Permit • CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00022
TIGARD 13125 ISSUED: 1/25/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S111BD 01509
SITE ADDRESS: 14905 SW 98TH AVE ZONING: R - 3.5
SUBDIVISION: ALDERBROOK FARM LOT: 006 JURISDICTION: TIG
PROJECT: ROTHSCHILD
Project Description: sewer connection
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
KEITH & JA FRENI- ROTHSCHILD Description Date Amount
14905 SW 98TH AVE
TIGARD, OR 97224 [PLUMB] Permit Fee 1/25/2008 $72.50
[TAX] 12% State Surch 1/25/2008 $8.70
Phone : 503 -684 -6078 Total $81.20
Contractor:
HOLLENBACH + HURD INC
3430 -A SW 209TH AVE
ALOHA, OR 97007 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -591 -5987
FAX 503- 848 -6832
Reg #: LIC 121807
PLM 34 -421
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 B % / ' 9 = ' 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.
Plambng Permit Application
li
Building Fixtures FOR 'OFFICE USE ONLY
1 �� i Received
City of Tigard PM 2 5 k Date/By' 7��/� 677- Permit No: -. e p yti ^ ` �{JOhOC -
IN . a 13125 SW Hall Blvd., Tigard, OR 97223 11 a plan Review �
Phone: 503.639.4171 Fax: 503.598.1960 (11"Y l Date/13 Other Permit No.,
TIGARD Inspection Line: 503.639.4175 gur >t 3 vgenlv1 �o y -r J�
L � Date ReadyBy: luris: ® See Page 2 for
Internet: www.tigard -oLgov Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description 1 Qty. Ea. Total
❑ Addition/alteration/replacement Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
- '1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
• Job site address: 1 f 9 0 - \) c7 ±' A Catch basin or area drain 16.60
City /State /ZIP " - 0 ,_ If-A__ ) t•, q 7 2 2 4f Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: �r Project name: / Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: /4t, ,r /�/ 1 t Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 4: / Page 2 :-%
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
e.4 {'nom �ax� /,a t ,F yn Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
(- Ejectors /sump 16.60
Name: KQ_ 1 til 4-c l a-- t.l,e, (‘ ( 1 0 1-A .a 4,,, ; / Expansion tank 16.60
Address: i , L q D J ,-- v 1 - ,,-. Ate- Fixture /sewer cap 16.60
City /State /ZIP: --r7 k_ a 5 . 7 .. i'71 Floor drain/floor sink/hub 16.60
Phone: 6 ee B,9 -.e, 0 7y Fax:
( _�� Garbage disposal 16.60
APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ^
Interceptor /grease trap 16.60
Contact name: ,s;9, -i& Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 4f a i', i y � / qC /_ v . t TQ Water heater 16.60
Address: `�t/C Other:
City /State /ZIP: - `? ',d R. 1-7476---7 Subtotal j�
oT Minimum permit fee: $72.50 11
Phone: (53 $ ( _ 5%--- Fax: ( ) Residential backflow minimum permit fee: $36.25 1 . `.----
CCB Lie.: (j..../ gn 7 Plumbing Lie. no. >� _
Plan review (25% of permit fee) /
p 7 State surcharge (12% of permit fee) F �..
Authorized signature:
/ _ TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
/SSit Fb 5 1£ FO/2/-) *Fee methodology set by Trt -County Building Industry Service Board.
I \Building\Permits \PLMF- PermItApp doc 12/27/06 440- 4616T(l0 /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 - 1s 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 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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $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 Backflow 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 Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ MY new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918 -780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial •
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i \Budding\Permits\PLM- PermitApp doc 12/27/06
CITY OF TIGARD
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
ECE
IMPORTANT PERMIT NOTICE JAN 2 208
HOLLENBACH + HURD INC CITYOF WARD
3430 -A SW 209TH AVE 8 UILDfNGDMSIO ,
ALOHA, OR 97007
Permit #: PLM2008 -00022
Date Issued:
Parcel: 2S111 BD -01509
Site Address: 14905 SW 98TH AVE
Subdivision: ALDERBROOK FARM
Lot: 006
Jurisdiction: R -3.5
Zoning: TIG
Project Name: ROTHSCHILD
Description: sewer connection
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
KEITH & JA FRENI - ROTHSCHILD HOLLENBACH + HURD INC
14905 SW 98TH AVE 3430 -A SW 209TH AVE
TIGARD, OR 97224 ALOHA, OR 97007
Phone #: 503 - 684 -6078 Phone #: 503 - 591 -5987
Reg #: L1C 121807
PLM 34 -421
AN INK SIGNATURE IS REQUIRED ON THIS FORM
)y• 7-7
ignatu of Authorized Plumber Name (printed)
CITY OF TIGARD _ l ,.
BUILDING DIVISION PERMIT #: i'I_h4 J008 0007
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/25/2008
Phone: (503) 639 -4171 / �»�Mpul � il
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/30/2008 TIME: 7 : 02AM PAGE: 40
SITE ADDRESS: 14905 SW 98TH AVE CLASS OF WORK:
SUBDIVISION: ALDERt3ROOK FARM LOT #: 006 TYPE OF USE:
PROJECT NAME: ROTHSCHILD
DESCRIPTION: sewer connection
OWNER: FRENI -ROTH CHILD, KEITH & JACQUELINE A PHONE #: 503- 684 -6078
CONTRACTOR: HOLLENBACH & HURD INC PHONE #: 503-591-5987
Inspection Request Scheduled For: Date: 1/30/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 :unitary sewer 064189-01 503. 936-5733 V
r.
Corrections/Comments/Instructions:
4 9 (.41 , 104,-v 1' Q a - -�.. L A
cA r� ,--1� 9
PASS ❑ PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: (� p tiA\1\‘ —, Date: 1.,3 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION A
PERMIT #: PLM2008-00022
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 112612008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 .-.:61- AIL
INSPECTION WORKSHEET FOR DATE: 1/79/2008 TIME: 7:02AM PAGE: 30
SITE ADDRESS: 14906 SW 9TH AVE CLASS OF WORK:
SUBDIVISION: ALDFRBROOK FARM LOT #: 006 TYPE OF USE:
PROJECT NAME: ROTHSCHILD
DESCRIPTION: sewer connection
OWNER: FRENI KEITH & JACQUELINE A PHONE #: 50,3
CONTRACTOR: HOLLENBACH & HURD INC PHONE #: 503.591.5987
Inspection Request Scheduled For: Date: 1/29/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer 06411401 503•936-6733 V
Corrections/Comments/Instructions:
N DI R (2,.J■
PASS PARTIAL APPROVAL D CANCEL n NO ACCESS
74,FAIL 0 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
•
Inspector: cri\n/i.-A--AA'AP" Date: I 1 21 1 ." .87) Phone #: (503) 718-
. .. . . —
28 JANUARY • net;
Monday • 2008 N 0 J q= 4-1-Lk
i SCHEDULE ACTION LIST ✓
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NOTES
Item N 061 -125VM
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ft ,
• --'. '''' LOA ATARY SERVICE
INVOICE NO.
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 1 229
503-644-2797 • 503-648-6254 * 503-639-5188
v -,,- „,,,-/ .c, j•
NAME: 7/'• /,' - :.t , - - 4.--1?-4:----t'- -,- - - 1.- -- -
ADDRESS:
Orr 4,1.--A . STATE: :, • ZIP:
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HOME: ,.(•:•:-:`-; I --- ,;4 7 ',/ ,' WORK: CELL:
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JOB SITE: ... ,./:,-/ RO it.
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PAID BY CHARGE El CHECK Et 7 CASH El CREDIT CARD 0
k '
DATE / - ,---;: -_-:„• - ;5 Z DRIVER i„,-, • j 7/:e„, Ilea/ AMOUNT
'- IP PUMP SEPTIC TANK - ,.. „ - --=-- cn 03
....„
U LINE OPENING 1
U INSPECTION FEE
' U SERVICE CALL
El LABOR, LOCATING, DIGGING, BACKFILL
U MATERIAL
/
1 2.
-
- - This Is IV oT A SEPTIC SYSTEM INSPECTION REPORT - TOTAL $
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_
LI
i r--- - - REMARKS -A
„
,,, : ,
TYPE OF TANK: TEEL. ' ''CONCRETE U PLASTIC - HOMEMADE U
---, ,
1 _,
nO RIZONTAL El VERTICAL El RECTANGLE El El OTHER
\
SIZE OF TANK: 350 U 500 0 750 U 1000 U 1250 U 1500 U 2000 0 3000 0
LID LOCATION: I NLET El OUTLEi\P s MIDDLE El ENTIRE TOP El
,„
TANK CONDITION: GOOD U FAIR El ';N: POOR El
FITTINGS: BAFFLES El CONCRETE . •■ CAST IRON U PLASTIC U
NEEDS NEW LID? YES El SIZE
GROUND COVER OVER TANK ,
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COMMENTS ON CONDITION OF DRAINFIELD ETC. •,„_,
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SIGNED BY DATE /- ,