Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00516
eel I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/26/2006
PARCEL: 2S 112CA - 04000
SITE ADDRESS: 15545 SW 79TH AVE ZONING: R -
SUBDIVISION: DURHAM ACRES LOT: 020 JURISDICTION: TIG
Project Description: LINE WORK AND LATERAL FOR SEWER CONNECTION. Septic system to be pumped and
filled or removed.
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: 200 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WILEY, JAMES E JR + SHELLEY J
15545 SW 79TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/26/200E $101.40
[TAX] 8% State Surcha 10/26/200E $8.11
Phone : 503- 684 -3585 Total $109.51
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 rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By �jto Permittee Signature: 1 • •A
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busin.s 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 City of Tigard Applicati � + Foli oHrl ,oil v
�� L.� ���� Received /�
.
il h
' 13125 SW HaII Blvd., Tigard, OR 97223 , v /T
��(1 l 6 Date /By /d2/ O 6 B6
2006 Plan Review Permit No.: �d6 ... 00 / 6,, C , Phone: 503.639.4171 Fax: 503.59 l f D /B Ot her Permit N -� /, _ nG 00
TIGARD Inspection Line: 503.639.4175 Date ReadyBy: J I ge II See Pag ' e R 2 corJ
for
Internet: www.tigard - or.gov CITY OF TIGARD. • Noatified/Method: ll•" Supplemental Information
TYPE OF wahnLDING DIVI5iUtt FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration/replacement Lir Other: ; s"14 New 1 2 family dwellings (includes 100 ft. for each utility connection).
- ; CATEGORY 'OF CONSTRUCTION '':2\3..,`)v (1) bath ', 249.20
NI 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building El 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: 5C.� - - ,S ' Catch basin or area drain 16.60 • City /State /ZIP: '�� Drywell, leach line, or trench drain 16.60
1 Ct2� - - j /?:2/
Suite/bldg. /apt. no.: . Project name: 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 J
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
RI F WO
. , . DESCPTION. OF Back flow preventer Page 2 •
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
f Ejectors /sump 16.60
Name: -, j ftkces , IA9I le c ir'_ Expansion tank 16.60
.Address : - 1 SS S cSLZ
City /State /ZIP: Z/ is A Fixture /sewer cap 16.60
11� i'1!'�U t c -
Floor drain/floor sink/hub 16.60 1
-
L, Phone: (c) ) , _35 8'� 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
. CONTRACTOR Water closet 16.60
Business name: di - lb; l J (3 , 0 -,„, ) ,, Water heater 16.60 •
Address: Other:
Subtotal
City /State /ZIP:
Minimum permit fee: $72.50 /
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 (0 / yr.
CCB Lic.: Plumbing Lic. no.: _
Plan review (25% of permit fee)
State surcharge (8% of permit fee) �� r'
Authorized signature: � � TOTAL PERMIT FEE / OCf 51
Print name: ` i �/ ,� Date: This permit application expires if a permit is not obtained within
V "" f tel v' 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMF- PermitApp.doc 04/06/06 440 -4616T(10 /02/COM/WEB) 1 ; 3S•
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information
• 7.
'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 . $115.00
Footing drain - each additional 100' 46.40 2,0.p 1. to'3,600 " ' $160.00
3;601 to 7,200 ' 4 $220.00
(wer )I st 100' 55.00 7,201 and greater $309.00
(S ej)eachadditional100' 46.40
Water Service - 1st 100' 55.00
1 6'5" ,/ Medical Gas Sy
Water Service - each additional 100' 46.40 �� 'TV
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 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 Compl 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
F'ixtu re, Type: ` Replace CI 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.
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 - multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2"
3" .
Submit 2 sets of plans with any of the above.
-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
Swifnpring Pool Filter
washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor er p
Wei Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
' r`s lit'"!t (at, % fees assessed for the sewer increase must be paid before the
o ther Futures: plumbing permit can be issued.
i: \ Building \Permits\PLM - PermitApp.doc 07/06/05
CITY OF ��nu n ��m— omm�K�m����
BUILDING DIVISION PERMIT #: pLM2006-00516
13125 SW Hall Blvd., Tigard, OR 97223 ' DATE ISSUED: 1028/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 A&�
INSPECTION WORKSHEET FOR DATE: 11/27/2000 TIME: 7:05AM PAGE: 17
SITE ADDRESS 15545fW7ETH AVE CLASS OF WORK:
SUBDIVISION: DURHAM ACRES LOT #: 020 TYPE OF USE:
PROJECT NAME: wily
DESCRIPTION: LINE WORK AND LATERAL FOR SEWER CONNECTION. S&ptic ystem to be pumped and filled
or removed.
OWNER: WILEf.JAMES E JR+SHELLEYJ. PHONE #: 503-684-3586
CONTRACTOR: OWNER PHONE
Inspection Request Scheduled For: Date: 11/27/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
350 Septic tank 040245-02 503-684-3605 W
Corrections/Comments/Instructions:
•
•
PASS PARTIAL CANCEL | | N��ACCESS
.
FAIL CALL FOR INSPECTION | | AOD0{]NALFEEGAGSEGSEO
Inspector: Date: Phone #: (503) 718-
�'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200G -00516
13125 SW Hall Blvd., Tigard, OR 97223 t A DATE ISSUED: 10126/2006
Phone: (503) 639 -4171 /aaip
Inspection Requests (24 Hrs.): (503) 639 -4175 sJ ,..
INSPECTION WORKSHEET FOR DATE: 11/27/2006 TIME: 7 :O5AM PAGE: 18
•
SITE ADDRESS: 15545 SW 78TH AVE CLASS OF WORK:
SUBDIVISION: DURHAM ACRES LOT #: 020 TYPE OF USE:
PROJECT NAME: WILEY
DESCRIPTION: LINE WORK AND LATERAL FOR SEWER CONNECTION. Septic system to be pumped and filled
or removed.
OWNER: WiLEY, JAMES E JR + SHELLEY J, PHONE #: 503 -694 -3585
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/27/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 040248 -01 503 -684 -3585 N
Corrections /Comments/ Instructions:
%��s� /,( ' �� «� p
Lf - 6 - 3 2/ --. p.13 5
.3 ci.e‘,.FT
PARTIAL APPROVAL (l CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: PI ,' /(./ Date: r l \ Phone #: (503) 718- 2-2K
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200 &00516
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/26/2006
Phone: (503) 639 -4171 //rmdl�� l A\
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/38/2006 TIME: 7 :03AM PAGE: 25
SITE ADDRESS: 15545 SW 79TH AVE CLASS OF WORK:
SUBDIVISION: DURHAM ACRES LOT #: 020 TYPE OF USE:
PROJECT NAME: WILEY
DESCRIPTION: LINE WORK AND LATERAL FOR SEWER CONNECTION. Septic system to be pumped and tilled
or removed.
OWNER: WILEY, JAMES E JR + SHELLEY J, PHONE #: 503 - 6943585
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 040325-01 503.684-3585 N
Corrections /Comments/ Instructions:
(///:]
/ �
) (PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL 1 I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
r1// I nspector: �' r Date: " -C/ Phone #: (503) 718-
l 04,51(0 JOB INVOICE
_ P.O. 50A 549
Ol'E OJ C�. ; OREGON S5��ccl1 97045 CUSTOMERS ORDER NO. DATE ORDERED
) OES-W2.5 2.5 q 1 g 1- 2 2- 0 6
ORDER TAKEN BY DATE PROMISED ❑ A M
Grace 1 gy 0 -292 ❑ P.M.
BILL TO PHONE
Jim Tlilev 0- 653 -1025
ADDRESS 1 5545 SU 79th Avenue 664 3555
CITY HELPER
Tigatrd , 97224
JOB NAME AND LOCATION
❑ DAY WORK
❑ CONTRACT
DESCRIPTION OF WORK
❑ EXTRA
OUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
d ALC*--
Tank pumping Jr, O. co
V
>
HOURS LABOR AMOUNT
TOTAL
MECHANICS fe? MATERIALS
HELPERS ® TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATE COMPLETED
TOTAL