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Permit
C ITY OF GARD PLUMBING PERMIT i DEVELOPMENT SERVICES PERMIT #: PLM2006 -10061 1I DATE ISSUED: 6/28/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 102 DC -00101 SITE ADDRESS: 09355 SW EDGEWOOD ST ZONING: R -4.5 SUBDIVISION: EDGEWOOD LOT: 017 JURISDICTION: TIG Project Description: Connect existing house to newly installed sewer lateral. Sewer Reimbursement District #31 fee paid on this date. CLASS OF WORK: NEW 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: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES LAWRENCE BAILEY Description Date Amount 9355 SW EDGEWOOD ST TIGARD, OR 97223 [PLUMB] Permit Fee 6/28/2006 $72.50 [TAX] 8% State Surcha 6/28/2006 $5.80 Phone : 503- 620 -4652 Total $78.30 Contractor: MICHAEL MCBEE 3039 SE 174TH AVE. PORTLAND, OR 97236 REQUIRED ITEMS AND REPORTS Contact # : FAX 503 -254 -1070 PRI 503- 239 -2707 Reg #: PLM 55821 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 111 y: �l,z� Permittee Signature: 6)--2 c e -.(Lo � 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. CITY TIGARD PLUMBING PERMIT i 4, DEVELOPMENT SERVICES PERMIT #: PLM2006 - 10061 l I ,. DATE ISSUED: 6/28/2006 -.'' - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 102DC - 00101 SITE ADDRESS: 09355 SW EDGEWOOD ST ZONING: R - 4.5 SUBDIVISION: EDGEWOOD LOT: 017 JURISDICTION: TIG Project Description: Connect existing house to newly installed sewer lateral. Sewer Reimbursement District #31 fee paid on this date. CLASS OF WORK: NEW 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: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES LAWRENCE BAILEY 9355 SW EDGEWOOD ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 6/28/2006 $72.50 [TAX] 8% State Surcha 6/28/2006 $5.80 Phone : 503- 620 -4652 Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Contact # : Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rule$-or._direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued F�G� Permittee Signatur tea. _ I 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. Building Fixtures Plumbing Permit Application /, : s% ty _f'': tt�li : ` ' ; w gpii �, • i` City Of Tigard Received p � , i D ao Permit No`: �/ " Date/By: Y t(: I , t5(Y - /pod V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r ® Ph 503.639.4171 Fax: 503.598.1960 Other Permit No. 2�,e / - / 3 i Date/By . r, G Inspection Line: 503.639.4175 Date Ready/13y: Juri See Page 2 for �tzP� Internet: www.tigard- or.gov Notified/Method: 1 Supplemental Info TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 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 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION •, - Site utilities 1« site addi4s: q 3 6 6' 5' ,, 0 A c,� A /66 ) sr, � Catch basin or area drain 16.60 {City/State/ZIE: - 9 epe 0 , 6 2(.'�.' t� 7 2 2 '� Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Fijectname: S 4)e "r r" i „k u `' 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.: ) cif" .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.: y Absorption valve 16.60 ` DESCRIPTIU NTOKWORIC'""� Back flow preventer Page 2 No o A. o p 0, f r y S e:L c k Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 . - „,, Drinking fountain 16.60 PROPERTY OWNER:_.l I ❑ TENANT ' Ejectors/sump 16.60 cNiime: ,) -02 epee Res e Oat 1 e Expansion ta nk 16.60 ( - A - a. dress; 9355" 3 u & :-I) &�r U1 eat J / • Fixture /sewer cap 16.60 City /State /ZIP, T-r' --kg © f q 72 Floor drain/floor sink/hub 16.60 Phone: ('50,3 (�( � et , ).. 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 Sink/basin/lavatory 16.60 Phone:( ) Fax::( ) Tub /shower /shower pan 16.60 E -mail Urinal 16.60 ` CO ^ CTOR' Water closet 16.60 Business name: 1 Q ) P Water heater 16.60 Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 v� Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 / A' CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) ,,_��. J / State surcharge (8% of permit fee) 3j , 80 -3(s, f � Au( � - ^ -'C I�L�Jt � O Y TOTAL PERMIT FEE 7E, PnttT 4�" w /TA � �, 6, r c 'Date: - ip6 This permit application expires if a permit is not obtained within 2 � 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1:\ Building \Permits\PLMF- PennitApp.doe 04 /06/06 440 -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' 55.00 0 to 2,000 $1 15.00 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 and up 'x$742.00 forthe 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 El 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 healthcare facilities - Jacuzzi /Whirlpool providing services to humari'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)j 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" 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 ermit 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 bepaid before the,:, Other Fixtures: - plumbing permit can be issued. is \ Building \Permits\PLM- PetmitApp.doc 07/06/05 • . CITY OF TIGARD BUILDING DIVISION PERMIT #: PLIVI2006- 10061 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/ - 006 Phone: (503) 639-4171 , i, Inspection Requests (24 Hrs.): (503) 639-4175 kV el I INSPECTION WORKSHEET FOR DATE: /15/2006 TIME: 7:03AM PAGE: 15 SITE ADDRESS: 09355 SW EDGEWOOD ST . CLASS OF WORK: SUBDIVISION: EDGEMOOD LOT #: 017 TYPE OF USE: PROJECT NAME: BAILEY DESCRIPTION: Connect existing house to newly installed sewer lateral. Sewer Reimbursement District #31 fee paid on this date. OWNER: BAILEY, LAWRENCE 503-620A652 PHONE #: - CONTRACTOR: MCBEE, MICHAEL PHONE #: 503-239.2701 Inspection Request Scheduled For: Date: 7 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 032739-01 503-481-5348 Y Corrections/Comments/Instructions: \ (} ( , . Tkit vv■ / 4 t i 12.e cc.t N ets \122.6." , 're 1 c Lev\ Ni) t ,e,--,i\ cir 1 PASS I I PARTIAL APPROVAL El CANCEL D NO ACCESS g FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED fi 4A dil 1 l/ Z/ Inspector: Date: N. 1 10..gr ili fr% Phone #: (503) 718- Y 2-J1 CITY OF TIGARD . A, / BUILDING DIVISION PERMIT #: PL/'laAO4 Ale 4I 13125 SW Hall Blvd., Tigard, OR 97223 I/ DATE ISSUED: . Phone: (503) 639 -4171 ��,,.��l Inspection Requests (24 Hrs.): (503) 639 -4175 ��_� __.... INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 96� Sw �ad. >c w�� CLASS OF WORK: /91-1--- SUBDIVISION: CF36S) LOT #: TYPE OF USE: 5/ PROJECT NAME: ) DESCRIPTION: 6 ELOL.�2 e0A)4 et770 _ v L zey OWNER: PHONE #: ,53//- ,377 -- 1/'' - � CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 7/3/00 Pour Time: Code #503 Inspection Description g, Confirm # Contact # Message PI(Vd Corrections /Comments/ Instructions: ❑ PASS i 1 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS . 17j FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Crb h M,J k t1,4„,...., Date: - 7/3 ) tic, Phone #: (503) 718-