Permit y � CITY OF TI CARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00590
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/14/2006
PARCEL: 2 S 111 A B -03100
SITE ADDRESS: 14135 SW 93RD AVE ZONING: R -4.5
SUBDIVISION: ELROSE TERRACE LOT: 027 JURISDICTION: TIG
Project Description: 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CHARLES SCHWARZ
14135 SW 93RD AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 12/14/200€ $72.50
[TAX] 8% State Surcha 12/14/200€ $5.80
Phone : Total $78.30
Contractor:
WESTSIDE UNDERGROUND UTILITIES INC •
30585 NW EVERGREEN RD
HILLSBORO, OR 97124 -1855 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -4631
Reg #: LIC 110690
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: • Permittee Signature: e
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.
Plumbing Permit Application
Building Fixtures R IV FO OF ICE USE ONLY '
City of Tigard DEC 1 4 2006 Received /2 / y_g /��� Permit No. l� /�/,�)/���9�
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
b = ilC` `,
Date/By Review
G Phone: 503.639.4171 Fax: 503.598.19 O ther Permit No.. SC ���3�
CITY OF TIGI�RD Da<eBY �(" n
Inspection Line: 503.639.4175 BUILDING DIVISION Date Read /B Juris: ® See Page 2 for
Internet: www.ti
T eG i\ It D ard - or. ov Ready /By: g
$ g Notified/Method: � Supplemental Information
TYPE OF WORK FEE* SCHEDULE ,
❑ Demolition For special information use checklist.
New construction Description I Qty. I Ea. I Total
• ❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF 'CONSTRUCTION - SFR(1)bath 249.20
1 26- 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
• - ..10I1 SITE INFORMATION AND LOCATION Site utilities
Job site address: /44 / 3 5 s g3,tQ /1(1.1--e Catch basin or area drain 16.60
City /State /ZIP: ' 7 5 (3,711Q or` 9 . z Z Y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
• Cross street /directions to job site: �(p, (,'i' �, 'C ,e-e..0"
/ /� n ` (� Manholes 16.60
/ S /"t C cIY- o (d/ . `)P f' c12c124.4,, P f L / o C a . '�`< Rain drain connector 16.60
3 rr
Zoe ..c,,, c a r Q dl-. Sanitary sewer (no. linear ft.: loo) 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
' ' , ` 'D `WORK ` • • ,' _, ,, , Backflow preventer Page 2
44 .( (0ol �er cc f'iri -- C3.4. - n //11 C_rn- „ ,,P��rl' Backwater valve 16.60
0 ; i .Pr°,r,.re� it 6 ,,,,L_
� j ,,. - ) 3,, 1)/ Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PR PTY OWNER I ' • 0 TENANT'
`` �ti ER _ Ejectors/sump 16.60
Name:} .� � C f , �.Z Expansion tank 16.60
Address: / C( r 3 S ,S(_..) 5'3 k 4,, Fixture /sewer cap 16.60
City /State /ZIP: 5 0,-, Ole_ 5)- 7-2-(f _Floor drain/floor sink/hub 16.60
Phone: (S 6 2 t{ _ .. s'- 2 C Fax: ( ) Garbage disposal 16.60
. . ''A ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: em e 04 0 4 , ore Medical gas (value: $ ) Page 2
. Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: • Urinal 16.60
" CONTRACTOR ,, _ Water closet 16.60
Business name: e �f - f� Water heater 16.60
C ..--1-
S - ,(^M (A_ art- c-' i 1 r•� .
. Address: 3 Y\ 1„,3 �\)�-& -- 2-e --7,0L.,,,, Other
City /State /ZIP: p \ , ..\ c , Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
. CCB Lie.: / M‘ 9 t;) iy5lc� Plumbing Lic. no.: _ Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Date: 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.
1:\ Building \Pennits\PLMF- PennitApp.doc 04/06/06 4404616T(l0/02/COM/WEB)
Plumbing Permit Application - City of Tigard - .
. Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) T ot al Square Footage: Permit Fee:.
•
Footing drain - 1' 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
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 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
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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for. Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed' greater, except systems designed and stamped by licensed
Fixture,Type: Replace engineer.
Previous Capped Added, Existing , ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918 780 - 0040.
Car Wash - Each Stall
- Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher - Commercial
Domestic I sometric, or Riser Diagram
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink - 2"
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
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 increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Building\ Permits \PLM- PermitApp.doc 09/22/06
- CITY OF TIGARD
IS ' A '
BUILDING DIVISION ,.. PERMIT #: PLM2006-00590
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1412006 ,
Phone: (503) 639-4171 • AzIAOMAIII
Inspection Requests (24 Hrs.): (503) 639-4175 ,431+1'' IL
INSPECTION WORKSHEET FOR DATE: 2117J2007 TIME: 7:05AM PAGE: 15
SITE ADDRESS: 14135 SW 93RD AVE CLASS OF WORK:
SUBDIVISION: ELROSE TERRACE LOT #: 027 TYPE OF USE: .
PROJECT NAME: SCHWARZ ,
,
DESCRIPTION: Sewer connection.
OWNER: SCHWARZ, CHARLES PHONE #:
CONTRACTOR: WESTSIDE UNDERGROUND UTILITIES INC PHONE #: 503-9694631
Inspection Request Scheduled For: Date: 2/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 043277-01 503-9694631 N
Corrections/Comments/Instructions:
• ZI/1/1
/
(./...!
/
kI PASS I I PARTIAL APPROVAL pi CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: I/ )- 7- " 6 " . " ---
A Date: / 1 7 Phone #: (503) 718--`77‘Y
• 1 -r , . .1 w1
-
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ALOHA SANITARY SERVICE ,r.
INVOICE NO.
8600 SW HiiIs,b Hwy., Hillsboro, OR 97123 11 3W
503 -644 -2797 * '503- 648 -6254 • 503 - 639 -5188
NAME: Lf / d //)6 t 4f' E '9j A./�
ADDRESS:
CITY: STATE: ZIP:
HOME: ,�^ WORK: CELL: Yd_ F- '5l // �, /
JOB SITE: j�'(.75 s z). �.� �- � � /i� "9 / ,e5/ P.0. #:
PAID BY CHARGE"r CHECK ❑ CASH ❑ CREDIT CARD ❑
DATE - (2-0 7 DRIVER A 74asd 1/.,u! AMOUNT
pip— PUMP SEPTIC TANK ,154
❑ LINE OPENING
❑ INSPECTION FEE
❑
•
SERVICE CALL
❑ LABOR, LOCATING, DIGGING, BACKFILL
- ❑ MATERIAL
r SLCCI�CrP # wA !.e (
eiC
- - THIS IS NOrR- SEPTIC INSPECTION REPORT - - I TOTAL $ � ®
- - REMARKS - -
TYPE OF TANK: STEEL ❑ CONCRETE ❑ PLASTIC ❑ HOMEMADE ❑
HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ ❑ OTHER
SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 1000_U- - 1'2 . 50 O 1500 ❑ 2000 ❑ 3000 ❑
LID LOCATION: INLET ❑ OUTL,E-T 0 MIDDLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD ❑ / FAIR ❑ POOR ❑
FITTINGS: BAFFLES ❑ CONCRETE ❑ CAST IRON ❑ PLASTIC ❑
NEEDS NEW LID? YES ❑ SIZE •
GROUND COVER OVER TANK
COMMENTS ON CONDITION OF DRAINFIELD ETC.
SIGNED BY DATE 1 �� �' 4(7