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Permit j .'r A CITY OF TIGARD PLUMBING PERMIT i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00308 �'' I ° 13125 SW Hall Blvd., Tigard, OR 97223 503-6394171 DATE ISSUED: 6/21/2006 PARCEL: 2S104AD-03900 SITE ADDRESS: 12600 SW WALNUT ST ZONING: R -7 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: New 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: 200 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES BRENDA CARLTON 12600 SW WALNUT ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 6/21/2006 $101.40 [TAX] 8% State Surcha 6/21/2006 $8.11 Phone : 503 -590 -2963 Total $109.51 Contractor: HOLLENBACH + HURD INC 3000 SW 174TH AVE ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 -591 -5987 FAX 503- 848 -6832 Reg #: LIC 121807 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 By: '":7)� ,1-43 Permittee Signature: A sp ,91 - 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. Buileing Fixtures _ - Plumbing Permit Ap ton ' 0 F 4 1 \ 1 roll c�i rig[ 11Sl oar City of Tigard Received PPermit No. p 131 SW Hall Blvd., Tigard, OR 97223 JUN �, l 00 Date/By 6 G( l l ajp / 00.3Qn Plan Review Phone: 503.639 4171 Fax: 503.598.1960 Other Permit N� Date/By sod oa . 8 24 -Hour Inspection Line: 503.639.4175 a _ Date ReadyBy rung 171 See Page 2 for Internet: www.tigard- or.gov �,L Liu "�� Notified/Method. � Supplemental Information e_n PSy1' FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other New 1 dwellings (includes 100 ft. for each utility connection) , 'CATEGORY' OF CONSTRUCTION SFR (I) bath 249.20 ❑ I- 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 0O Sw aim( k 5+ Catch basin or area drain 16.60 City /State /ZIP: ^r' , 0 re_ q7 a 2-3 Drywell, leach line, or trench drain 16.60 • Suite/bldg /apt. no.: I 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. ) 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 Back flow preventer Page 2 • - at,u -PA r P--(4 j • _ ' Backwater valve 16 60 Clothes washer 16.60 Dishwasher 16.60 L PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: rpm lL. Expansion tank 16.60 . Address: I 24000 S G() v - S Fixture /sewer cap 16.60 City /State/ZIP: 7-1 i O J 712 Floor drain/floor sink/hub 16.60 Phone: ( 5`73) 5q0 ati G 3 Fax. ( ) Garbage disposal 16.60 ' ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 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 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 • E -mail: Urinal 16.60 CONTRACTOR / `�� ���7 Water closet 16.60 Business name. e t c l _� .tic I_ Water heater 16.60 � Other. ther. I Subtotal City /State /ZIP: • Minimum permit fee. $72.50 f Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 AV, l CCB Lic.: Plumbing Lie. no • Plan review (25% of permit fee) ` e State surcharge (8% of permit fee) A. / Autho signatu `�1h� TOTAL PERMIT FEE / 7 9 57 Print name: ire n cict., 6. L ac."1-II to h Date: lv /af /of, 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 12/30/05 440.4616T(10/02/COM/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 - 1r 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' I 55.00 7,201 and greater $309.00 Sewer - each additional 100' i * 46.40 Water Service - 1st 100' 47 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 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 Structur 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 ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash 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 \Buddina\Permtts\PLM- PermitApp doc 07/06/05 FAX NO. :503 848 6832 Jul. 05 2006 11:56AM P2 (‘' FROM :HOLLENBACH & HURD Inc ,-- ' - -..-.' -- ' ,--..- !..-. • --'7; .--1 4i-7 - ;-- -, , -, - I . :' i ,-,,, ,., ." ---' , .- 1_ -- ' 'i_.., I f.i ,. r 1!4 :1 3430-A S.W. 209th Ave., WA VATING AND VT/LIMES Office (503)591. Moha. , Olt 97007-1073 OCCB #121807 Fax (503) 848-61 Email: handh20(411 RESIDENTIAL SANITARY SEWER AS-BUILT Date: ea - 30 - t" 41 Buikling Permit # Pim acc4o1 e8 Building Contractor: E „ . __________________. Subdivision: , I Address: _1.,#.-- .._ Depth of Connection to City Stubout: + Distance off curb to City Stubout: 4 ' TYPe of PiPe: .. --._1.(1 Size of Pipe: 1 n rype of Connection: ______4_,Z_____:::—.:— Inspection Date: j ......... 0 45' P(`) ......•._. _• ...nee •-••••••••• C• 0 d$1• • d ..______. _______ 45 c / /, C , 4.6 /p Y by 47 — --- • / lk 1 r glver . ____, ki ____ ....._____ Aoll . 1 0 • 4 6 • f ______________ : .._____ ____. _ ..__________ ... .,.................,......_ ...........).. 1;, 4 0 0 ki , 1/1/ v -/-- 5 -1-- • FROM :HOLLENBACH 8 HURD Inc FAX NO. :503 848 6832 Jul. 05 2006 11:57AM P3 ALOHA SANITARY SERVICE INVOICE N0. 8600 SW Hillsboro Hwy., Hillsboro, OR 97123 10 8 6 7 503- 644 -2797 • 503 -648 -6254 * 503 -639 -5188 NAME: i 4 L V !.'G/1 � `�P�1- h ��f�`' ADDRESS: Crrv: _, - STATE: _ ZIP: HOME: WORK: CELL: JOB SITE: 1 e:00 PAID BY ciaididedV CHECK pif CASK ❑ CREDIT CARD ❑ DATE 4 - 7 - ©‘ DRIVER 6 , 4 , I L E 74 4 loti f AMOUNT PUMP SEPTIC TANK L j eJ clic? ❑ INSPECTION FEE ❑ SERVICE CALL ❑ LABOR, LOCATING, DIGGING, BACKFILL - THIS IS Nor A SEPTIC SYSTEM INSPECTION REPORT - 'TOTAL - - REMARKS - - TYPE OF TANK: STEEL ❑ CONCRETE 0 PLASTIC U HOMEMADE HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ O_ OTHER _ SIZE OF TANK: 350 L7 500 ❑ 750 ❑ 14.-zi 0 ❑ 1500 ❑ 2000 ❑ 3000 ❑ LID LOCATION: INLET ❑ O T Q � r MIDDLE ❑ ENTIRE TOP 0 TANK CONDITION: GOOD ❑ AIR ❑ POOR ❑ FITTINGS: BA FL'ES i CONCRETE ❑ CAST IRON ❑ PLASTIC ❑ NEEDS NEW LID? YES ❑ SIZE GROUND COVER OVER TANK COMMENTS ON CONDITION OF DRAINFIELD ETC. SIGNED BY DATE ev e ' _ .. d r CITY OF TIGARD • BUILDING DIVISION Y _ • PERMIT #: PLM2006 -00308 13125 SW Hall Blvd., DATE ISSUED: 6/21/2006 d., Ti ard, OR 97223 9 Phone: (503) 639 -4171 �a Inspection Requests (24 Hrs.): (503) 639 -4175 ! `'I I.. INSPECTION WORKSHEET FOR DATE: 6/30/2006 ' TIME: 7 :01AM PAGE: 26 SITE ADDRESS: 12600 SW WALNUT ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: CARLTON DESCRIPTION: Now sewer connection. OWNER: CARLTON, BRENDA PHONE #: 503.590 -2963 CONTRACTOR: HOLLENBACH + HURD INC PHONE #: 603- 591 -5987 ' Inspection Request Scheduled For: Date: 6130/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 032500 -01 603 - 936 -5733 N Corrections /Comments/ Instructions: / 1 /- 6 II . - , 7 d . 4? /---1/1"" l' / _..--; r ,,,,, ,.. . •. . . . . , . , • 4 p,oest ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: &/5 Date: 1 Phone #: (503) 718 - 1/23 3