Permit CITY OF TIGARD PLUMBING PERMIT
''I a ..'.. COMMUNITY DEVELOPMENT Permit #: PLM2013 -00171
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2013
Parcel: 1 S135DB05504
Jurisdiction: Tigard
Site address: 11350 SW 95TH AVE
Project: Kreisberg Subdivision: THOMAS TERRACE Lot: 5 -6
Project Description: Connect existing house to sewer service, 100' or less Septic tank is to be properly abandoned. No existing lateral
on property, PFI2013 -00018 issued 06/04/13.
Contractor: ALWAYS READY PLUMBING & REPAIR CO Owner: KREISBERG, LOUIS & ELIZABETH J
PO BOX 505 11350 SW 95TH AVE
CORBETT, OR 97019 TIGARD, OR 97223
PHONE 503 - 351 -1904 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 if Water Service 06/05/2013 $62.54
Specifics: 1 ea Hose Bib 06/05/2013 $25.02
1 12% State Surcharge - 06/05/2013 $10.51
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 Noti -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or dir- • questions to O b C • z. Ilin. 503 232.1987 or 1 800 332.2344.
Iss ed By: / / 4 / Permittee Signature:
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.
1,
Plumbing Permit Application .
•
Site Utilities ��}/�
City of Tigard Rey ea / 3 Permit No.:. / rte`.' `7/
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Date/By: � •
m Phone: 503.7182439 Fax: 503.598.1960 Other Permit No.: / /.H0O/3 - Z.(/
'r � t ; n K (t Inspection Line: 503.639.4175 Date Ready/By: hais See Page 2 for
Internet: www.tigard -or.gov Notified/Method: I B Supplemental Information
- TYPE OF WORK , ' FEE*. SCHEDULE
❑ New construction ❑ Demolition For special 1)t orinolion use checklist -
Deseription I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION -' . , ) SFR(1) bath " : ' 312.70
■
❑ 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.1 Fire sprinkler ( sq. ft.) - Page 2
• JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I / 2 -0 5� ( �Ci ,4. t Catch basin or arca drain 18.76
Drywall, leach line, orgirncn drain
City/State/ZIP: c C l 7 2-Z 3
Footing drain (no. linear l .: ) Page age 2
2
Suite/bldgJapt. no.: c Project name: Manufactured home tttilitfr 50.03
Cross street/directions to job site: Manholes 18.76 -
Rain drain connector 18.76
Sanitary sewer (no. linen' Page 2
Storm server (no. linear ft.:, • ) age 2
Water service (no. linear ft. :(er, ' C- Page 2 (.), 74j
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
/,,1 Z Kit �i' Fl 25.02
Name: LOU t
O IA) ( v ` Floor drain/floor sink/hub 25.02
Address: S Garbage disposal 25.02
City/State/ZIP: --ri- oil, Qf 9 12.4 Hose bib 1 25.02 a5'
Phone: ( 509 RlaO 1 2 3C 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: ( ) I Fax: : ( ) Tub/shower /shower pan 12.51
E -mail: Urinal 25.02 .
CONTRACTOR Water closet 25.02
,/� } (^ l Water heater 37.52
Business name: i �u-kt t"2„-to _F l (J �(; )l 04-- 04-- Water piping/DWV
(S
Address: 1 / Q Other: 25.02
City/State/ZIP: h � q DI 63 Subtotal
Phone: ( 3) d 1 !' +� 9 ` U Fax: ( ) Minimum permit fee: $72.50
Plan review (25%ofpermit fee)
CCB Lic.: ! 5 1 9 1,1 / z . 4 4 '/, 5 Plumbing Lic. no.: 7 C' - 7q q State surcharge (12% of permit fee)
Authorized signal Q 7 P131111/4/ TOTAL PERMIT FEE '�„ -
1
Print name' t I Dom. ��� . ?, I This permit application as beef a permit b as not obtained within 180 days
' !✓ alter er it t has been accepted to t:o complete.
• Fee methodology set by Tri- County Building Industry Service Board i C(''
1:1Duna [ryNcrmlu'J mmunpp.ex 'o/ot/on 441)J61 6T(1 0/Q7/CO \1!l \'FB)
cfornbitri
P.� , -) , -PL4 Loe
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COD 11II111111 IL .. �"
.. •.�, e' Date 06/18/13
Scheduled 06/19/13 Septic C.O.D. Work Order# W0167188
12:00:00 River City Environmental, Inc,
503-252-6144 Complete Industrial
P.O. Box 30087 Salem 503-363-2464 Vancouver 360-896-5256 Waste Removal
Septic Tank Cleaning
Portland, OR 97294 t� Sump Line Cleaning
F6t4ZOIS". (301 (
Liz Kreisberg Liz Kreisberg
11350 SW 95th St 11350 SW 95th St Tigard 97233
Tigard, OR 97233
Contact: Liz Kreisberg 503-968-1239
503-968-1239 PO#
Cesspool @
Septage Overage ` !° f; �'
Notes COD. Liz Kreisberg called in for service 503-904-3679 home and 503-396-3474 c&L Pump p
decomission. You will need 150ft of hose with you. .h. °
t
Please call when you are on your way. k
Thanks!
Total Charges -
River City Environmental,Inc.is in no way responsible for damage to any vehicles,personal or real property.
Terms:Net 10 days. 1.5%per month will be charged on past due accounts(18%per annum).
Terms and Conditions The Right to Lien
The customer agrees to pay all invoices arising out of services,and any other special services herein within 10 days.
The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered,over and above the normal servicing
schedule,on behalf of the customer
The customer agrees to assume responsibility damage to customer's real or personal property ansing from services which take place
on customer's premises,where the drivers and vehicles of River City Environmental,Inc have been instructed to enter
This includes,but is not limited to driveways,trees,power lines or poles and building structures.
If River City Environmental finds it necessary to add liquid to the tank on jobsite,customer will be charged for the additional gallonage resulting from these condidtions.
Customer agrees to reimburse River City Environmental for all reasonable attorney's fees court costs and other expense incurred by said company to enforce
collection or to serve their rights under this agreement.
If this work order is not contested in writing within 10 days the full amount is considered due and payable.
Customer agrees to the above conditions_ A fax on the work order is considered an original. Redeemable in Multnomah C unty
Check# Visa MC�:,r� . • . �7. 83`43V .3 ''-' Exp Date VcodeAV..
Work Authorized (please t) F '''t _ Date l ,; / i A.±
Signature k„
9 �+,
Service Tech#1 j(':C 1Y Service Tech#2 Da* /CO/ " Time Y
1
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11350 SW 95TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
06/25/2013
PLM2013-00171
PASS - No C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11350 SW 95TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
06/25/2013
PLM2013-00171
Scheduled
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11350 SW 95TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
06/25/2013
PLM2013-00171
PASS - No C of O
Violation Summary:
Inspector Contractor