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Permit X07 Sw Erirc / Sf /LA/(2a/3 - 00 z//‘0, RECE' .Y.• � ,r Debbie Adamski 13125 SW Hall Blvd. NOV ] C) Tigard,Or.97223 CITYOI° 1luaHp Ref: 10940 SW Errol St. BUILD ING DIV;s,o�� Dear Debbie, Enclosed is the Plumbing Permit Application for the sewer connection along with a check for the fees. $7870.18 Reimbursement dist. $4835 Sewer connection $150 for 250 Sanitary sewer run For a total of$12,855.18 Jeff Maxwell of Maximum Excavation will be the contractor and will pick up the permit.If you could send me a copy I would appreciate it. I will be at the following address until Dec.1,2013. 26441 Thunder ridge Road Conifer,Co. 80433-6120 Home address after December 1st;PO Box 3857,Sunriver Or.97707 Or,you can email it to me at njohnadrienne @aol.com Thanks for your help with this process. Sinc ly ohn Newman 541-593-6420 ,r , 1299 l o • ' PO BOX 1130,Wilcnne`le OR 97070 • Septic Service Phone:503-682-1929 ._..503-570-0779 I � UL a?"nrdablesepticservice @yahoo.com ,,w affc '.. esepticsvc.com 5U3-t82-1929 rt CCB w ioa246 DEQ#37918 ustomer PO# Contact Phone /7'•Q-X/.-t V o L Date Name _ Address • V� -: o' Technician / Mark Payment C:leck(Write#) Cash Credit Card Bill Account Other Type: De5criptior QTY 'Unit •Unit Price For /0 9 'tD {. LI) Fx/zo 7.y, ec-/ f ��c_ . �/ 7 a t7L r) „Zv 13 -cc/6 _ t2g147e F L.L ygt-c 114! .; Invoice Total Recommendations(if any): —t is the pure 'r's c 7n to clearly mark underground utiliti.-and under°oun('I' `n systems. °ce is NOT resp-nsible for unmarked utilities and/or ir. Lems. Date Claims'% - oe accompanied by this bill • CITY OF TIGARD PLUMBING PERMIT '1 2 • COMMUNITY DEVELOPMENT Permit#: PLM2013 00416 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/19/2013 Parcel: 2S103AD00407 Jurisdiction: Tigard Site address: 10940 SW ERROL ST Project: Newman Subdivision: ECHO HEIGHTS Lot: PTS 12- Project Description: Connect existing house to sewer service,approximately 250'. Septic tank must be pumped and filled. Contractor: MAXIMUM EXCAVATION LLC Owner: NEWMAN,MICHAEL J 2076 SW SUNRISE CIR KARJALA, NICOLE TROUTDALE,OR 97060 10940 SW ERROL TIGARD, OR 97223 PHONE: 503-839-7826 PHONE: FAX: FEES Quantity Description Date Amount 250 If Sewer Service 11/19/2013 $137.58 Specifics: 1 12%State Surcharge- 11/19/2013 $16.51 Plumbing Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $154.09 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 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 icatr i do Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or dir t questions to O C by calling 503.232.1987 or 1.800.332.2344. 1 Is ued By: L Permittee Sign- 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 FINED City of Tigard 1 Received ved ii l g /3 �� Permit No.: A.tiaD�3_�p�* U 13125 SW Hall Blvd.,Tigard,OR 97223 NOV 19 9 2013 Plan Review Other Permit No.: � ko'D/ �V� ri �Phone: 503.718.2439 Fax: 503.598.1960 Date/By: T I GA IZ D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: E1 See Page 2 for Internet: www.tigard-or.gov (�� y� 1� /� t Notified/Method: Supplemental Information TYPE OF WORf�'ILDIIVG DIVISION 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 ❑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: /b 9 V z---,24Z. Catch basin or area drain 18.76 � w Drywell,leach line,or trench drain 18.76 City/State/ZIP: '; 2 iQ° o�• . g 7.1,23 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 1 Project name: �L4.)n 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 /37, j 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 /_ /,� Clothes washer 25.02 SE/A,/& G� .)/1/Z G72"N Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 gi• PROPERTY OWNER I • ❑ TENANT Expansion tank 12.51 Name: �/G/'�sL ,, J- j/7/?/L/ Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: /i)/-lxp ,W, 4 '4' Z i ,S,-- Garbage disposal 25.02 City/State/ZIP:7:1Z.y1,,Z p, G4 4707-7 3 Hose bib 25.02 Phone:67/) �,x_gs'/L5 Fax:( ) Ice maker 12.51 ❑ APPLICANT • ❑ CONTACT PERSON I 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 Water closet 25.02 • 'CONTRACTOR . ' ll Water heater 37.52 Business name: /'7"9Jt./r7�n £xG,/V/11721)4// GL G Water P tP in WV 56.29 F� Address: Q7 6 S j $CIAl4)5r L/,cG a Other: 25.02 City/State/ZIP.""M Nr:i9LZ)l 0,4, 9704,0 Subtotal /37.51 Phone:6o g3 cJ 73.. .z Fax:( ) Minimum permit fee: $72.50 CCB Lic.: //17.1/ .g- Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%ofpermit fee) (/v$/ Authorized signal e• TOTAL PERMIT FEE I I 546.1 Print name: 4,/./,,lig/(/Lt%(,( km./ Date frC_/c7/--,72475 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-PermftApp.doc 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-I'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 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: . $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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive 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 Riser4Diagram .. ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. 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 -Com/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 Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 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 10940 SW ERROL ST, TIGARD, OR, 97223 Residential - Plumbing 399 Plumbing final 2014-02-13 (null) PLM2013-00416 PASS - No C of O Violation Summary: Inspector Contractor