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Permit
III CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT • Permit#: PLM2015 00075 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/16/2015 ©9 Parcel: 2S103BB06700 Jurisdiction: Tigard Site address: 12385 SW 121ST AVE Project: Humphrey Subdivision: BROOKWAY Lot: C Project Description: Connect existing house to sewer lateral,less than 100'.4/9/15,Reprinted to add additional 95'of sanitary sewer& (1)backflow device. - Contractor: FLYING H CONSTRUCTION CO Owner: HUMPHREY,GRETCHEN G PO BOX 2533 12385 SW 121ST AVE WILSONVILLE,OR 97070 PORTLAND,OR 97223 PHONE: 503-678-4224 PHONE: 503-329-6461 FAX: 503-678-4221 FEES Quantity Description Date Amount 195 If Sewer Service 04/09/2015 $100.06 Specifics: 1 ea Backflow Preventer 04/09/2015 $31.27 1 12%State Surcharge- 04/09/2015 $15.76 Type of Use: SF Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $147.09 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or dir questio • OUNC by calling 503.232.1987 or 1.800.332.2344. Iss ed By: Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures RECEIVED City of Tigard Received Y g Datel6y: .1 le, y `AFj Permit No.: etl/o' l5-Ca7S INI 13125 SW Hall Blvd.,Tigard.C)R 97223`,A �� I Plan Review Phone'. 503.71$.2439 Fax: 5o3.598.19611/�R 16 2015 DatelByl Other Permit No. 64)490/5-calp,7 Inspection Line: 503.639.4175 t>am /B male fa See Page 2 for lti:�tu) Internet: www.tigard-or.gov CITY OF TIGARD NotdiReeddiiMethnd' I Supplemental Information TYPE OF AtitDING LIVJStON FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist _ Description I Qty. I_ Fa. 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 rg -and 2-family dwelling ❑Commercial/industrial SFR(2)bath -_-_ 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 -..__. ,_ .......- ._,- Each additional batltikitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: t a �' S /.2 1 fi J Catch basin or area drain 1$.76 City/State/ZIP: --r-,(5,,,,l_. j op 9 7�tz3 Footing 1.leach line,or trench drain Page Footin drain(no.linear ft.: ) l age 2 Suite/bldg./apt.no.: Project name: e_Lje-- Co 4 if ec.fie vt Manufactured home utilities 50.03 Cross sireetAiiretxions to job site: Manholes 18.76 Rain drain connector y5, 18.76 Sanitary sewer(no.linear ft.:/a n Page 2 100,6s \ Storm sewer(no.linear ft.: ) Page 2 N _...-._,.. _.---.,__.__--.__...._. _....___ Water service(no.linear 8: ) Page 2 Fixture Subdivision: Lot no.: ---.-___._..._......-- - - xture ar item: lax map/parcel no Back flow preventer j 31 27 3 i 1- -'' DESCRIPTION OF WORK Backwater valve 12.51 ., Clothes washer 25.02 _c i A H ec 4- 4-0 t/v\.a.LA-1 ‘S C'c.1 C y' 1 1 ti t! Dishwasher 25.02 'V Drinking foumain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER l ❑ TENANT Expansion tank 12.51 CV) /44.1, Fixture/sewer cap 25.02 Name: e rteT� ,Q 0 ii■lT C e" Floor drain/floor sirk/hub 25.02 Address: la Ti-c- !(,3 1 2! /9 r/ Garbage disposal 25.02 City/State/ZIP: fl A , O I Z 9 7.223 Ilose bit 25.02 Phone:(Qj S)Z 9- 6" / Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 V Business name: Medical gas(value:S ) Page 2 t� Primer 12.51 i, Contact name: Roof drain(commercial) 12.51 " Z Address: ---_--_... -- SmlabaslNlavatory 25.02 1..: City/State/ZIP: Solar units(potable water) 62.54 { Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 cT Urinal 25.02 E-mail CONTRACTOR Water closet 25.02 Water heater 37.52 cJ Business name: : M�,i. ---_ ,- Unfrr. p(+D 6/"" 56.29 wAddress: ,0n -: :Z5'3'' Other: 25.02 City/State/ZIP: LO t. .. .r.-.y I L.L.I 6) 97C90 Subtotal •x i Phone:(f'i) Lag- LI??if Fax:( ) 7/,/,7 Minimum permit fee: $72.50 7.A.co 5.3,5-3t ��j Plan review (25%of permit fee) CCB Lie.: i'Z''/( .' ? '4'f/o Plumbing Lie.no.: 5- 46 Pi3 State surcharge(12%ofpermit fee) g- 70 7e Authorized signature: /, '� .�- g Y I{L' G Lt Ly"' ' (' ', ' TOTAL.PERMIT FEE g f.,3,c Print name: �� } / May This permit application expires if a permit is not obtained within ISO days L-//e( `r leis C7 f l�I h( !r y' ' - 5 after it has been accepted as complete- / •Fee methodology set by Tn-County Building Industry Service Board�' .,:, I au ilding'.Prnmis'PLML-PermttApp doe I0/01 TN 440-46161(10VO.CCMLWt?H) _r4. 45,C?I&'• '1i, _ 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-l'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 ( )'.�l 7,201 and greater $327.54 Sewer-each additional 100' 1 37.52 `7. Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $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 ect Ins ions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Inspections 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) .j 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 El New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher. Commercial El Any multipurpose fire sprinkler system. Domestic El 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 Riser Diagram -4„ ❑ 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 MachiRefrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -LavBar 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 aid before the Water Extractor p Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 :1111q CITY OF TIGARD PLUMBING PERMIT 1 COMMUNITY DEVELOPMENT Permit#: PLM2015-00075 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/16/2015 Parcel: 2S103BB06700 Jurisdiction: Tigard Site address: 12385 SW 121ST AVE Project: Humphrey Subdivision: BROOKWAY Lot: C Project Description: Connect existing house to sewer lateral,less than 100'. Contractor: FLYING H CONSTRUCTION CO Owner: HUMPHREY, GRETCHEN G PO BOX 2533 12385 SW 121ST AVE WILSONVILLE, OR 97070 PORTLAND, OR 97223 P PHONE: 503-329-6461 PHONE: 503-678-4224 FAX: 503-678-4221 FEES Quantity Description Date Amount 100 If Sewer Service 03/16/2015 $62.54 Specifics: 1 12%State Surcharge- 03/16/2015 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 03/16/2015 $9.96 Plumbing Class of Work: ALT 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 qu- '. s to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued =y: , 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. Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLI City of Tigard Received DateBy: t�[ if& a2 Permit No.: r)6/ !S- vS ■ 13125 SW Flail Blvd.,Tigard,OR 97223 (I( III I Phone: 503.718.2439 Fax: 503.598.19MAR 16 2 O 15 Plan Review Other Permit No.: i-_Q^_, ,,,�/� Date/By: ��CR.?�4 5-C.i-C,.P,7 Inspection Line: 503.639.4175 Date Read B Juris Ell See Page 2 for TIGARD Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE OF A -DING DIVISION FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Descri.tion St . Ea. 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 01-and 2-family dwelling 11 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: )a,3 8� S(.a/ 12/ p J Catch basin or area drain 18.76 City/State/ZIP: V w� ' �& / 9 7223 Footvell,leach line,or trench drain Page 2 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:'c�'eL 1e,-. t'on$eefiaN Manufactured home utilities 50.03 l Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 `` Sanitary sewer(no.linear ft.:tan Page 2 67 cy \ Storm sewer(no.linear ft.: ) Page 2 l` Water service(no.linear It.. ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 l hoe washer 25.02 CO t1 f1 CC+ 1 Inns.l ft. �' CLsJ s^ / f i a Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 CY) 0 rti e v, /u�� I r Fixture/sewer cap 25.02 Name: rG Y1 i /gyp Floor drain/floor sink/hub 25.02 Address: 113�� ccW /21/4tJ Garbage disposal 25.02 City/State/ZIP:Tj fa t^C , 6 )2_ 9 7 a 23 Hose bib 25.02 Phone:(9 j 3) /- 6' / Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 O Business name: Medical gas(value:$ ) Page 2 \ Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 Q City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 c E-mail: Urinal 25.02 \.1 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: i 7 t vx i k C6 P13 �Y �it 56.29 Address: 1 0 x a 5 3 �`� 3 3 Other: 25.02 W City/State/ZIP: LAD Lrx, V I L L£ O2 97 C70 Subtotal ,\A Phone:( J).3) (e•1$- 4,99.1r Fax:( ) 7/,1/7 Minimum permit fee: $72.50 7a.50 CCB Lie.: (0"4'?? /44/x, Plumbing Lic.no.: 3- 'e P/J Plan review (25%of permit fee) State surcharge(12%of permit fee) g_70 Authorized signature: y �l>!� k 6 r' 1 V f4 t ifZi..-1•-6•- TOTAL PERMIT FEE g1. Print name: / Date: ,J This permit application expires if a permit is not obtained within 180 days G`//e( t` �i [�J e/7/'�(� 3 tp 5 after it has been accepted as complete. r / *Fee methodology set by Tri-County Building Industry Service Board. c.,p 1:\Building\Permits\PLMU-PermitApp.d°c 10/01/09 440-4616T(10/02/COM/WEB) O� --`o.9L =f,,of ' 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-1"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 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $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 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 S100.00 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 Quantiy 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 Baptistry/Font El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. El Car Wash: -Each Stall New exterior plumbing site utilities for any complex structure -Drive Stall as defined in OAR918-780-0040. 1=1 Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system. -Domestic El 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 Riser Diagram ❑ 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 Filler 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: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 I ( 1 • ALOHA SANITARY SERVICE INVOICE NO. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 1 8 8 8 3 503-644-2797 • 503-648-6254 • 503-846-1951 (FAX) www.alohasanitary.com • Email: info @aloha PL H(90 I NAME: i i - I_. /z //I // ADDRESS: L ;AV ,..- L- l / J CITY: ,� ,i�/i21� a , ZIP: HOME:32-ff— /b/ WORK: CELL: JOB SITE: "f F.O.#: PAID BY CHARGE ❑ CHECK ❑ CASH ❑ CREDIT CARE! DATE r—/ —26/- DRIVER _ f 74 ! AMOUNT PUMP SEPTIC TANK �•/" i � : •r INSPECTION FEE ❑ SERVICE CALL ❑ LABOR, LOCATING, DIGGING, BACKFILL Aill TOTAL $ - - TH/S IS NOT A SEPTIC SYSTEM INSPECT/ON "EPORT- - - • TYPE OF TANK: STEEL ❑ . CONCRETE J, PLASTIC ❑ HOMEMADE ❑ HORIZONTAL\VERTICAL RECTANGLE ❑ ❑ OTHER SIZE OF TANK: 350 ❑ 500 0 750 1000? 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑ LID LOCATION: INLET ❑ OUTL•T ❑ MiDDLE ❑ ENTIRE TOP ❑ TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑ FITTINGS: BAFFLES ❑ CONCRETE rA - CAST IRON ❑ PLASTIC ❑ GROUND COVER OVER TANK COMMENTS C i-U-, 4 i Customer Signature DATE Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 12385 SW 121ST AVE, TIGARD, OR, 97223 Residential - Plumbing 399 Plumbing final PASS - No C of O PLM2015-00075 George Heimos NOTE Sewer camera from bldg c/o to public sewer tie-in, pass Violation Summary: Inspector Contractor