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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00216 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2008 PARCEL: 25101 DC -02300 SITE ADDRESS: 07610 SW CHERRY ST ZONING: R -3.5 SUBDIVISION: ROLLING HILLS PLAT 2 LOT: 033 JURISDICTION: TIG PROJECT: TAKAHASHI 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: 110 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES TAKAHASHI, WAYNE H SHARON S Description Date Amount 7610 SW CHERRY ST [PLUMB] Permit Fee 5/15/2008 $101.40 TIGARD, OR 97223 [TAX] 12% State Surch 5/15/2008 $12.17 Phone : Total $113.57 Contractor: BRIAN CLOPTON EXCAVATING INC PO BOX 509 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 682 -0420 Reg #: LIC 50337 PLM 3 -517PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued Byi(a: Permittee Signatur �// Call 503.639.4175 by 7:00 a.m. for an inspection that • siness day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Applica� ' E1VED , Building Fixtures FOR OFFICE USE ONLY City of Tigard MAY 1 5 200$ Received Date /By: 47,:;.0,:F ��, y , � Permit No. :A,7 o 0F DD-a /e„ - IN' q 13125 SW Hall Blvd., Tigard, OR 9 223 Plan Review Phone: 503.639.4171 Fax: 5006 10 � 60r 1 Other Permit No.S(URoi p�D7b f� /� D ate /B y TIGARD` Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov • Notified/Method: Supplemental Information TYPE.�OF'WORK .,.. FEE *.SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description Qty. Ea. I Total ❑ Addition/alteration/replacement KOther: New 1- 2- family dwellings (includes 100 ft. for each utility connection) • , CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20 1711- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ID Accessory building El 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: 7 6 /6 S6(,) C/&---- , y 3'7- Catch basin or area drain 16.60 City /State /ZIP: i! la r _ d c9 e q 7 2 Z3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: 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.: aft) Page 2 j j) /, 9e • Storm sewer (no. linear ft.: _) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRII'TION'.OF ,WORK Backflow preventer Page 2 e w e y- Co Kite(' Fl /k- Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 `' PROPERTY OWNER , . ,` ❑ TENANT Ejectors /sump 16.60 Name: W ety f./ Q /cQ%LLs 4l - Expansion tank 16.60 Address: 76, 7 /U S a) r//Le 01 !J ill ✓e Fixture /sewer cap 16.60 City /State /ZIP: l - a rn / ()f 1 ' 7 Floor drain/floor sink/hub 16.60 Phone: ( 3) (�_ 4V t � Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 • ❑,x APP T' LICAN ` ` - , ' .. • la CONTACT 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: ( ) Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 * g p , CONTRACTOR.. - . - , _ . Water closet 16.60 Business name: 6,2m,.) , - „/ J, va. f tety Water heater 16.60 Address: A D b 0 A 5-1J 9 Other: Subtotal City /State /ZIP: a)( LSdt 4 7617 / Minimum permit fee: $72.50 3 / ®/ (] y Phone: 5' ) �ja _ p yc2 D Fax: ( ) e Residential backflow minimum permit fee: $36.25 CCB Lie.: $'• J 7 Plumbing Lic. no.: 3 -.7/ -7/Q Plan review (25% of permit fee) State surcharge (12% of permit fee) ,.7 /. Authorized signature: TOTAL PERMIT FEE //3 37 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. 1:\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: Sate Utilities. R Qty ; Fee (ea) `T otal i Sgiiate ootage:;,.. , Permit Fe 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 1 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 .S5; O 7,201 and greater $309.00 Sewer - each additional 100' 46.40 y` Yd Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 . Valu'at 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 - .. additional $100.00 or fraction thereof, to and Fixture or Item" a. Qty, Fee (ea) ` .Total: ss 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for /v / , % ' each additional $100.00 or fraction thereof Commercial Fixture Work: .Plan:Review- for.Pluilnbing Install 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 aP t �Quautity by (Fixture) Work Performed,° greater, except systems designed and stamped by licensed Fixture Type: - ,. , ' . Replace engineer. - - . , - • l'revioas t .C apped 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 o ' 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: is\ Building \Permits\PLM- PermitApp.doc 12/27/06 A AFFORDALE SEFTt C SfRV CE P.O.BOX 1130 WILSONVILLE, - (503) 682-29 FAX 10:03705770.0779 CUSTOMER'S ORDER NO I PHONE DATE NAME egZ4A TG Kg) . ADDRESS 71 O j® 3 k) f2-E'( 7 O o ` SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT ,Y OTY j DESCRIPTION ` '; PRICE AMOUNT /6 6 PT e ar 32-5 - 0 r? 13s • 4.`," /74j/11: / # 4 '-,46 /1 47 fr f TAX RECEIVED BY TOTAL 32 oa All claims and returned goods MUST be accompanied by this bill. / l/ To Reorder. THANK YOU 800-225-6380 or nebs.c om FROM BRIAN CLOPTON EXCAVATING 503 682 0967 (TUE)MAY 20 2008 14:09/ST.14:05/No.6804641519 P 1 CITY OF TIGARD ° COMMUNITY DEVELOPMENT ]E C FISTED TIGAR-D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 MAY 1 6 2008 BY: Plumbing Signature Form IMPORTANT PERMIT NOTICE BRIAN CLOPTON EXCAVATING INC PO BOX 509 WILSONVILLE, OR 97070 Permit #: PLM2008 -00216 Date Issued: 5/15/2008 Parcel: 2S101 DC -02300 Site Address: 07610 SW CHERRY ST Subdivision: ROLLING HILLS PLAT 2 Lot: 033 Jurisdiction: R -3.5 Zoning: TIG Project Name: TAKAHASHI 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: TAKAHASHI, WAYNE H BRIAN CLOPTON EXCAVATING INC SHARON S PO BOX 509 7610 SW CHERRY ST WILSONVILLE, OR 97070 TIGARD, OR 97223 Phone #: Phone #: 503- 682 -0420 Reg #: LIC 50337 PLM 3 -517PB AN INK SIGNATURE IS REQUIRED ON THIS FORM - X — b � cJSK Signature of Authorized Plumber ame (pri ted) ' . - _- . CITY OF - ��uu m ��m TIGARD BUILDING DIVISION ~�~°"=~~~""~~° ~°"°"~°,~,,° PERM|T#: PLN12008-00216 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/15/2008 Phone: (503) 639-4171 - 414, Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 5/16/2000 TIME: 7:00Ak4 PAGE: SITE ADDRESS: U7$1O SVVCHERRY ST CLASS OF WORK: SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 033 TYPE OF USE: PROJECT NAME: TAKAHASHI DESCRIPTION: Sewer connection. OWNER: TANAHASH|.VVAYNEH. PHONE #: CONTRACTOR: L3RIANCLOPTON EXCAVATING INC PHONE #: 503-682-0420 Inspection Request Scheduled For: Date: 5/1E/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 071427'02 503'849'7607 Y Corrections/Comments/Instructions: ~T� �� \ ^�`' '� �- � � /—�l�e. �r���� ��� .• X PASS 0 PARTIAL APPROVAL 7 CANCEL El NO ACCESS | I FAIL 0 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED Inspector: Date: / \ \\ Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2008-00216 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/16/2008 Phone: (503) 639-4171 I Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: W11/2008 TIME: 7:00AM PAGE: 2 SITE ADDRESS: 07610 SW CHERRY ST CLASS OF WORK: SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 033 TYPE OF USE: PROJECT NAME: TAKAHASHI DESCRIPTION: Sewer connection. OWNER: TAKAHASHI, WAYNE H, PHONE #: CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420 Inspection Request Scheduled For: Date: 6/11/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 071234-02 603-849.7607 Corrections/Comments/Instructions: 4- ( 17 1 2k: let i , : i t R19164_4 + • g PARTIAL APPROVAL El CANCEL n NO ACCESS El FAIL n CALL FOR INSPECTION LII ADDITIONAL FEES ASSESSED Inspector: Crb \I \A- Date: C I I. Phone #: (503) 718- _ .