Permit •
IN a CITY OF TIGARD ]jp PLUMBING PERMIT
*.' COMMUNITY DEVELOPMENT �/ Permit #: PLM2013 -00120
T R ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 25111 BA00805
Jurisdiction: Tigard
Site address: 14130 SW 100TH AVE
Project: Randall Subdivision: TIGARDVILLE HEIGHTS Lot: 25
Project Description: Connect existing house to sewer service, approximately 160'. Septic tank is to be properly decommissioned.
4/22/13, reprinted to add sewer ejector pump.
Contractor: RIVER CITY ENVIRONMENTAL Owner: RANDALL, MARIA L
PO BOX 30087 14130 SW 100TH AVE
PORTLAND, OR 97220 TIGARD, OR 97224
PHONE: 503 - 899 -7363
HONE: 503 - 252 -6144
FAX: 503 - 288 -3658
FEES
Quantity Description Date Amount
160 If Sewer Service 04/15/2013 $100.06
Specifics: 1 12% State Surcharge - 04/15/2013 $12.01
Plumbing
Type of Use: SF 1 ea Ejectors /Sump 04/22/2013 $25.02
Class of Work: ALT 0 12% State Surcharge - 04/22/2013 $3.00
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $140.09
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
issuanc- • • ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U " Notification Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OU • by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ Permittee Si. ature:
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.
' CITY OF TIGARD PLUMBING PERMIT
si
' C OMMUNITY DEVELOPMENT P ermit #: PLM2013 -00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 2S 111 BA00805
Jurisdiction: Tigard
Site address: 14130 SW 100TH AVE
Project: Randall Subdivision: TIGARDVILLE HEIGHTS Lot: 25
Project Description: Connect existing house to sewer service, approximately 160'. Septic tank is to be properly decommissioned.
Contractor: RIVER CITY ENVIRONMENTAL Owner: RANDALL, MARIA L
PO BOX 30087 14130 SW 100TH AVE
PORTLAND, OR 97220 TIGARD, OR 97224
P
PHONE: 503 - 899 -7363
PHONE: 503 - 252 -6144
FAX: 503 - 288 -3658
FEES
Quantity Description Date Amount
160 If Sewer Service 04 /15/2013 $100.06
Specifics: 1 12% State Surcharge - 04/15/2013 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 - ' a: • - nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d' - ct questions to Ob C b calling 503.232.1987 or 1.800.332.2344. ,,,,0,,„ 1
Is ed By: , Ail . / ' Permittee Signature: j r'
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.
Plumbing Permit Application
Building Fixtures 1t,R t,I I ICE USE ONLY
RECEIVED City of Tigard Received a R� 1 j Al Permit No.: ( p ,�(
111 . • 13125 SW Hall Blvd., Tigard,OR 977„7A : ��t' �"'
0k} p Plan Re
Phone: 503.718.2439 Fax: 503.59A 2013 Plan Review 3 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard- or.gov CITY OF - AGAR n Notified/Method: Supplemental Information
TYPE OF MIMING DIVISION ISIOP' 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 ❑ Comerciallindustrial SFR (2) bath 437.78
m
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
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: iii in n d§' /OD - Catch basin or area drain 18.76
City /State /ZIP: Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear f.: , ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
/� /� DESCRIPTION OF WORK Backwater valve 12.51
0 -CXX- (t- ,_51--K. ✓ 4 / f� H2O / �j -D6 /�j Clothes washer 25.02
J t D ishwasher 25.02
1 (-A-A--0 • Drinking fountain 25.02
o Ejectors/sump I 25.02 As or
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
y ��� Water heater 37.52
� 1 .
Business name: � ! I(]Uo-t^ - e ( Water piping/DWV 56.29
V C
Address: Other: 25.02
City/State /ZIP: Subtotal ,A.5 -
Phone: ( ) Fax: ( )
Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) 5 0
Authorized signature: TOTAL PERMIT FEE itg g' p
Print name: I1/, ‘,...; ,.-■ Date: 47- Z Z_ i 3 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\PLMU- PennitApp.doe 10/01 /09 440- 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 - 1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font
El Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
-Jacuzzi/Whirlpool engineer.
t ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage - Domestic non -food
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: - Lav/Bar non -food related
- Bradley
-Corn/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF - PermitApp.doc 08/04/2011 2
bins Permit Applicat r cII/ED
B ing Fixtures 10R OFFICE LSE ONLI
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City of Tigard 1 5 2013 Received /S / perniti No.: L�/7/ /J?� dd l
13125 SW Hall Blvd.. Tigard. OR 97223 APR Pla Re ��f �'�
Plan Review n ^ /5 O /
Phone: 503.718.2439 Fax: 503. Other Permit No.: d �+ O �
X11 F TIGARD
Date
'By: Line: 503.639.4175 [ Pate Ready/By: )oris ® S!tPent for
Supplemental Internet: wwa.tigard- or.gov BUILDING DIVISION l I
Notified kmental lnformation
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
II_Addition/alteration/replacernent ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
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: (y 13o SW / op 4-1., Au-L Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: -C c� I i
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: P roject name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Leg) Page 2 MO rt*
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
L I Clothes washer 25.02
1` Ll� Dishwasher 25.02
�
p c-t�Ir S `7 54erx Drinking fountain 25.02
0` I
Ejectors /sump 25.02
® PROPERTY OWNER I ' ❑ TENANT Expansion tank 12.51
zzl
Name: Maria Randall Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
-• Address: 14130 SW 100' AVe
Garbage disposal 25.02
�`._ City /State /ZIP: 97224 Hose bib 25.02
A....
Phone: (503)899 -7363 Fax: ( ) Ice maker 12.51
fa APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: R;�� Ct kj, Medical gas (value: $ ) Page 2
4 + Primer 12.51
Contact name: t M t --
C 5" Roof drain (commercial) 12.51
Address: Add
Q Old 0 F3 Sink/basin/lavatory 25.02
City /State /ZIP: ` cx-�- 0 �� 2 / 1 Solar units (potable water) 62.54
NI • . Phone: ("JD ) 25 2. Cp L Li Fax: : ( f '25$ - 3 (.,s" 1 ub /shower /shower pan 12.51
\ E -mail: Urinal 25.02 osr, 1h (� ` t 1 V� •C V/�1 Water closet 25.02
�� ��• 444TTT CONTRACTOR Water heater 37.52
(� Business name: 51�ME Water piping/DWV 56.29
�J Address: Other: 25.02
City /State /ZIP: Subtotal /669. -C �
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee) (--
CCB Lic.: (t{ 73s3 Plumbing Lic. no.: 226p '78 Vec - State surcharge (12% of permit fee) J, -D
Authorized signature: TOTAL. PERMIT FEE ap., ,07
Print name: n )v ` C 1- . Date: 7'- /7-/3 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.
I \ Building \Permits\PLMU- PermitApp. 101)1109 440 - 461611 I0/02/COM!wER)
- COD IIIIII1IIIIIIIIIIIII
Date 04/30/13
Scheduled 05/02/13 Septic Service Work Order# W0164209
10:00:00 River City Environmental, Inc,
503- 252 -6144 Complete Industrial
P.O. Box 30087 Salem 503 - 363 -2464 Vancouver 360- 896 -5256 Waste Removal
Septic Tank Cleaning
Portland, OR 97294 Sump Line Cleaning
47) Lm pia t3-- oo6o?U A
Rich Randall Rich Randall
14130 SW 100th Ave 14130 SW 100th Ave Tigard 97224
Tigard, OR 97224
Contact: Rich Randall 503- 515 -4511
503 - 515 -4511 PO#
Septic Service @
Septage Overage @
Notes Ryan M job. Meet the crew on site and pump for the contracted work.
Total Charges
River City Environmental, Inc. is in no way responsible for damage to any vehicles, personal or real property.
Terms: Net 10 days. 1.5% per month will be charged on past due accounts (18% per annum).
Terms and Conditions The Right to Lien
The customer agrees to pay all invoices arising out of services, and any other special services herein within 10 days.
The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered, over and above the normal servicing
schedule, on behalf of the customer.
The customer agrees to assume responsibility damage to customer's real or personal property arising from services which take place
on customer's premises, where the drivers and vehicles of River City Environmental, Inc. have been instructed to enter
This includes, but is not limited to driveways, trees, power lines or poles and building structures.
If River City Environmental finds it necessary to add liquid to the tank on jobsite, customer will be charged for the additional gallonage resulting from these condidtions
Customer agrees to reimburse River City Environmental for all reasonable attorney's fees court costs and other expense incurred by said company to enforce
collection or to serve their rights under this agreement
If this work order is not contested in writing within 10 days the full amount is considered due and payable.
Customer agrees to the above conditions. A fax on the work order is considered an original. Redeemable in Multnomah County
Check # Visa MC Amex Card # Exp Date Vcode
Work Authorized by (please print) Date / /
Signature
Service Tech #1 r c , Service Tech #2 Date 5 1: //3 Time
e ilit. ,m;
•i
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14130 SW 100TH AVE, TIGARD, OR, 97224
Residential - Plumbing
505 Sanitary sewer
05/02/2013 00:00
PLM2013-00120
PART
NOTE 2" discharge pipe rough/test with water pass,
completion of tank/vent/ and pump to come.
Violation Summary:
Inspector Contractor