Permit X07 Sw Erirc / Sf /LA/(2a/3 - 00 z//‘0,
RECE' .Y.• � ,r
Debbie Adamski
13125 SW Hall Blvd. NOV ] C)
Tigard,Or.97223
CITYOI° 1luaHp
Ref: 10940 SW Errol St. BUILD ING DIV;s,o��
Dear Debbie,
Enclosed is the Plumbing Permit Application for the sewer connection along with a check for the fees.
$7870.18 Reimbursement dist.
$4835 Sewer connection
$150 for 250 Sanitary sewer run
For a total of$12,855.18
Jeff Maxwell of Maximum Excavation will be the contractor and will pick up the permit.If you could send
me a copy I would appreciate it. I will be at the following address until Dec.1,2013.
26441 Thunder ridge Road
Conifer,Co. 80433-6120
Home address after December 1st;PO Box 3857,Sunriver Or.97707
Or,you can email it to me at njohnadrienne @aol.com
Thanks for your help with this process.
Sinc ly
ohn Newman
541-593-6420
,r
, 1299
l o • ' PO BOX 1130,Wilcnne`le OR 97070
• Septic Service Phone:503-682-1929 ._..503-570-0779
I � UL a?"nrdablesepticservice @yahoo.com
,,w affc '.. esepticsvc.com
5U3-t82-1929 rt CCB w ioa246 DEQ#37918
ustomer PO# Contact Phone /7'•Q-X/.-t V o L Date
Name _
Address •
V� -: o'
Technician / Mark Payment C:leck(Write#) Cash Credit Card Bill Account Other
Type:
De5criptior QTY 'Unit •Unit Price For
/0 9 'tD {. LI) Fx/zo
7.y, ec-/ f ��c_ . �/ 7 a
t7L r) „Zv 13 -cc/6 _
t2g147e F L.L ygt-c 114! .; Invoice Total
Recommendations(if any): —t
is the pure 'r's c 7n to clearly mark underground utiliti.-and under°oun('I' `n systems.
°ce is NOT resp-nsible for unmarked utilities and/or ir. Lems.
Date
Claims'% - oe accompanied by this bill
•
CITY OF TIGARD PLUMBING PERMIT
'1 2 • COMMUNITY DEVELOPMENT Permit#: PLM2013 00416
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/19/2013
Parcel: 2S103AD00407
Jurisdiction: Tigard
Site address: 10940 SW ERROL ST
Project: Newman Subdivision: ECHO HEIGHTS Lot: PTS 12-
Project Description: Connect existing house to sewer service,approximately 250'. Septic tank must be pumped and filled.
Contractor: MAXIMUM EXCAVATION LLC Owner: NEWMAN,MICHAEL J
2076 SW SUNRISE CIR KARJALA, NICOLE
TROUTDALE,OR 97060 10940 SW ERROL
TIGARD, OR 97223
PHONE: 503-839-7826 PHONE:
FAX:
FEES
Quantity Description Date Amount
250 If Sewer Service 11/19/2013 $137.58
Specifics: 1 12%State Surcharge- 11/19/2013 $16.51
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $154.09
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 icatr i do 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 dir t questions to O C by calling 503.232.1987 or 1.800.332.2344.
1
Is ued By: L Permittee Sign-
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.
Plumbing Permit Application
Building Fixtures FINED
City of Tigard 1
Received ved ii l g /3 �� Permit No.: A.tiaD�3_�p�*
U 13125 SW Hall Blvd.,Tigard,OR 97223 NOV 19 9 2013
Plan Review Other Permit No.: � ko'D/ �V�
ri
�Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
T I GA IZ D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: E1 See Page 2 for
Internet: www.tigard-or.gov (�� y� 1� /� t Notified/Method: Supplemental Information
TYPE OF WORf�'ILDIIVG DIVISION FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.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: Fire sprinkler(_sq.ft.) Page 2
• JOB'SITE•INFORMATION AND LOCATION Site utilities:
Job site address: /b 9 V z---,24Z. Catch basin or area drain 18.76
� w Drywell,leach line,or trench drain 18.76
City/State/ZIP: '; 2 iQ° o�• . g 7.1,23 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: �L4.)n Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft ) Page 2 /37, j
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
DESCRIPTION OF WORK • Backwater valve 12.51
/_ /,� Clothes washer 25.02
SE/A,/& G� .)/1/Z G72"N Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
gi• PROPERTY OWNER I • ❑ TENANT Expansion tank 12.51
Name: �/G/'�sL ,, J- j/7/?/L/
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: /i)/-lxp ,W, 4 '4' Z i ,S,--
Garbage disposal 25.02
City/State/ZIP:7:1Z.y1,,Z p, G4 4707-7 3 Hose bib 25.02
Phone:67/) �,x_gs'/L5 Fax:( ) Ice maker 12.51
❑ APPLICANT • ❑ CONTACT PERSON I 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:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
• 'CONTRACTOR .
' ll Water heater 37.52
Business name: /'7"9Jt./r7�n £xG,/V/11721)4// GL G Water P tP in WV 56.29
F�
Address: Q7 6 S j $CIAl4)5r L/,cG a Other: 25.02
City/State/ZIP.""M Nr:i9LZ)l 0,4, 9704,0 Subtotal /37.51
Phone:6o g3 cJ 73.. .z Fax:( ) Minimum permit fee: $72.50
CCB Lic.: //17.1/ .g- Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%ofpermit fee) (/v$/
Authorized signal e• TOTAL PERMIT FEE I I 546.1
Print name: 4,/./,,lig/(/Lt%(,( km./ Date frC_/c7/--,72475 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.
I:\Building\Permits\PLMU-PermftApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: .
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
P and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain •
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3" - -.,.Isometric:or Riser4Diagram ..
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related •
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station -
Shower: -Gang ,
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related •
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10940 SW ERROL ST, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
2014-02-13 (null)
PLM2013-00416
PASS - No C of O
Violation Summary:
Inspector Contractor