; '" � • �.._.. : :... \. . i � ' .. �•u�:l'... ' 1•Y... � „�M Clothes washer 2502 Dishwasher ) 25.02 0 , _ /I ' • _ 1 I r . c . � _ l _ 'J lt► 1 Drinking fountain 25.02 t I Pra J . � Ejectors /sump 25.02 - .. -• -t -- - -r 5555 ,.. 1,. r :•. :.�,r.'�, >- ,, : :. : : __ :. ::�• , = ..__:...___ _ 5555 775 E _ _t °` -_'•` Expansion tank ': _ ..�. - =_. � .s�iOF , :.� :. " =_= r � -_ _ �`� }i:� =_ = :�� = e+; ;: �,�; :.1: : -: � : -�: xP 12.51 : FF�, ... ,::.. : ................. �..-- .................,.r•�.....,:. _ -.. -57x5 .� tic Fixture /sewer cap 25.02 Name: of �I On Floor drain/floor sink/hub 25.02 Address: i • • .1 A. i 1 S , �J Garbage disposal 25.02 City /State/ZIP: , 1NIMPZJIM Hose bib 25.02 Phone: ( ) I Fax: ( ) t Ice maker 12.51 ... H Y,.,:au;o-S IN „a 7-� •4l'r' Cl +{;av - ssit,t'a i1`. Fn :.�.rt a : 6� :nu• . ; t x =7-77515x.. BL w "'' " � ' il! 9!41s �. - . u ; ,l Interceptor/grease trap 25.02 5151•x,- .,,- ,r::..' ... �.,;, � d +�Ql'�'� 5551 l�V_-: ..'.�: : 51x::5- � :4 �.•;.. •�M. :. IZ{,. 41: Q 1{....._S.N, { I . r.. .. N ,�. ,:, bit it tin ` , ' VI` Medical gas (value: $ ) Page 2 Business name: Mi�i� T Primer 12.51 n9 Contact name: a , r, / / Roof drain (commercial) 1151 vArbi Address: a d r _ r i ms, Sink/basin/lavatory 25.02 City / State/ZIP: ` kiff r Solar units (potable water) • 62,54 t �/� /� ub /shower /shower an 12.51 Phone: ( .I• ! Fox:: M I I r!..d T _ _ P E-mail; Urinal 25.02 { c:;:- : __:'•_ 1 " - � itr.' : : :':: : :t Fiji .:", r -., Water cicat 25.02 i6i1 v� , : :... :,: ? : :_ 4 � z :x :7LL�; }.p.. ��� ' . r ' �_hr,��. :.- : u�..., - 7517... - "..�,Ss�f•'rt• 10- :i � iuw-- 51.51 _.. __ ..t ..:: = ... ..........._ 5517... • n a :,.-, ,., {+ :___., 51 x5; __ - s_ :.., :,..... .�>��(5��;rs :�: : , :_-r. �r� � -_ _ _� _,� . �tiw� Water talc :., : ,._....._. x55. heater 37.52 Business name: A'/ 1 I e ' ( )I _ el1 i i A lk I , Water t in WV Address: ' b ! a! i� / i� Other. P l� 56.29 25.02 City / State/ZIP: r j g `1! Subtotal • . hone: ~ , , , J ►, ^)� 1 l / gI, Minimum permit fee: $72.50 iifiii � e ,mrlii,,,-i.j is - no.: l' Plan review (25 %ofpermitPec) � ��}' 1 State surcharge (12' ofpermit fee) if ?(7 Authorized signalu � ' TOTAL PERMIT FEE SC 'i � 1 _ �r �. l�� Date L • lraIPA This permit application expires it a permit is not obtained within78D days after It has been accepted as complete. " Pee methodology set by Tri- Counly Building Industry Service Board ImvilelatPermilskfl. U- Pernshapp.doe 10/01/09 44 1616T(10/0VCOM/WBB) III I V TIGARD City of Tigard August 22, 2012 Apollo Drain & Plumbing Attn: Scott D Bird 2208 NW Birdsdale Ave., #8 Gresham, OR 97030 Re: Permit No. PLM2012 -00186 Dear Mr. Bird: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10385 SW Century Oak Dr Project Name: Coffield Job No.: N/A Refund Method: n Check # in the amount of $ . ® Credit card "return" receipt in the amount of $65.97. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. n Trust account "deposit" receipt in the amount of $ . Comment(s): Per applicant's request refund 80% of permit fees as job was canceled. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. I:\ Building \Refunct3y464 o litcBihAdarterre€g ieit alegbn 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov Irr City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Apollo Drain & Plumbing DATE: 07/26/2012 Mtn: Scott D Bird 2208 NW Birdsdale Ave., #8 REQUESTED BY: Dianna Howse Gresham, OR 97030 TRANSACTION INFORMATION: Receipt #: 187454 Case #: PLM2012 -00186 Date: 07/09/2012 Address /Parcel: 10385 SW Century Oak Dr Pay Method: CreditCard Projcct Name: Coffield EXPLANATION: Refund 80% of permit fee per applicant's request as job was canceled. REFUND INFORMATIONr Fee Description From Receipt Revenue Account No.. Refund Example: Building Permit-Fee Example: 2300000 - 43104 • : $ Amount Permit Fee 230- 0000 -43101 $58.00 / S0 12% State Surcharge 100 - 0000 -24001 7.97 , 3 TOTAL REFUND: $65.97 ✓ APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager 111\AM.A. If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board = FOR'TIDEMARK,SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: tyf Z-- By: 1: \ Building \ Refunds \RefundRcquest.doc z 09/01 /2010 Jul. 13. 2012 9:12AM Apollo Drain No. 2498 P. 1 RECEI Community Development JUL 16 2012 I' LGARL� Request for Permit Action CITY OFTIGARD t ION TO; CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503,718,2430 Fax: 503.598.1960 www.tigard- or.gov FROM 0 Owner Applicant Q Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) APOLLO DRAIN & ROOTER SERVICE INC. Mailing Address 2208 NW BIRDSDALE AVE #8 City /Statc /Zip: GRESHAM OR 97030 Phone No,: 503 - 239 -8801 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (/)r ❑ CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available), ID INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #; 1'M? 012 -ool st Site Address or Parcel #: 1 O 3s- FA L u (') A Dr Project Name: P I I ■ iI . - I I .t .a Subdivision Name: Lot #: EXPLANATION: .1 I ! A . .111. aA . A Al ►� 20P Signature: - Date: Itefuhd Polity 1. Tim Director or Building 011icial may authorize the refund on a) any fee which was erroneously paid oe eolkcted. b) not more than 8094 of the land use application tse when sit application fs withdrawn or canceled before any review effort has been expended. c) not mote than 80°A of die land use application fee tot issued permits. d) nor more than 801/4 of the building plan review fee when an application is canceled before any plan review effort h ss been expended. e) not more than 80% of due building permit Ito foe irsued permits prior to any inspection requests. 2, Refunds will be returned to the original Payer in the same ntethod in which payment was received- Please allow 1 -2 weeks for processing refands. VOlC, OFFICE JSF. ON .1' Rte to S s Admin: Tate /1/f/EMQA ] Rte to Bid., Admin: Date a ®® B 40 Refund Processed; Date , AlMellerihYA Invoice Proceseedl Date B Permit Canccicd: Date 017, / By : Parcel Tit Added, Date By Receipt #.4 VS' Date 9 Method C Amount$ I: \Iiu'dding \Irornns \Req ermitrlcdon, e r02/23 2011 Jul. 6. 2012 5:26PM Apollo Drain No, 2393 P. 3 rurtlanurviap5 L etau icep page i of 1 o Ian r a New Search ps Map in Advanced I Gooale Earth I I + # 1 � 1 \.rl +J I _ p � I portlandOnlIne, • 10385 SW CENTURY OAK DR - Explorer I Property, I Maps I Projects I Crime I Census I TIGARD Environmental I Transportation . Explore the area, view different themes Property Detail Long - 122.78421 Lat 45 40502 ft,- cr:..,xrr,x4a. .., RtCi ,. -: -z i }4 , r , .3tit{sq. . t•'xu 7 ?11 ---- pT ;. � - L:. _ • • ,s[ [,Ea , r ,. t.-'- _ ...::�.,:: ,r., . ,� : , , ' , r�tzt _ �- � - s -ra. 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TH8 ACCURACY OP THE MAPS AND ASSOCIATED DATA. THE CITY OF POR TLAN D MAKES TRT WARRAMjY, RBPR6SSNTATION OR GUARANTEE AS TO TFIB CS NTENi; SEQUENCE, ACCURACY, TIMELINESS OR COMtPLE71'NENI CIE ANY OP TIDI DATA PROVIDPD NPAFIN. TY{E USER OF THPLtGTIHOUL RE ATA D M EEB N ANt3A$0}t, THE PORTAND LICITLY DISCLAIMS ANY OP TIDIDATA I' REPRESENTATIONS AND WARAAN 11 INCLUO r, 3 WI TH AP OUT itT ATION S , TIo D D•Oi'L NOT W AALY RMK�S ON THE D OP bI RQIA AI.'D FOR FITNESS POE A PARTrcOLA . PURPO EXP CITY OP PORTi All SNAJ.L ASSUME NO LIABILITY FOR ANY ERRORS. OMISSIONS. OR DTACCURACIES DI THB INFORMATION PROYIOW REOAAD OP HOW CAUSI".Y D. R 2f(B Ctl'Y Of FOR TLANb OP SHALL A SSUNff NO FOR ANY DECISIONS MADE OR ACTIONS TAKEN OR NOT TAKEN BY THE USER. OF APEliGT1OA5 @I RELIANCE upon ANY aTFORMATIONOR DATA PURIa13HED 1MPAEUN PO R 1fPDATBD AIPORMATION ABOUT THBMAPDATAO M' YT. AtaD '$PLEA S ERPPPIS TOPIT`1MPTArI.T FOR QUESTIONS ABOUTASSESSMNI4TINFORMAT I ONPI.EA$ECONTACI"TMIH COUNTY ASSESSORS O FFICE NYOURCOUNTY. Address I Mapping J Advanced J Google Earth I xi..qig I About PortlandMaps © 2012 City of Portland, Oregon • http:// www.nortlandmans.com/detail,cfm? action - W251424 &state id... 7/6/2012