Permit CITY OF TIGARD PLUMBING PERMIT
.-' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00303
Date Issued: 10/05/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel 2S103DC00808
Jurisdiction: Tigard
Site address: 13635 SW 114TH AVE
Project: Kakesako Subdivision: VIRGINIA ACRES Lot: 6
Project Description: Connect existing house to sewer service.
Contractor: HOLLENBACH & HURD, INC Owner: KAKESAKO, RANDALL M & KATHLEEN N
3430 A SW 209TH AVE 13635 SW 114TH
PORTLAND, OR 97007 TIGARD, OR 97223
PHONE: 503 - 591 -5987 PHONE:
FAX: 503 - 848 -6832
FEES
Quantity Description Date Amount
50 If Sewer Service 10/05/2011 $62.54
Specifics: 1 12% State Surcharge - 10/05/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 10/05/2011 $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 N • ation - • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or dire' questions to OU C by c -fling 503 232 1987 or 1.800 332 2344.
Issu =d By: ■ • Permittee Signature: 0
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.
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• P1umbine Permit Application
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• 13125 SW Hall Blvd.. Tigard, OR 97223 Plan Review Q -
;y':: e• Phone: 503 7182439 Fax: 503.598 1960 Other Permit N : e[t)" 0
DateBy:
Inspection Line: 503.639 4175
T I G 4�RD Date Ready /By. Jutis 0 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 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 312 70
® 1- and 2- family dwelling ❑ Commercialiindustrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500 32
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: 13635 SW 114 Ave Catch basin or area drain 18 76
Drywall, leach line, or trench drain 18.76
City/State/ZIP: Tigard, Or. 97223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Fairhaven Manholes 18.76
Rain drain connector 1E76 1
Sanitary sewer (no linear R: 50) Page 2 62.54
Storm sewer (no. linear ft.: 1 Page 2
Water service (no. linear ft. ) Page 2
Subdivision: Lot no.:
Fixture or item:
Tax map /parcel no.: Baek[low preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
` Clothes washer 25.02
abandon septic and connect to pablic sewer Dishwasher 25.02
Drinking fountain 25 02
Ejectorsisump 25.02
® PROPERTY OWNER ❑ TENANT Expansion lank 12.51
Name: Randall Kakesako Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13635 SW 114 Ave. Garbage disposal 25 02
City /State /ZIP: Tigard Nose bib 25 02
Phone: ( ) Fax: ( ) , Ice maker 12.51
® APPLICANT El CONTACT PERSON Interceptor /grease trap 25.02
Business name: Hollenbach & Hurd inc Medical gas (value. S ) Page 2
Primer 12.51
Contact name: Joe Hurd
Roof drain (commercial) 12.51
Address: 3430A SW 209" Ave. Sink /basirvlavatory 25.02
City/State/ZIP: Aloha, Or. 97007 Solar units (potable water) 62.54
Phone: (503) 591 -5987 Fax: : (503) 848 -6832 Tub /shower /shower pan 12 51
E -mail: handh20Cjuno.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Hollenbach & Hurd Inc. Water pipmg/DWV 56 29
Address: 3430A SW 209 Ave. Other. 25.02
City/State /Z1P: Aloha, Or. 97007 Subtotal
Phone: (503) 591 -5987 Fax: ( ) Minimum permit fee: $72.50 7A ,5
CCD Lic.: 121807 ?// rt7 Pl ing Lic. no.: 34 -421PB Plan review (25% of permit fee)
1 State surcharge (12 %ofpermitfee) 3,70 50
Authorized signature ; j / TOTAL PERMIT FEE -l
( Print name: Joe Hui �� ((( Date: 9 - 1 I I This permit application expires if a permit is not obtained within ISO days
a y s
after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
t::i BuildinpWermits1PLMtJ- PemritApp doe IO /O:/09 440- 46167(10 /02 /COM/WEa) ' 1.
Oct 17 11 11:32a HOLLENBACH AND HURD IN 503 - 848 -6832 p.1
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3430-A S.W. 209th Ave_, EXCAVATJ1VGAND U7TIITJS Office (503) 591 -598"
Aloha , OR. 97007 -1073 OCCB #121807 Fax (503) 848 -683'
Email: handh20gltno.ca
FAX TRANSMITTAL
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Oct 17 11 11:32a HOLLENBACH AND HURD IN 503 - 848 -6832 p2
ALOHA SANITARY S ERVICE INVOICE NO
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 16
503 - 644 -2797 * 503 - 648 -6254 • 503 -846 -1951 (FAX)
www.alohasanitary.com Email: info @alo e . sanitary.com
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ADDRESS: CITY: ZIP:
HOME: �7 WO" r� CELL / ,!
.JOB SITE: !' ,,.cam 3 - 5 t, . ///7-/ f ,,,,, ,/� rg . „
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PAID BY CHARD() CHECK CASH ❑ CREDIT CARD ❑
DATE* -7- // TIME DRIVER t �..„/ TANK 7444,4 f AMOUNT
`CN , PUMP SEPTIC TANK k-r'' 7(5 CJ }
❑ INSPECTION FEE ,
Q SERVICE CALL f
❑ LABOR, LOCATING, DIGGING, BACKFILL
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— — THIS IS NOT A SEPTIC SYSTEM IN P ECTION REPORT — — 4 TOTAL $7�
rn +-c+ecl in on 0 -1z -11
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TYPE OF TANK: STEEL ❑ NCRETE Q PLASTIC Of? HOMEMADE ❑
HORIZO L ❑ /VERTICAL ❑ RECTACSLE ❑ ❑ OTHER
SIZE OF TANK: 350 U, 0' 750 ❑ 1000 1250 ❑ 1500 El 2000 ID 3000 ❑
> LID LOCATION: INLET 4 ❑ OUTLET 0 M DLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD D IR ❑ $OOR ❑
FITTINGS: BAFFLES ❑ C0 CRETE ❑ CAST IRON ❑ PLASTIC ❑
GROUND COVER OVER TANK /
COMMENTS i /5
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Customer Signature DATE /. 0 `?_ /7