Permit ,
{ `„ CITY OF'TIGARD
PLUMBING PERMIT
•• COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00172
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/27/2007
PARCEL: 2S 111 CA -14100
SITE ADDRESS: 15060 SW 98TH AVE ZONING: R -3.5
SUBDIVISION: DARMEL LOT: 008 JURISDICTION: TIG
PROJECT: ESTRADA
Project Description: Line work for sewer connection. Septic 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ESTRADA, JOSE L + OLIVIA J
15060 SW 98TH Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/27/2007 $72.50
[TAX] 8% State Surcha 4/27/2007 $5.80
Phone : 503- 624 -7969 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 rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: J� _____ GC j Permittee Signature: . a v ( )
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.
.
r. 1.
Plumbing Permit Application ` T5� �' . ° R or FICP t ir S N '`oNL l 4:„^j,::-,'".;;4::.i..-.--,40,4,_,.,; " � k ` P,
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City of Tigard - 7 'Received
r v 13125 SW Hall Blvd., Tigard, t l 23 � `� --'`' Lh/ (, Permt N ytt 7 /��06 I r ` /�✓
®, .,. Phone: 503.639.4171 Fax: 503.598.1960 Date/By. t
I G
Other Permi, Q) r b
7 1:191 fD
t i ,i Inspection Line: 503.639.4175 APR P 2U�7
T A K D ' F1 IlZt Dote ed/Met Ready/By:
Notified/Method: loess Se See Page 2 for
Internet: www.tigard-or.gov Supplemental Information
'va; }Y :"'WO k ',�.. ,�x �s « - ^;lr ,' .s,;c, . '1 w. :;xt: .:;5�;x,'.�¢• q' :..r�;�: .r ?' :: - - ,rc .A''' +"•-•..-:••
, ±��" TYPE " .OE • rCVO ={ �.• .-:.' * ,Y ' , Y, 4 '. a;° ., y,,.1,.
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❑ New construction
� a a-'%
of n For special information use checklist. t - Lt Ir � , � ' �' Description Qty. Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
;` k$: ; ?Aw? ` : -W, ' x CA_TEOY pF ,C.9 TRUCTIOn`.0 {� '_ SFR 1 bath
5.x� *.,K�:• . '. .,.," ` ,. >w,:: w:>,,, - r G
''., R� _..4.�. M > - c:�. �:,, c: k. �;"' t�: 4; ER .«.� "��i�.�;;�`;' O 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
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
. ;s;°r ,, ;4'i'•;f` . ;�S*'' ,:1JO13 INFORA
MTION',AND�;�I:DCATION.,' '�M " '� `, 416/
a +e_- .).:�F'a �'a tti � -f�•. �tiu r,�,..a �.ra•.�, "x.��. �r,,, .,s �,,. .. , ✓�a.. °.icn.�-x >�i,,�46n`1Ys � "� _"
Site utilities
Job site address: /i6/26 U .5 t) e )' /6 Catch basin or area drain 16.60
City /State/ZIP: r'f C.. -//7 () a q 7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I 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.:)1O0) 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.:
r �° . ; -.�. -, .- :- , Absorption valve 16.60
.c '. '� 4, '.e. _ ;.. , ?i;DESCRIPTION ,0 :11.* ' ',;;h�, ° ,'', " ';'i;;' „
_ > ° ° °^° L - � � •, - . x �"� �� �•�° � Back flow preventer Page 2
(it t L _ L Qrf 2, KQ.J . Backwater valve 16.60
A J`iL/t.. A , J Clothes washer 16.60
Dishwasher 16.60
{' F' °A wiz y " �• ° r �' .i � ; n ti: -° , 1. �, . 1: Drinking fountain 16.60
",ic ' -far ,tit °:, f' �,r,�,; `:�^�ta. r, �3'`t;.,H- �' -`� {,� g
r: `t ;. ':'PROPERTY OWNER ?r.. , ,..;,,,�;.•, , ,� ._:0 TEIYANT- $4,• ;¢_ „�-,.' rnn 16.60
_ "kl n, i4,.. .r •t.x .. w, i?,:" P'a. ?>h .t3n.x. b .. :�:^•�,.R ',4r' '.xr i'`, -. _ �'''9�+v,
`� Ejectors/sump
Name: j ( e 1, .f- 12L 11/ /�4- ( r s IVA Expansion tank 16.60
Address: /0e/0 t 5) q3m_- ) Fixture /sewer cap 16.60
City /State/ZIP: 7 672. �/ 2' 2 -"G' Floor drain/floor sink/hub 16.60
Phone: ( 4 .5T 4,9,z/ ` 19'7 9 ' -- Fax: ( ) - Garbage disposal 16.60
:.:4,`-( 5 n._ .. ��. - 4 . ... d ' .• .. - - e,- , -a,r - *.,,s-.:',-'• Hose bib 16.60
Vi s � " � t : c , '�,:
<<1 '= - ,..,, ® ;`A , .,, rr;. ` . ` ;;t °', ° r:. ' ❑A ,... -TACT • PE R SON.
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) 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:
`q . i5 Urinal 16.60
.; .,.e,-4.,, ' i . , ,,, : ` CONTRACTOR M c : °r .. s " " . * 1 " ; * Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City / State/ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: '7.y
( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 !A,„
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
��� State surcharge (8% of permit fee) "Iii, A O
Authorized signature: Ca7 � �Q.�d -� TOTAL PERMIT FEE /1 4 30
Print name: ( - / via r,, ,e A A Date: 1- //,9,77 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.
I:\ Building \Pennits\PLM- PermitApp.doc 06/26/06 440.4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard - .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
e re r ^;r a•n:.a+ �: :'�.�f,�; a. ti v., ;.;t +.zr,7 -: �• . „, ,
e ,( ,,Tutal;;� ��S uare.;Foota e� *� »�Permlt�.lF'ee � `#'` °' �° �F
vre��;�<'u�F �.�. ,;.arX�`'.,, r�. `� e_ rt �., _ .:�a�h'M.s�ev� �r3'S:.:ti,� ,F,
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 $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00
Medical Gas Systems:
•
Water Service - each additional 100' 46.40 e u a • aa° .,f a
Val u a on '$�Pe r ffiet e e:fr 1` k ;' • 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
�F1Xtlt`C, OC ItCffi;„ )� additional $100.00 or fraction thereof to and
taRsQty:, "a 9 tTotal
. ax 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
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: JZ Plan: Review for Pluml >ng Installation s--- ,
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
w j ` , y °' QuaotitY- 6yl(Fix`iure)rWo�k,Perto�mea greater, except systems designed and stamped by licensed
'FratureaType a ; i vzo- „ � w Reptace,ep engineer.
•'rPre i us t61111k411 ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic ,
�. � =mo
Drinking Fountain "�"A a ;d,,, �1 . _ Aiiiiletric or Riseraiaga an k v.:. gw
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink -2" that meet the qualifications above.
-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 *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
•
Urinal
Other Fixtures:
i:\ Building \Pennits\PLM- PermitApp.doc 09/22/06
A.MFORDARE
SLENEC S2RVECE
P.O.BOX 1ln
WILSONVIU.E, OR 97070
(503) C@PACe pozD 07042779
myvaacatablesepticsvc.com
CUSTOMERS ORDER NO. PHONE DATE
• -7
NAME
ADDRESS •
SOLD : Y SH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT *
Vd6+0
•
•
TAX
RECEIVED BY
TOTAL
All claims and returned goods MUST be accompanied by this bill.
A-Zmi To Reardsr: THANK YOU
B00-2254380 or nebs.com
' -
CITY ��������������� ' .�
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! ��UUUU BUILDING DIVISION
� ~�~°.~~~=""°~= ~�.~"~°"~~,~ PERMIT #: PLk8200700172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2007
Phone: (503) 639-4171 . �1�
Inspection Requests 24 Hrs.): (503) 639-417 "-~�K
INSPECTION WORKSHEET FOR DATE: 6/2/2007 TIME: 7:01AM PAGE: 31
SITE ADDRESS: 16O6OSW90THAVE CLASS OF WORK:
SUBDIVISION: 0ARIvIEL LOT #: 008 TYPE OF USE:
PROJECT NAME: ESTRADA
DESCRIPTION: Line work for sewer connection. Septic to be pumped and filled or removed.
OWNER: ESTRADA, JOSE L OLIVIA J, PHONE #: 503-624'7969
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/2/2007 Pour Time:
Code # | nopection Description Confirm # Contact # Message
399 Plumbing final 047531'01 5O3-969-9548 \'
Corrections/Comments/Instructions:
1-4 || ���l�� �br -~
^' ~ , . -~ -~~r~~^°A
Sct, A-
KPASS I I PARTIAL APPROVAL ri CANCEL n NO ACCESS
I FAIL EI CALL FOR INSPECTION pi ADDITIONAL FEES ASSESSED
Inspector: CM PY `^* Date: r ch 1 t. - 7 Phone #: (503) 718-