Permit 1 3 3 cro w0S1, --
A 4, CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00401
, .� �I DATE ISSUED: 8/30/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S104AC - 10800
SITE ADDRESS: ZONING: R -4.5
SUBDIVISION: HANDY ACRES LOT: 034 JURISDICTION: TIG
Project Description: Sewer and storm sewer line work. Septic system to be pumped and filled or removed.
. - `-v ----
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 100 ft
Owner: FEES
MIKE WYNANDE
13300 SW WALNUT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/30/2006 $110.00
[TAX] 8% State Surcha 8/30/2006 $8.80
Phone : Total $118.80
Contractor:
SITE TECH INC.
15875 SE 114TH AVE, STE C
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 650 -7378
Reg #: LIC 102415
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: lic 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.
Building Fixtures Se tA) C 1 Al 6 - C 0
Plumbing Permit olli t>to n FOR OFF ICE USE ONl. -
City of Tigard nII ((;� ": � . 2006 p y fir" i Permit Nor a,( 0 ""
v 13125 SW Hall Blvd, Tigard, AO - 2 /3
Plan Revie � `
C Phone: 503 Line: 503.6 .639.4171 0 7 Y ur �� Fax: 503.598.1960 , Datr/Date/By. Other Permit • T I C A R I� Inspection 4 Date Ready/By J""'� El See Page 2 for L.
p
- Internet' www.tigard - or- o v r g yO'T Notified/Method Supplemental Information
- T O F WORK - FEE* SCHEDULE ,
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea- I Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
ql- 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 addres sPV i' / , Catch basin or area drain 16.60
City /State /ZIP: 7 ; y � v/ 0 r 7 'Z Z 3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: 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. :/ / Page 2 5:5:
Storm sewer (no. linear ft.: /00 - Page 2
Subdivision: I Lot no.: Water service (no. linear ft.• ) Page 2
Fixture or item
Tax map /parcel no.
_ Absorption valve 16.60
• DESCRIPTI N OF WORK Back flow preventer Page 2
1 ' . (A) GOad x ,014.40 t Backwater valve 16 60
`. .V e 1` Clothes washer 16.60
Dishwasher 16.60
/,PROPERTY OWNER I ❑ TENANT - Drinking fountain 16.60
q� / Ejectors/sump 16.60
Name: , " ` t !CL L ) )/ h A h //[ C , Expansion tank 16.60
Address: / 3 3Q0 s (A) 1, /h -z('f Fixture /sewer cap 16.60
City /State /ZIP: r / '�� rt 0 /l to Z 2 Floor drain/floor sink/hub 16.60 '
Phone: ( ) J Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Business name. Ph C I L I.C Npv Lan" IDF v'c, Interceptor /grease trap 16.60
Contact name: 5 ye.. f K ' o5'�� Medical gas (value: $ ) Page 2
Address: / Z7 /U) wR� r Primer 16.60
/v(
City /State/ZIP: n A t'/ l r� ) / 2? Roof drain (commercial) 16.60
C� r Sink/basin/lavatory 16.60
Phone: ( 503) ,'% y 7 2 - 04/7 f
ax:: (5) ) 5-3 / ! o
Tub /shower/shower pan 16.60
E -mail:
Urinal 16.60
- CONTRACTOR Water closet 16.60
Business name: 54012 5--,.., F F C ( _ Water heater 16.60
Address: l stA) �/ rJ l g C - G Other:
City /State/ZIP: 7 7 Subtotal
O' Minimum permit fee: $72.50
Phone: ( ) V -73 0� Fax: ) i o
'G 1 ► I 4/ c Residential ba minimum permit fee: $36.25 //O.t0
l4 ;∎ ( ►" Plan review (25%ofpermit fee)
CCB Lic.: f //i IV" Plumbing Lic. no.:
Authorized signature: State surcharge (8% of permit fee) Q , ic0
L `5 TOTAL PERMIT FEE // , go
Print name: - G� / ' //Ls- I Date. 1 1 -3( )(, This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
I \ BuildmgTamits\PLMF- PermitApp.doc 04/06/06 440 .4616T(l0 /02/COM/WEB)
Plumbing Permit Application - City of Tigard a / -"
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
6..4. 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 -5:00 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
. Fixture or Item • Qty. Fee (ea) Total 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 Back flow 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.
. - Quaudty by (Fixture) Work Performed ❑ Any new commercial building.
Future Type: Replace El Any new exterior plumbing site utilities.
. Previous _ Capped Added E,istiog ❑ 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 installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 - D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain Isometric•or Riser Diagram
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 - under this permit results in an
Water Extractor
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\Peimits\PLM- PermitApp doc 07/06/05
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MATERIALS PRICE 1- 800 - 200 -0457
P.O. Box 33585 Portland,OR 97292
-[-��J SERV ICES info @mrp- serwces.com
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BILLING NAME f I ( 1+ 4c' /1,, , ® 0 so 2
I JOB NAME DATIs OO�a -��
..- ��0 ..� / <iEc 10/7 g
1 CITY /STATE 1 &r A 10/8 /U 6
PRODUCT: r c /
PHONE p� .5 `I PHONE (CONTACT TECH. i
ADDITIONAL LINES: DESCRIPTION OF WORK - I
CONSUMABLE MATERIALS: 1 ,
• RATE ' EQUIPMENT . • I �
-_ ��� v 1 �. _�
' 7; & 1 (9-15 -- , /,. ; _
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v1 „ ' ' \ � � , I 20 03/ V ■
JANES E9 ELLI SU;:! i
I IE. TECH I;. r
TOTAL OTHER CHARGES 0 .2-75a:: 10. O. 2 7 - da--
. • RECOMMENDATIONS TERMS: DUE.UPON COMPLETION ---
z" I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO ORDER AS FUEL ,L. -
= ---r- ! •- OUTLINED ABOVE IT IS AGREED THAT THE SELLER WILL RETAIN TITLE TO SURCHARGE
C----,- � �'LO) (,r-P ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL & COMPLETE PAY -
: � MENTISMADE, AND IF SETTLEMENT IS NOT MADE ASAGREED , THE SELLER TRUCK ( 20.00
SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD CHARGE - - - - - - - CUSTOMER P.O. HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL THEREOF
TAX ,�f
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LOCATION OF REPAIR: O ' P \J AMOUNT
PROBLEM FOUND: AUTHORIZED SIGNATURE . DUE
c ABOVE ORDERED WORK HAS BEEN COMPLETED AND I ACKNOWLEDGE RECEIPT OF MY COPY
l (, I HAVE READ THE FRONT AND BACK OF THIS CONTRACT AND UNDERSTAND ITS CONDITIONS
HOW PAID: , -) .- • + 06 01004487 .1-(
WARRANT(' X ' - ' srC Ic-
SECONDMAN #: DATE
CCB# 106824 Wash Lic #METRORPO44KW ORIGINAL — WHITE BILLING — BLUE CUSTOMER — CANARY
'
1 Customer is aware and agrees that unknown defects may he B. Exclusions and Limitations .
present in the existing plumbing, and holds Company , ' '
harmless for discovery thereof. Such defects include. but are 1 All conditions including but not limned to'
not limited to those above items listed under'l above , : _
- 2 Defects caused by mistreatment or,neglect. '
Existing illegalities, 3 Defects from intervening
' ' Improper or defective plumbing 4 'Defects caused by acts beyond the control of
Damaged or defective lines, pipes, or traps; i Company, including but not [Muted to Acts of
Any other condition which may adversely effect Company s • God.
work •
. Company shall riot be liable for incidental,
II Customer is responsible for providing property boundary consequential or other damages as a result of the work '
markers and obtaining access required through other done hereunder, and the Customer s sole remedy is the
properties for Company s use during the course of . right to repair or: replace defective materials and/or '
Company s woik. Customer agrees to hold Company workmanship. '
harmless from all risks thereof. '
No other warranties, either express or unplied are made,
III Customer shall at its expense perform all acts required for ' i unless otherwise required by the provisions of applicable .
Company to perform its s'ork in a safe, efficient law.
' environment, including but not limited to
VI ATTORNEY FEES •
- A Preventing entry on the work site by children or _ '
animals. If any suit br action is filed by any party to enforce this
B' Providing insurance for all materials or equipment agreement. including but not limited to an action to collect •
left on the work site during the course of work: any past clue sums required to be paid by the terms 'of this
. C Notifying any neighbors and securing their agreement, the prevailing party:shall be entitled to recover
permission when Company s work may cause an reasonable attorneys fees incurred in the preparation and
interference to such neighbors prosecution or defense of such suit or action as fixed by
the trial court, and if any appeal is taken from the decision
Customer hereby indemnifies and hold harmless Company of the trial court, reasonable attorneys fees as fixed by the
from and' all liabilities Company as a result of the work appellate court.
done on Customer s behalf. . . •
VII VENUE •
IV Customer agrees to protect or remove all property, both c
inside and out, including but not limited to: , . , • 'hi ,agreement shall be governed by, and construed in
, , -- - • - accordance with' the laws of the.State•ofOregon. If any •-.._ . •
, A • Furniture and carpeting; c ,stut'or action: is filed by any party to enforce this
' B Plants and shrubs; l ",' =' agreenment or, otherwise with respect to the subject matter , •
C , Any other item which may he at i isk'due to of this agreement, venue shall be in the Federal or State
Company s work. c., courts of Multnomah County. Oregon.
Customer hereby indemnifies and VIII 1N �ENTiRE : AGREEMENT
holds harmless Company from any and all damage to or 63i •
liability for personal and real property of Customer or any ? s This clncument contains die entire agreement between the
third party , • ., padre "s and oral representations shall not bind either party. '
1 , :?s. all sQnatures of Customer bind it jointly and severally,
1 V LIMITED WARRANTY ' G , - long with their heirs, survivors, representatives• agents •
�•5.
r .� :vmd assigns • A Warranty * s
,
IX ,tJi PAYMENT TERMS
The Company warrants its work to be fee' from defects as to • , . Y , •
materials and workmanship for the time period stated on the ' ayment is clue at the tune services are completed as
. face hereof. Comm any ,
p� an y will remedy 'in y such detects within a ,_�:Yequired by the terms of this agreemem. If payment is not
reasonable time and during normal business hours •; '''Wade within ten (10) days for the date of completion, a
r c'..,••delinquency charge equal to 5% of the outstanding balance
I
Warranty repair seryree must be obtained by calling - is due, in addition to the outstanding amount. Thereafter,
1
the Company s telephone number stated on the face hereof. ; of not so paid, a delinquency charge equal to 15 % per
and referring to the,igvotce number and date of service on - ; month will be added to the unpaid balance until paid. No
this invoice. , , 'extension of credit is offered, intended or should be
implied by the terms of this agreement.
This Warranty extends only to the Customer and does not t , .
extend to others
i ! ,
, i
-
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i
CITY OF TIGARD
'BUILDING DIVISION PERMIT #: PLM200&00401
SW Hall Blvd., Tigard, OR 97223 r+ DATE ISSUED: 8/30/2008
Phone: (503) 639 -4171 i 4.
Inspection Requests (24 Hrs.): (503) 639 -4175 .' ^'I �..
INSPECTION WORKSHEET FOR DATE: 9/5/2006 TIME: 7 :03AM PAGE: 4'1
SITE ADDRESS: 13300 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: HANDY ACRES LOT #: 034 TYPE OF USE:
PROJECT NAME: WYNANDE
DESCRIPTION: Sewer and storm sewer line work Septic system to be pumped and filled or removed.
OWNER: WYNANDE, MIKE PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 8/5/2008 Pour Time:
Code # Inspection Description Confirm # Cont t # Message
605 Sanitary sewei 035979 -01 583 -887 -1549 Y
Corrections /Comments /Instructions: •
i .
. C
❑ PASS PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL[] CPL FOR INSPECTION ADDITIONAL FEES ASSESSED
f
Inspector: Date: 0 Phone #: (503) 718- /13
I'
CITY OF TIGARD
BUILDING DIVISION . ,r,-- #: PLM2006 -00401
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 0/30/2006
Phone: (503) 639 -4171 .V
it Requests (24 Hrs.): (503) 639 -4175 ...' "'I -L.
INSPECTION WORKSHEET FOR DATE: 9/11 /2006 TIME: 7 :00AM PAGE: 10
SITE ADDRESS: 13300 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: HANDY ACRES LOT #: 431 TYPE OF USE:
PROJECT NAME: WYNANDE
DESCRIPTION: Sewer and storm sewer line work. Septic system to be pumped and filled or removed.
OWNER: WYNANDE, MIKE PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 036321 -01 503 - 319-1432 N
Corrections /Comments/ Instructions:
.---- `' V
i / / %r/
Aiatimpre
i
1.5 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
LP if? 2 /V
Inspecto Date: (/ � Phone #: (503) 718-
CITY OF TIGARD
' BUILDING DIVISION PERMIT #: PLM200600401
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3012006
Phone: (503) 639 -4171 m
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/13/2006 TIME: PAGE:
9 1131x0 06 7 :02AM 4
/,
SITE ADDRESS: /? /' 'J CLA"S OF WORK:
.i
SUBDIVISION: HANDY ACRES 33 & `L• / : $ t TYPE OF USE:
PROJECT NAME: WYNANDE
DESCRIPTION: Sewer and storm sewer line work. Septic system to be pumped and filled or removed.
OWNER: WYNANDE, MIKE. PHONE #: ,
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 036435 -01 503 - 887 -1549 N
Corrections /Comments /Instructions: •
/
•
- 0 /, jdr1 4
[PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 Date: ` V - Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200& -00401
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/30/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ''I�� "
INSPECTION WORKSHEET FOR DATE: 9/13/2006 TIME: 7:02AM PAGE: 42
SITE ADDRESS: 13300 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: HANDY ACRES LOT #: Q34 TYPE OF USE:
PROJECT NAME: WYNANDE
DESCRIPTION: Sewer and storm sewer line work. Septic: system to be pumped and filled or removed.
OWNER: WYNANDE, MIKE PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
350 Septic tank 036435-02 503.887 -1549 N
Corrections /Comments /Instructions:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-