Permit Y `' J P
CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES . P #: PLM2005 -00077
_ t . DATE ISSUED: 9/12/2005
' `- -.. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S113B0 -00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
Project Description: Durham Facility, Phase 4: site utilities for new influent pump station, potable water only.
•
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: ft
WATER CLOSETS:. WATER LINE: 550 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
. CLEAN WATER SERVICES Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 [PLUMB] Permit Fee 8/10/2005 $72.50
[TAX] 8% State Surcharl 8/10/2005 $5.80
Phone : 503-681-3600 [PLUMB] Permit Fee 8/18/2005 $214.50
[TAX] 8% State Surcharl 8/18/2005 $17.16
Contractor: Total $309.96
• D P PLUMBING /DARREN T PLACEK
15825 NE SPRINGBROOK RD REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
Phone : 537 - 9492
Reg #: LIC 110612
PLM 36 -70PB
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 a o follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01 -0010 • •ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 - 246 -66• : or f f- 332 -2344.
Ise ed By: - _•__!. 4 , ,. Permittee Signature: X ti itolv
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit can 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.
.. ; ' - : ` -i ECE VED
Plumbing Permit ApU1k ition : , FOR 'OFFICE USE ONLY'
City of Z 1 and MiAt? ✓ 3 Received *
Y g �L f AR Date /By: 64 7 0 � Permit No.: �, ,p�p
13125 SW Hall Blvd., Tigard, OR 97223 I Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 nrl 1 G Aid , j Other Permit N
24- Hour Inspection Line: 503.639.4 75 { t~ I l�
1
j Date /By: guns: l
. . Date Ready /By: 0 S ee Page 2 for
Internet: www.ci.tigard.or.us Notified /Method: / J i5 . 6. Supplemental Information
TYPE OF WORK FEE SCHEDULE t
® New construction ❑ Demolition For special information use checklist. , i
Description 1 Qty. 1 Ea. I Total Ns
❑ Addition/alteration/replacement ❑ Other: External Potable Water New 1- 2- family dwellings (includes 100 ft. for each utility connection) '1k
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 Q
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 1
SFR (3) bath 399.00
❑ Accessory building ❑ Multi- family
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( , sq. ft.) Page 2 `- '
JOB SITE INFORMATION AND LOCATION Site utilities C.
Job site address: 16580 SW 85th Ave Catch basin or area drain 16.60
City/State /ZIP: Tigard, OR 97224 ee.-vrp._ WR-rse. . 5614)cce.5 Drywell, leach line, or trench drain 16.60
' ' ' Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: N/A I Project name:
Cross street/directions to job site: SW 85th Ave. and SW Durham Rd Manufactured home utilities 110.00
----
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: 600 Water service (no. linear ft.: 550) Page 2y, -‘ () ,
Tax map /parcel no.: 2S113B Fixture or item
Absorption valve 16.60 / '
DESCRIPTION OF WORK Backflow preventer /7
Page 2 C/� �
New raw sewage influent Pump Station, associated pipework and site work, Backwater valve 16.60
including flow splitter structures, meter vaults and odor control units. Clothes washer 16.60
� o „ r , PLt I ^ _ n 0/3(,)/ � t , ! t Dishwasher 16.60
� �, K. Z Drinking fountain 16.60
® PROPERTY OWNER - 1 ❑ TENANT Ejectors /sump 16.60
Name: Clean Water Services -Main Office Expansion tank 16.60
Address: 2550 SW Hillsboro Hwy Fixture/sewer cap 16.60
City/State /ZIP: Hillsboro, OR 97123 -9379 Floor drain/floor sink/hub 16.60
Phone: (503)681 -3600 Fax: (503)681 -3603 Garbage disposal 16.60
Hose bib 16.60
Ci APPLICANT • ❑ CONTACT PERSON Ice maker 16.60
Business name: Clean Water Services - Durham TPS Interceptor /grease trap 16.60
Contact name: Randy Naef Medical gas (value: $ ) I Page 2
Address: 16060 SW 85th Ave Primer 16.60
City/State /ZIP: Tigard, OR 97224 Roof drain (commercial) 16.60
Phone: (503) 547 -8175 Fax: : (503) 547 -8196 Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: NaefR@CleanWaterServices.org
CleanWaterServices.org Urinal 16.60
CONTRACTOR Water closet 16.60
Business op lr i V ,,,,,,b ( t j 3 1n.C. Water heater 16.60
Address: is- 9 Zs- tE .prtvt(ss -vok Other.
f Subtotal
City /State /ZIP: kat o4 ok, i713
Minimum permit fee: $72._` �., �, c , :
Phone: (g ) s3) - i i a Fax: ( , s - 0 ?) Sjg,tada Residential backflow minimum permit fee: $36.;...) ..G.
Plan review (25% of permit fee) 1 - 1
CCB Lic.: t1 Plumbing Lic. no.: j6_70Pe
Authorized signature: i pe _ . I
'vG1{,IA✓
State surcharge (8% of permit fee) 1 ; 1.-
TOTAL PERMIT FF► 4 10e:") e., C
Print name: batite'e.i P f J t K . Date: N b // z / This permit application expires if a permit is not obtaineu wha 0
` 180 days after it has been accepted as complete.,. I
*Fee methodology set by Tri-County Building Industry Service Board.
is \Building \Permits \PLM- PermitApp.doc 12/03 440- 4616T(I0 /02 (COM/WEB) _ / 6
r \ ,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00077
13125 SW Hall Blvd.,'Tigard, OR 97223 DATE ISSUED: 9/.12/2005
Phone: (503) 639 - 4171 ���
Inspection Requests (24 Hrs.): (503) 639 -4175 -
INSPECTION WORKSHEET FOR DATE: 9/23/2(7f)8 TIME 7 :OOAM PAGE: J1
SITE ADDRESS: - S 135 ft I AVE
OF WORK:
SUBDIVISION: SEWER TREATMENT PLANT
#: TYPE OF USE:
PROJECT NAME: CLEAN WATER SERVICES
DESCRIPTION: Durham Facility, Phase 4: cite utilities;: for new influent pump station, potable water only. Peinv~t.ated
2J6100
OWNER: CLEAN WATER SERVICES, PHONE #:
503- 681-3600
CONTRACTOR: D P PLUMF3ING /DARREN 'f PLACEK PHONE #: 531 -9,492
Inspection Request Scheduled For: Date: W23/ 00i3 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 075788 -01 503 -519 -7488 N
Corrections /Comments/ Instructions:
c v .,. d w d t 4-01 atk -k-f v 1 L
Jam ✓ v� u 1T 1 v o i Aq Co r .- Oil_ 1 V N 4Z t, e A / Mx,
C fc- " ri
PASS I 1 PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: cr7 i tf_- Date: 9 t23 10 7> Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 1.1 2OC15-QOO77
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ' 2/2(O;;
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/1E/2OO8 TIME: 7.00AM PAGE: 4
SITE ADDRESS: 16580 So 0I; I - 1 AVE CLASS OF WORK:
SUBDIVISION: f EWER TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: (LEAN WATER SERVICE,-.7;
DESCRIPTION: Durham Facility, Phase 4:: site utilities for new influent pump station, potable water only. Reinstated
7J6/tJft
OWNER: CLEAN WATER SERVICES, PHONE #: 603-681-3600
CONTRACTOR: () F' PLUMF3ING /DARREINI T PLAM< PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 2/1 &200l3 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 W=ater SOIVICO 06511G-01 503619.7448 N
Corrections /Comments /Instructions:
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P d ✓-4 w\ Co N►.c, t "TO IPwA. 1k. 1\A&.)
W (,.,A-C/ S e✓ v i 2 1/4. P ,v V i•-
- L (J) 1 `‘c/ t evutA
ea v ► dk�- OD G g . V O€ V f
S Q,l: t ." CO — 2- Q C'Ow(c•Ile ,
n PASS ' PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
n FAIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: -A..ri Date: 2 '1 h S Phone #: (503) 718-
_ �I