Permit ,o PLUMBING PERMIT
t�, -�� CITY OF TIGARD
' " COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00229
DATE ISSUED: 6/4/2007
pTIgg 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 CB -00102
SITE ADDRESS: 10150 SW MURDOCK ST ZONING: R -3.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: ALEXANDER
Project Description: Line work to connect sewer. Septic system to be pumped and filled or removed.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ALEXANDER, RONALD E
MARY T Description Date Amount
10150 SW MURDOCK [PLUMB] Permit Fee 6/4/2007 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/4/2007 $5.80
Phone : 503- 639 -0359 Total $78.30
Contractor:
CANTRELL & SONS CONTRACTING
6860 SW NORSE HALL RD
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 638 -0800
Reg #: LIC 97005
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: 16 ..,, Permittee Signature: (
Call 503.639.4175 by 7:00 a.m. for an inspection that business da
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 Ap 7._, >u.. q ., .
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PPIOS City of Tigard DateBy e vo ' N 1 Permit No.: �L- h'jow67.(J .7
` ' `a 13125 SW Hall Blvd., Tigard, OR d Plan Revie 4: r, 0 ''... Pho ne: 503.639.4171. Fax: 503. $.19b�J 2�U1 Other Permit
J DateBy: J IZol� r 3 4
t ,
M _ ) Inspection Line: 503.632`4 1 ,, 1 ,. Date Read /B orr is: la See Page 2 for
TvI r Ready /By: B
lmr ito5,, Internet: www:tigard -or a 1 ;� l k a ti , tic I ,% Notifed/Method: ' Supplemental Information
tittleICAtel R J .j2 ;• ITri FEE*" SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 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
U '- 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: //� 50 i �1 S 0 Catch basin or area drain 16.60
City /State /ZIP: V� d i C Q C 3 - 1.1 a 4 Drywell, leach line, or trench drain 16.60.
Suite/bldg: /apt. no.: Projec ame:
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: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:. Absorption valve 16.60
DESCRIPTION -OF WORK Backflow preventer Page 2
( .- W CI L /A ) � j t. Backwater valve 16.60
✓'� Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT • . Drinking fountain 16.60
Ejectors /sump 16.60
Name: %--- `V irbkaa /,(. Expansion tank 16.60
Address: 1 0 1 6 0 5u Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: Fax: ( ) Garbage disposal 16.60
��� ` ? � Hose bib 16.60 •
❑ .'APPLICANT ❑ • CONTACT PERSON •
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Cl..-v Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) 1 Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR • • Water closet 16.60
Business name: C Mit -ALAI' Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum.permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
1 Authorized si • . urejA -n / State surcharge (8% of permit fee) !j KU
_ / / - TOTAL PERMIT FEE 7 g, so
4 T his application expires Print name: IL � _ _ t , Date: _ D permit a lication ea Tres 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 \PLM- PermitApp.doc 12/27/06 440- 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 - 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
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 Backflow Prevention Device . each $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:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations.
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that'apply. ' •
. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Types • Replace greater, except systems designed and stamped by licensed
Previous. Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 - 0040. ,
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
• Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
• Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley p
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service • fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet • •
Urinal •
•
Other Fixtures: •
1:\ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00229
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/4/2007
Phone: (503) 639 -4171 4'44101 4\
Inspection Requests (24 Hrs.): (503) 639 -4175 Ail. . 64 !
INSPECTION WORKSHEET FOR DATE: 6/11/2007 TIME: 7:OOAM PAGE: 11
SITE ADDRESS: 10150 SW MURDOCK ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ALEXANDER
DESCRIPTION: Line work to connect sewer. Septic system to be pumped and filled or removed.
OWNER: ALEXANDER, RONALD E, PHONE #: 503639 -0359
CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503. 6313 -0800
Inspection Request Scheduled For: Date: 6/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 04997601 503 - 638.0800 N
•
Corrections /Comments/ Instructions:
d'Al■ ■//
f
i
►2 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /14 f Date: 9 Phone #: (503) 718 - J"
A /1020 - 6 1 7 Ua zz�
•
ORVALL T. CADE JOB INVOICE
BYER'S SEPTIC TANK SERVICE, INC.
P.O. BOX 549 []7 Wants Morn.
9
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO. D T ORDER D
(503) 656 -3326 gE
oE A �
ORDER TAKEN BY DATE PROMISED ❑ A.m.
Grace 6 -8 ❑ P.M.
PHONE
BILL TO Scott 312 -1363
Gene Cantrel MECHANIC • I -
ADDRESS
•
HELPER
CITY
JOB NAME AND LOCATION ❑ DAV WORK
101 -5 SW Murdock / off 103rd. ❑ CONTRACT
DESCRIPTION OF WORK ❑ EXTRA
I �
OUAN N T PRICE 1 AMOUNT
DESCRIPTION OF MAT IAL USED �
- Tank pumping
•
•
•
I I
I - '
> •
HOURS LABOR - AMOUNT TOTAL •
MECHANICS MATERIALS
•
TOTAL
HELPERS LABOR
•
•
I hereby acknowledge the satisfactory I TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATE/ OMPE TED TOTAL
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