Permit CITY TIGARD PLUMBING PERMIT
i 4 ' DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00683
` 1 1 1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/12/2005
PARCEL: 2S 111 AB -00201
SITE ADDRESS: 09033 SW MOUNTAIN VIEW LN ZONING: R -4.5
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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
• Owner: FEES
SUSAN MADISON
9033 SW MOUNTAIN VIEW LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 12/12/200f. $72.50
[TAX] 8% State Surcha 12/12/200f $5.80
' Phone : 503- 624 -1466 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
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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 rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: �s Permittee Signature:
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.
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BuilIlipgSixtures
Plulmbin2 Permit Application I OR o•l:lcI.: Hsu oN
City of Tigard
v Y 0 -a A�/7 Permit Nd�� l 6s O Q /lj 2
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r add l.?
Phone: 503.639.4171 Fax: 503.598.1960 � y „d1 . ;, Date/By. Other Permit No , 5 zvy0
24- Hour Inspection Line: 503.639.4175 11,1 - �� Date Ready/By. �"" '� ®Se Page 2 for
Internet: www.ci.tigard.or.us Notified/Method -PIU Supplementallnoformation
TYPE OF WORK 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 249.20
.- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi -family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities •
Job site address: q0 A" dl in View , Lr , Catch basin or area drain 16.60
City /State/ZIP: -r`T� l ` C 4 _..{ Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft: ) Page 2
Suite/bldg./apt. no.: Project name: t
1� p P.,r\nech >Sr1 m Manufactured home utilities 1 10.00
Cross street/directions to job site: 1 ldrn °`-- -
Manholes 16.60 .
• Rain drain connector 16.60 .
_ 54+S Cert MIA cC• q04-1.\ 4 Sanitary sewer (no. linear R: 3O ) Page 2
M r -r\A .k n e_it..). 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
1 Cn - 5vP -Lc 3,QX t5r) C UD-N/\, in Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
`EPPROPERTY OWNER I 0 TENANT Drinking fountain 16.60
Ejectors/sump
Name: . 16.60
J
Expansion tank 16.60
Address: °I, ®33 Si 0 f _ j �� 2„ e ) Fixture/sewer cap 16.60
City /State/ZIP)i , R • '^ C � T Floor drain/floor sink/hub 16.60 •
Phone: 3) llJ� q t / _ Fax: ( ) Garbage disposal 16.60
�C' Hose bib 16.60
APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
it°
Business name: S a b - ,re 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: ( ) I Fax :: ( ) Sink/basinflavatory 16.60
Tub /shower/shower pan 16.60
E -mail' Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
Subtotal
City/State/ZIP: 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)
State surcharge (8% of permit fee)
Authorized signature: , `i' t TOTAL PERMIT FEE 7 30
Print name: 512san / /(.mil a ,) I Date: /Z / / /(�� This permit application expires if a permit is not obtained within • Z 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pennits\PLMF- PennitApp.doc 06/05 4104616T(16102/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
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 Backfiow 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 $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: 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 ❑ 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.
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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 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 be paid before the
Other Fixtures: _ plumbing permit can be issued.
is\ Building \pennib\PLM- PenmitApp.doc 07/06/05
3/1/2007
Case Activity Listing
'�CCEL Case #: PLM2005 -00683 12:15:04PM
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
PLM1010 Application received 12/12/2005 None RECD DER 12/12/2005
DER
PLM1020 Permit created 12/12/2005 None DONE DER 12/12/2005
DER
PLM1030 Check for parcel tags 12/12/2005 None DONE DER 12/12/2005
DER
PLM1280 Issue permit 12/12/2005 None DONE DER 12/12/2005
DER
PLM2505 Sanitary sewer 9/7/2006 9/8/2006 9/8/2006 None PASS JW 9/8/2006 036240 -01 — 503- 624 -1466 — VM -
STI Y
PLM1740 Case finaled 3/1/2007 None DONE JMT 3/1/2007
JMT
Page 1 of 1 CaseActivity..rpt
'CITY OF TIGAR®
BUILDING DIVISION • . PERMIT #: PLI+42005.0O6 83
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13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 12/12j2005
Phone: (503) 639-4171 00vfil,,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/Bf2006 TIME: 7 : PAGE 36
SITE ADDRESS: 09033 SWMOUNTAIN VIEWLN _ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MADISON
DESCRIPTION: New sewer °connection. _
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OWNER: MADISON, SUSAN •' PHONE #: 503621 -1466
CONTRACTOR: OWNER • , PHONE #:
Inspection Request Scheduled For: • Date:- 5002006 Pour Time: -
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 036240 -01 503 -624 -1466 Y'
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Corrections /Comments /Instructions:
i" i%t 'w� J K .� � ✓JJ � G \(_ �J' ," �!llr �p C✓ l.•..J �;�� C_..� t�I�.�:al��` -
<1 v J
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PASS ❑ ' PARTIAL APPROVAL 1 1 CANCEL • ❑ NO. ACCESS
n FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED . -
Inspector-: Date: ''f ` Io C. Phone #: .(503) 718-
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