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Permit •„ CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00275 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/20/2008 PARCEL: 2S 103BA -00107 SITE ADDRESS: 11710 SW ANN ST ZONING: R -4.5 SUBDIVISION: LERON HEIGHTS LOT: 007 JURISDICTION: TIG PROJECT: POTTHOFF Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement District #40 fee paid. CLASS OF WORK: ALT 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES ROGER POTTHOFF PATTISON, SHANTHI A Description Date Amount 11710 SW ANN ST [PLUMB] Permit Fee 6/20/2008 $72.50 TIGARD, OR 97223 [TAX] 12% State Surch 6/20/2008 $8.70 Phone : 503- 244 -4334 Total $81.20 Contractor: LIBERTY PLUMBING 19363 WILLAMETTE DRIVE #232 WEST LINN, OR 97068 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 888 -8830 FAX 503- 699 -7630 Reg #: LIC 176655 PLM 3 -493PB 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. Issue = � ,��j /L �� Permittee Signatu _,•� I �,��/ �, 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. "'' Pltmbing Permit Application 1 Building Fixtures FOR OF FICE USE ONLY g � CEIVE® t,„ BUII . 0 13125 SW Hall Blvd., of Tigard 2 N 2 0 2008 Date/By: (? 0 Permit No.: •/ , Tigard, gard, OR 97 �► I g "09v i = Plan Review Phone: 503.639.4171 Fax: 503.598.1960 �a7O Inspection Line: 503.639.4175 G1TV6 Other Permit No.: o C TIGARD Other .639 1 I r Date Ready/13y: ® See Pa e 2 for TIGARD . Internet: www.tigard- or.gov B nIVISION Notified/Met pp QI111 DIN Su IemeotalInformation - , -- TY OF WORK , ' 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 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 'JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 1 1110 ci,j y Catch basin or area drain 16.60 City /State /ZIP: I t G bale O Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: ( Project name: pv ,,e_ 0„ Aelcittr Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.11 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 • Sep-A-3eAl___ "k V e Backwater valve 16.60 Clothes washer 16.60 . Dishwasher 16.60 Drinking fountain 16.60 ❑-`PROPERTY ^.OW - ❑ TENANT ,. Ejectors /sump 16.60 Name: 41 PAf PO4 - Expansion tank 16.60 Address: k U 71/ 0 5O AAA/ \. St' Fixture /sewer cap 16.60 City /State /ZIP: --r1 i U Phone: Fax: Floor drain /floor sink/hub 16.60 (5 3) a,4 f - y33 V / ( ) Garbage disposal 16.60 ' ❑ APPLICANT Hose bib 16.60 0 PERSON` Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone:( ) I Fax::( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR _ _ Water closet 16.60 Business name: Li elc9lv�L Water heater 16.60 Address: ( ( Ot her: ad] Subtotal City /State /ZIP: PO ' D 16 c17a -c- 0 Minimum permit fee: $72.50 50 OF a Phone: (5i3 ) d - �a Fax: ( ) Residential backflow minimum permit fee: $36.25 72 CCB Lic.: 17 ( 4,,J ) Plumbing Lic- no.: Plan review (25% of permit fee) t e9- Authorized signature: State surcharge (12% of permit fee) V, 70 TOTAL PERMIT FEE g i - Print name: Date: 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\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard • ., . • . � " , • Page 2 - Supplemental Information , Fee Schedule: Residential Fire Suppression Systems: Fee ea ;Total ,p" ': Perm it'FCe , Si U tilities Qty , ' ;_ Square'F ®otage :: • Footing drain - 1s 100' 55.00 O to 2,000 .. $115.00 Footing drain - each additional 100' 46.40 2,00110 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 ValiiatlOn: ".� _ ._ 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 Q ty. • Fee (ea) �, Total' additional $100.00 or fraction thereof, to and " Flxture OY''Itfrinr' 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: Pla Review Plumbing' Instal 1 : 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 *. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Figture'Type: ' '° Replace engineer. Previous. ,:'Capped . Added' ` Eiistin�.. ❑ 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 ;Isometl is Or Riser Diagram, Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -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 Buildin g\Permits\PLM- PermitApp.doe 12/27/06 414 AI[PAUE , . ;. SEPTIC SEEV IOE RO.6OX 1130 WILSONVILLE, OR 97070 ,�, (503) (SB2 i 929 FAX ( ) 57044779 CUSTOMERS ORDER NO. PHONE DATE 1 � j /�� /! f 5' 3 . /ge, 3V44 OC l rte". NAME ( Z 1 Q o ADDRESS I1 .S /9 41/ 5%. %- 12.°P • SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT QTY. - `DESCRIPTION PRICE AMOUNT • >6/0® c if -/TIC S t 3Z _ 490 • TAX • RECEIVED BY (1 TOTAL 5i5 00 All claims an r turned goods MUST be accompanied by this bill. `I T° R3ordar THANK YOU 225.8380 or rabs.cam Juri Fotoo u /.:JCd JJwi tJVi rauu�uvu r •— __ CITY OF TIGARD .0.. COMMUNITY DEVELOPMENT T 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 Plumbing Signature Form IMPORTANT PERMIT NOTICE Permit #: Date Issued: Parcel: 2S 103 BA -00107 Site Address: 11710 SW ANN ST Subdivision: LERON HEIGHTS Lot: 007 Jurisdiction: R-4.5 Zoning: TIG Project Name: POTTHOFF Description: 579 sq. ft. addition. 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: ROGER POTTHOFF L ‘ c �1!/1w�1A: I� 4. PATTISON, SHANTHI A ,, `` ¢� 11710 SW ANN ST iV L-t I4 D i AL Y Sr TIGARD, OR 97223 1vcwrtAgt, ore_ 912:2,c, Phone #: 503 - 2444334 Phone #: stn 6. (8463 ra • Reg*: 3.43 p CAS n6655 AN INK SIGNATURE IS REQUIRED ON THIS FORM aSA A A. - kkitik bt•AUINCL Signature of Authorized ber Name (printed) 'd Ebt.S ES2 COS Rgle3 db0:TO 80 61 unr , . CITY. OF TIGARD BUILDING DIVISION . PERMIT #: PU/12008-00275 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6120/2008 Phone: (503) 639-4171 ,,..... 4 " u p , i l it Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6/23/2008 TIME: 7:01AM PAGE: 38 SITE ADDRESS: 11710 SW ANN ST CLASS OF WORK: SUBDIVISION: LFRON HEIGHTS LOT #: 007 TYPE OF USE: PROJECT NAME: POTTHOFF DESCRIPTION: Conned existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement District #40 fee paid. OWNER: POTTHOFF, ROGER PHONE #: 503-244-4334 CONTRACTOR: LIBERTY PLUMBING PHONE #: 503-888-8030 Inspection Request Scheduled For: Date: 8123/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 071730-01 603-803-6424 N r,..l. Corrections/Comments/Instructions: ce t.. AFT \ C CA_ i *SS El PARTIAL APPROVAL 0 CANCEL fl NO ACCESS El FAIL El CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED Inspector: (11N4..A.--;+ \ \\ AA.,----A„ Date: ( \ 2 3 1 0-c) Phone #: (503) 718 INSPECTOR'S SIGNATURES ARE NOT Inspections Required for: P REQUIRED ON GREEN INSPECTION C. ✓, Code Inspection Description PASS Date I By ✓ Code Inspection Description PASS Date By BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground /slab cover 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service • 205 Fooling 120 Electrical rough -in 805 MFG-Structure grading /footing 125 Wall cover 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab 140 Sign installation 310 Crawl drain 145 A/C or heating unit circuit 225 Post /beam structural 150 Not tub /spa /pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors _ 199 Electrical final 240 Exterior sheathing 245 Firewall 250 Roof nailing ELR - Restricted Energy Permit 255 Wtr proofing basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing 810 MFG- Structure set -up • MEC - Mechanical Permit 280 Insulation 605 Post /beam mechanical 285 Drywall nailing 610 Gas line 287 Suspended ceiling 615 Mechanical rough -in 295 Misc. inspection: 620 Hydronic piping ' 899 MFG - Structure final 625 Duct work 498 Grading final 630 Fire damper 299 Final inspection 635 Smoke detector shutdown 640 Exhaust hood 695 Misc. inspection: 699 Mechanical final BUP - Fire Protection System Permit 905 Sprinkler underfloor /slab 910 Sprinkler rough -in PLM - Plumbing, Permit 915 Fire alarm rough -in 305 Plumbing underslab 920 Suppression trip test 310 Crawl drain 995 Misc. inspection: 315 Post /beam plumbing 998 Alarm final 320 Plumbing rough -in 999 Sprinkler final 322 Shower pan 330 Water service _ 335 Rain drain 340 Storm drain SIT - Site Work Permit 505 Sanitary sewer 405 Excavation 345 Culvert /catch basin 410 Fill 350 Septic tank 415 Grading 395 Misc. inspection: 205 Footing 399 Plumbing final 210 Foundation walls 215 Fooling drain 420 Sprinkler supply lines SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final 595 Misc. inspection: 499 Final inspection 599 Final inspection I: \ Building \Forms \InspCard- AOP- Blankdoc 02/02/07 ., CITY OF TIGARD R PLUMBING PERMIT 1 : COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00275 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/20/2008 PARCEL: 2S 103BA - 00107 SITE ADDRESS: 11710 SW ANN ST ZONING: R - 4.5 SUBDIVISION: LERON HEIGHTS LOT: 007 JURISDICTION: TIG PROJECT: POTTHOFF Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement . District #40 fee paid. CLASS OF WORK: ALT 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES ROGER POTTHOFF Description Date Amount PATTISON, SHANTHI A 11710 SW ANN ST TIGARD, OR 97223 [PLUMB] Permit Fee 6/20/2008 $72.50 [TAX] 12% State Surch 6/20/2008 $8.70 Phone 503- 244 -4334 Total $81.20 Contractor: LIBERTY PLUMBING 19363 WILLAMETTE DRIVE #232 ®' WEST LINN, OR 97068 REQUIRED ITEMS AND REPORTS + 00 Contact # : PRI 503- 888 -8830 1 FAX 503- 699 -7630 0 CI Reg #: LIC 176655 tr,j PLM 3 -493PB ((.��� vl • 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. Issue By: / � � �/ / Permittee Signatu -. _ ,`� •I z �,L:./ ` 1/�/(, 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.