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Permit ' CITY TIGARD PLUMBING PERMIT 4l DEVELOPMENT SERVICES PERMIT #: PLM2005 -00532 � 111 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/27/2005 PARCEL: 1S126DC-03100 SITE ADDRESS: 09330 SW LEHMAN ST ZONING: R -4.5 SUBDIVISION: LEHMANN ACRE TRACT LOT: 007 JURISDICTION: TIG Project Description: Site utilities for new minor land partition. LE it N - tAre S i CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 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: 406 ft DISHWASHERS: RAIN DRAIN: 190 ft Owner: FEES DALE RICHARDS Description Date Amount 12655 SW NORTH DAKOTA ST TIGARD, OR 97223 [PLUMB] Permit Fee 10/27/200E $342.00 [PLMPLN] Plan Review 10/27/200E $85.50 Phone : 503-783-4375 [TAX] 8% State Surcharl 10/27/200E $27.36 Total $454.86 Contractor: NEW WEST CONSTRUCTORS INC PO BOX 19588 REQUIRED ITEMS AND REPORTS PORTLAND, OR 97280 -2909 Phone : 503- 977 -2909 Reg #: LIC 1052U PLM 26 -783PB 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 -00' e : e rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calli • 503 - 246 -66 • or 1-800- Iss ed By: , , ; i�� ,i 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. • is 93 3a „Si") L...hji1 Sife'Utilities Plumbing Permit , • ;, . `4 e C) � FOR -011 ICE IJSL'•ONLY City of Tigard T Received /n - e l -D5 Permit No +\22p6s - 445:7, 13125 SW Hall Blvd., Tigard, OR 972.3� y ii ryry Phone: 503.639.4171 ax: 503.59811 :1 1 1 LO05 / j � sr �. „ Plan Review t t . O ��� Other Permit No.: p 24- Hour Inspection Line: 503. 639.4175 � "k� G i i �,' Date /By. J I/v [ i }i Dale Ready/By: Ju" ® See Page 2 for • Internet: www.ci.tigard.or.us CITY OF TIGARD Y Notified/Method: "AV Supplemental Information .IDOL {IFION . FEE* SCHEDULE III construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total El Addition /alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION • SFR(1)bath 249.20 ID 1- and 2- family dwelling 0. Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 ,-� J Each additional bath/kitchen 45.00 El Master builder U Other: Si 7� ' - t )t t ie Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION _ • Site utilities • Job site address: 1330 5 iiti 1-9A, , t y Catch basin or area drain 16.60 City/State /ZIP: T■ J tk r / ©ri,z- 9 2'2> 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: /. 1 _.r ` 1 Footing drain (no. linear ft.: ) Page 2 L t✓� Vd. C� h I .vc� . tI. Y�� 7%yu Manufactured home utilities 110.00 Cross street /directions to job site: Manholes 16.60 9 A) f j7.►. CO /..e. L 1M!/i t Rain drain connector • 16.60 . Sanitary sewer (no. linear ft.: ) Page 2 444.i i . 11_A Storm sewer (no. linear ft.: j'yt)) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: `i'0(-.) Page 2 N/ Fixture or item Tax map /parcel no.: / i 2,‘ .0C 3 i Absorption valve 16.60 DESCRIPTION OF WORK Back flow preventer Page 2 . . t to (,l 'i'r I .tte.,I ,Stye to., J e.& t;,tJa. fe.r Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER I ❑TENANT Drinking fountain 16.60 Ejectors sump 16.60 Name: DA. n . 1 ` I0 / 1.I.) H14 WwJ Hak, 1 Expansion tank 16.60 Address: I 1 S-f SW Nor 11, ak ict. J Fixture /sewer cap 16.60 City /State /ZIP: Ti, a y72 3 Floor drain/floor sink/hub 16.60 Phone: (St 2) 79 0 4.3 -7J Fax: (,s"ds) I �"2S'/ 7..5-6 Garbage disposal 16.60 Hose bib 16.60 APPLICANT ❑ CONTACT PERSON I A Ice maker 16.60 Business name: ��K t.-4 kGS ; I AS,..) C c. i,Ct _Lk. Interceptor /grease trap 16.60 Contact name: C r•,. Kaye c,,.< L Medical gas (value: $ ) Page 2 Address: /5J -s o 4 . ). J-ay i re.e. t Primer 16.60 City /State /ZIP: U i, �• / 7 "o6 Roof drain (commercial) 16.60 .,ci �e i.-- ,,� Sink/basin/lavatory 16.60 Phone: (SD, )' .CSFIf.. 6 g Z 'Fax: : (,(03) 6 c f y 731 )' Tub /shower /shower pan 16.60 E -mail: Gi 1�N.c I k z kid1ra - iI . G oy+. . ✓ ./ Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: • Me-u/ Wa.st CD,na / ruci4DY:s ItA e . Water heater • 16.60 Address: e 0 6p y, /1. I9e Other: Subtotal City /State /ZIP: POI'-'4- f d e t4.) 0 7 lS � �''� 0 Minimum permit fee: $72.50 6 J G � Phone: (�f QS) y69 _ 6307 Fax: (S03) `1772-5 �) Residential backflow minimum permit fee: $36.25 T '� 31 f e a® Plan review (25% of permit fee) _CCB Lie.: 1�� / Plumbing Lie. no.: t‘- ]Q,� f 8 4�. /� - .. �$ State surcharge AL ERM permit FEE fee) Authorized signature: � �� G -� ' "\ 9.1 . 56 TOTAL PERMIT Print name: / r / Date: /Q�j / /Cj This permit application expires if a permit is not obtained wt hin G �,. ' ,.� '�. 1 � i R3 `v 1 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. is \Building \Permits\PLMU - PermitApp.doc 06/05 440- 4616T(10/02/COM/WEB) / / / to • • w Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ca) Total Square Footage: - Permit Fee: Footing drain - 1" 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 Storm & Rain Drain - 1st 100' 55.00 Valuation: . Permit Fee: $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 Back flow 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 Complex Structures Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped • Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi /Whirlpool providing services to human beings. Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service -Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor /Water Aspirator are being installed for the food service area. Dishwasher -Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain Eye Wash ❑ Any NFPA 13 - multipurpose fire sprinkler system. Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain Isometric or Riser Diagram Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service . Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor • `Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. i:\ Building \Pennits\PLM- PennitApp.doc 07/06/05 ..., CITY OF TIGARD BUILDING DIVISION 411) PERMIT #: PLM200E;.00632 13125 SW Hall B[yd., Tigard, OR 97223 DATE ISSUED: ion 112005 Phone: (503) 639-4171 aniiivA0 Inspection Requests (24 Hrs.): (503) 639-4175 AO- Ii.. INSPECTION WORKSHEET FOR DATE: 2/16/2006 TIME: 7:07Am PAGE: 26 SITE ADDRESS: 09330 SW LEHMAN ST CLASS OF WORK: SUBDIVISION: LEHMANN ACRE TRAcT LOT #: 007 TYPE OF USE: PROJECT NAME: LEHMAN PARTITION WEST DESCRIPTION: sito utilities for :. now minor land partition. OWNER: RI CHARDS DALE PHONE #: 603.703, CONTRACTOR: NEW WEST CONSTRUCTORS INC PHONE #: 503 Inspection Request Scheduled For: Date 2116/2006 Pour Time: Code # . Inspection Description Confirm # Contact # Message 399 Numbing final 027014-02 603-969-6307 N Corrections/Comments/Instructions: M I O.. A.- -- 3 - 0 is. ,S; -i-e., or A--r" ( 13 ,....4,1 1 0 Lo ....c.,, ivA.A"....-. P 2.7 eitA--.- ::11-i.- \ 0.- 10) 1,7 i 0 (' /Ai V.z .ciAct.i.,4,./ t'cli i.-4---c. A t- e ,,, TO j■A, V-Vo■-t kg-,..,,,-1.,....4 4' , ,..,-)ris , 0 it-. „.1.p....4,. (Li 6 .....1,t...i r A-4-- At_ 1V1e.— t...k it, , / 1 _ - . .• , / 11/1 ' 6 / -- ‘L- 1 A ) -4 ' ' ,' ' - r C- / , s- -) 1] " ib . i ...^ - .../ a _ A -41J i Simw . i -il / . 4 , - st. A IINIIMMLOW/Zi / 1' - .. r,- k .----- V, PASS I I PARTIAL APPROVAL El CANCEL n NO ACCESS FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 1 k---/\ lAi\ Date: 2.) ii /0 L Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION 13125 SW Hall Blvd OR 97223 .1, PERMIT #: PLM2005-00532 DATE ISSUED: 10127/2005 \I , • Phone: (503) Z39-4171 Inspection Requests (24 Hrs.): (503) 639-4175 A- Ai. INSPECTION WORKSHEET FOR DATE: 10/290005 TIME: 7:18AM PAGE: 50 SITE ADDRESS: 09330 SW LEHMAN ST CLASS OF WORK: SUBDIVISION: LEHMANN ACRE TRACT LOT #: 007 TYPE OF USE: PROJECT NAME: LEHMAN PARTITION WEST DESCRIPTION: Site utilities for new minor land partition. OWNER: RICHARDS, DALE PHONE #: 503-783-4375 CONTRACTOR: NEW WEST CONSTRUCTORS INC PHONE #: 503-977-2909 Inspection Request Scheduled For: . Date: 10/28/2005 Pour. Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 019700-03 503 7804375 y Corrections/Comments/Instructions: li'• . 0- — / 1 ._.S -- ■- 1 ° - _....-- -- ./ / . /14111 JO 4 .■,;Ar-,/ QV . -- ___. _... .gi 4 A F I i I r. I r ,-. ■/MAIIIF / AG . /Al P1 M1 II P" ' .- -"U-1.11 . 111 1 11101 1111111111111.1111.1111111111 111 . 11111..... - ' - _ in - ASS I I PARTIAL APPROVAL I CANCEL n NO ACCESS FAIL I I CALL FOR INSPECTION [I ADDITIONAL FEES ASSESSED Inspector: ir Date: Phone #: (503) 718- -_ - ,