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Permit `'�' CITY OF TIGARD ' J S PLUMBING PERMIT PERMIT #: PLM2006 -00128 sill� DEVELOPMENT SERVICES DATE ISSUED: 4/11/2006 13125 SW Hall Blvd., Tigard,,OR 97223 503 - 639 -4171 PARCEL: 2S102CD -00600 SITE ADDRESS: 09530 SW O'MARA ST ZONING: R.4.5 SUBDIVISION: EDGEWOOD LOT: 017 JURISDICTION: TIG Project Description: Connect existing house to sewer service. Removing septic tank. Reimbursement district fee paid this date. 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: 270 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft • Owner: FEES FUCHS, ARNOLD C + SHIRLEY K 9530 SW O'MARA Description Date ' Amount TIGARD, OR 97223 [PLUMB] Permit Fee 4/11/2006 $147.80 [TAX] 8% State Surcha 4/11/2006 $11.82 [PLMPLN] Plan Review 4/11/2006 $36.95 Phone: 503 - 538 -1260 Total $196.57 Contractor: A- AFFORDABLE SEPTIC SERVICE PO BOX 1130 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 969 -9548 FAX 503 -570 -0779 . Reg #: LIC 158246 • 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 : / / ,, �� / Permittee Signature: lerk„/ ,i '' A , V if 5 Call 503- 639 -4175 by 7:00 a.m. for an inspection that business • . y. This permit card shall be kept in a conspicuous place on the Job site until corn • letion of the project. Approved plans are required on the job site at the time of each inspection. Building Fixtures { Plumbing Permit Application City of Tigard t I1 06 Permit No.: 44 p.g. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �/ ' Phone: 503.639.4171 Fax: .503.598.1960 / %. ,:: ,;, y Date/By: Other Permit No.:�W,�O[�p� (9db(o 24- Hour Inspection Line: 503.639.4175 i i I Date Ready/13y: l° See Internet: www.ci.tigard.or.us Notified/Method: 4 (p SupplementaPage 2 for 1 nformation I ' 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 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 yj Other: S rli9 up LATE -L Fire sprinkler ( s ft I � Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: ! g 0 S V/ 1 ©Pt Ai A S- Catch basin or area drain 16.60 City /State/ZIP: ""11 , , ®Q onZZ y� Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Suite/bldg. /apt. .. tz L - F .AL Footing drain (no. linear ft.: ) Page 2 • Manufactured home utilities 110.00 Cross street/directions to job site: r2;eW i 6-- Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.:79) Page 2 /4 IjQ • 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.: Ti Lo-r � i 5. i ®7i t o X17 Q78 600 Absorption valve 16.60 DESCRIPTION OF WORK r Back flow preventer Page 2 3)P k i51 mil p / F L I f SE .j C 7zAd Backwater valve 16.60 4 k 15 r 1J2P Q7, L -To Clothes washer 16.60 �( � t � S Dishwasher 16.60 6 i-r"f tS�C(ll ' it o - '" - -`' � Drinking fountain 16.60 PROP ERTY OWNER Name: I ❑ TENANT Ejectors/sump 16.60 N 0 L� Ft, t° # - � Expansion tank 16.60 Address: 9 S W 0 pip, ? 'S T , Fixture/sewer cap 16.60 City /State/ZIP: ° � &A l� OR- 7gt % Floor drain/floor sink/hub 16.60 1 F ax: I Garbage disposal 16.60 Phone: (5-05) 6-5 8...(24--0 S�� �3� -�Z� 1 ❑ APPLICANT X CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: / i s r . - P A 4 ■ . OA ., fInterceptor /grease trap 16.60 Contact name: n� i Li e" s D p (J 5.7- Medical gas (value: $ ) Page 2 Address: (7 I .f r ox �g2 Primer 16.60 City /State/Z U�B it7G C q7 / l Roof drain (commercial) 16.60 � , ` `- . Sink/basin/lavatory 16.60 Phone: L1 )g,' 7 - 6 9 Fax:: 3j 6-17-Z /Z(0, Tub /shower /shower pan 16.60 E *012 vej/l'G/ h-P=t Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: - 5 Vil� s C. Water heater 16.60 Address: T, m• Z n x' 1 o Other: Subtotal /47, yo City /State/ZIP: UtjIlsau ll.t= (011. 91 \ Minimum permit fee: $72.50 Phone: (3'0; ) G $Z • \ 92/ Fax: ( ) • Residential back flow minimum permit fee: $36.25 • 1 Pl rev (25 %ofpermit fee) 5G /< CCB Lic.: bing Lic. no.: t Authorized signature: C/ % State surcharge (8% of permit fee) 4/ Si2 • _. . TOTAL PERMIT FEE / 6 , 5 ` Print name: ` 1 , t o l? e, Date: 11706, '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. is \Building\ Permits\PLMF - PermitApp.doc 06/05 440.4616T(10/07JCOM/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 - 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 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 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 -D 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 P 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 \Permi&PLM- PennitApp.doc 07/06105 A SEPTIC SERVICE: PO BOX 1130 WILSONVLLE, OR 97070 r, (503) 6.' 21R FAX (503) 5704779 www.aafforclablesepticsvc.00m CUSTOMERS ORDER NO. PHONE DATE NAME /r ADDRESS c, e A SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. REVD. PAID OUT gg QTY. DESCRIPTION PRICE AMOUNT. TAX RECEIVED BY TOTAL All claims and returned goods MUST be accompanied by this bill. (AEI To Reorder. THANK YOU L_ 800 - 2258380 or neba.com CITY OF TIGARD BUILDING DIVISION .. : PERMIT #: I'LM2006 C0 i "l -t3 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1112006 Phone: (503) 639 - 4171 A it Inspection Requests (24 Hrs.): (503) 639 -4175 ......- `__.. INSPECTION WORKSHEET FOR DATE: 4/19/2006 TIME: 7:02AM PAGE: 17 SITE ADDRESS: ff3530 SW O'MARA ST CLASS OF WORK: SUBDIVISION: L :DGEUVOOD LOT #: 017 TYPE OF USE: PROJECT NAME: FUCH'IS DESCRIPTION: Connect existing house to sewer service. Removing septic tank. Reimbursement district fee paid this date. OWNER: FUCH S, ARNOLD C 4 SHIRLEY K, PHONE #: 503 CONTRACTOR: A AFFORDABLE SEPTIC SERVICE PHONE #: ?50 "3.969 - 9f4B Inspection Request Scheduled For: Date: 4/19/2OO6 Pour Time: Code # Inspection Description Confirm # Contact # Message .506 Sanitary sewer 028313-01 503 -9G9 -9548 Y Corrections /Comments /Instructions: r -m J 05 ec-� NOS (}G . _ t PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL F•R INSPECTION ❑ ADDITIONAL F ES ASSESSED Inspector: `� / Date: 1 1/ Phone #: (503) 718 - Li CITY OF TIGARD BUILDING DIVISION PERMIT #: Plan 02006 - UO /ag 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639- 4171 of Inspection Requests (24 Hrs.): (503) 639 -4175 ' `'It INSPECTION WORKSHEET FOR DATE: / 0/ aoo(o TIME: PAGE: SITE ADDRESS: ci 5 3 0 S GV 0 '4IARA 54, CLASS OF WORK: SUBDIVISION: F d e LOT #: TYPE OF USE: u�oa PROJECT NAME: � s DESCRIPTION: 1- uc 1., 5 OWNER: PHONE #: 5b3 - 53e - to 0 CONTRACTOR: PHONE #: 6'63 - y 69 _ 5 L Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 359 PhL,piio'r Corrections /Comments /Instructions: AIM ■A` I f PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL II CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I ffi k Inspector: IIA ^o - A Date: 0 C Phone #: (503) 718 - '�3