Permit C TY OF TIGAR dilkkg D PLUMBING PERMIT •
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00474
`" A II DATE ISSUED: 9/21/2005
13125 SW Hall Blvd., Tigard, O R 97223 503 - 639 -4171
PARCEL: 25111 BD -00506
SITE ADDRESS: 14980 SW 98TH AVE ZONING: R -3.5
SUBDIVISION: DARMEL LOT: 006 JURISDICTION: TIG
Project Description: 80' of sewer line.
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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MARION L. ROEMHILDT Description Date Amount
14980 SW 98TH AVE
TIGARD, OR 97224 [PLUMB] Permit Fee 9/21/2005 $72.50
[TAX] 8% State Surchan 9/21/2005 $5.80
Phone : 503 639 - 3974 Total $78.30
Contractor:
A- AFFORDABLE SEPTIC SERVICE
PO BOX 1130 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
Phone : 503 969 - 9548
Reg #: L1C 158246
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 o follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00i - 0010th • gh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calli . 503 - 246 -6699 I - Aft - 332 - 2344.
Issue By: j ' l . Permittee Signat re: fc-r C.641
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.
�a �d
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00474
R 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/21/2005
PARCEL: 25111 BD -00506
SITE ADDRESS: 14980 SW 98TH AVE ZONING: R -3.5
SUBDIVISION: DARMEL LOT: 006 JURISDICTION: TIG
Project Description: 80' of sewer line.
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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ROEMHILDT, MERTON ESTATE OF Description Date Amount
14980 SW 98TH ST
TIGARD, OR 97224 [PLUMB] Permit Fee 9/21/2005 $72.50
[TAX] 8% State Surcharl 9/21/2005 $5.80
Phone : 503 639 - 3974 Total $78.30
Contractor:
A- AFFORDABLE SEPTIC SERVICE
PO BOX 1130 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
Phone : 503- 969 -9548
Reg #: LIC 158246
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 rule - s-tforth in *AR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rul: or • q estions to o UNC by
calling 503 - 246 -6699 or - 800 - 332 -2344. /
Issued By: L _� _ l.�j Permittee Signature:
r
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.
•
-Building Fixtures --
Plumbing Permit Application FOR OFFICE USE ONLY .
City of Tigard .} Received 7 permit N
Date/By:
13125 SW Hall Blvd., Tigard, OR f� - GE ��E i Plan Review
�� l �� t � ��
Phone: 503.639.4171 Fax: 503. "8. 960 ((�� U�n_,dr � . \ Date/By:
Other Permit No.:
24- Hour Inspection Line: 503.639.4175, 1 N •' 1 I Date ReadyBy: Loris ® See Page 2 for
Internet: www.ci.tigard.or.us �� Notified/Method: - IV pp
5u lemental lnfortnation
TYPE O dCARD FEE'! SCHEDULE
❑New construction Ca
5 1t " � F or s pec i al i n f ormat i on use check • gutLp 3� l�m
� Description Qty E a. Total
b°6 Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION. l SFR (1) bath 249.20
j/: I - 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
. • JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / *"9 20 /0, 9� fL Catch basin or area drain 16.60
City /State /ZIP: , c.,A , O� 977.2 5/ Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: '' I Project name: 1
� / U // O� f Manufactured home utilities 110.00
Cross street /directions to job site: /l
Manholes 16.60
/56 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
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
eriii. s/ 6-t. /x4.5 / f / . / - Backwater valve . 16.60
AP/A' , ,� _ ' / Clothes washer 16.60
Dishwasher 16.60
�( Drinking fountain 16.60
f,l PROPERTY OWNER ❑ TENANT
'�j/� / Ejectors/sump 16.60
Name: ///4.,,_,M2/1 /�O /
/ / Expansion tank 16.60
Address: /y9'SO S of Fixture /sewer cap 16.60
City /State /ZIP: / / � �/ ee 972. Floor drain/floor sink/hub 16.60
Phone: ( ) � Fax: ( ) Garbage disposal 16.60
APPLICANT CONTACT - PERSON Hose bib 16.60
/� .+'� Ice maker 16.60
Business name: •
� i 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. Z 3 97,---7._ -
! C"l I Fax: ( ) Sink/basiti/lavatory 16.60
�'( Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
I CONTRACTOR Water closet 16.60
Business name: A -/�. , M ms s, ,'� J, ( Water heater 16.60
Address: ?C /v 7X X3 O `o Other:
f Subtotal
City /State /ZIP: a )l,cnil /,, OR 77(2 7b
//� 1 / Minimum permit fee: $72.50
Phone: (< 7 ) - 95-Vg Fax: ( •63 ) 577 _ b 77 q Residential backflow minimum permit fee: $36.25
CCB Lic.: /5 ,2 y mg Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE i 3'
Print name: / � 7 � � Date:9 J� 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 \Permits\PLMF- PermitApp.doc 06/05 440-4616T(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: ' ' - ` Perriiit.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
Commercial Back Flow Prevention Device 46.40 including 14. for the first $
$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 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 fixture s 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.
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"
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
Swimming Pool Filter
• Washer - Clothes *Note: If the fixture work under this permit 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.
i.\ Building\Permits\PLM- PermitApp.doc 07/06/05
r .,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005- OIki7�
�aam
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9!11!2005
Phone: (503) 639 -4171 ll
Inspection Requests (24 Hrs.): (503) 639-4175 `__..
INSPECTION WORKSHEET FOR DATE: 9!22!1005 TIME: 7:12AM PAGE: 66
SITE ADDRESS: 14980 SW 98TH AVE CLASS OF WORK:
SUBDIVISION: DARNEL LOT #: 006 TYPE OF USE:
PROJECT NAME: ROEMHILDT
DESCRIPTION: 80' of sewer line.
OWNER: ROEMHILDT, MERTON ESTATE OF, PHONE # : 503-639-3974
CONTRACTOR: PHONE #:
A-AFFORDABLE SEPTIC SERVICE 503 - 969 -9548
Inspection Request Scheduled For: Date: 9/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 016348 -01 503-969 -9548 Y
Corrections /Comments /Instructions:
/ // / d s
Af ,i
.p;- IIMIIIr
1
SS I 1 PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
)____?4__A j
Inspector: h Date: A Phone #: (503) 718 -