Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: P 23/20% -00281
All DEVELOPMENT
SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6!23!2005
PARCEL: 2S 111 BD -00320
SITE ADDRESS: 14720 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: PEMBROOK HEIGHTS LOT: 010 JURISDICTION: TIG
Project Description: Line work to connect existing house to sewer lateral. 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: 55 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SLEEGER, PRESTON A JR AND Description Date Amount
KATHLEEN M
14720 SW 100TH [PLUMB] Permit Fee 6/23/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar1 6/23/2005 $5.80
Phone : 503 684 - 4082 Total $78.30
•
Contractor:
ARTS EXCAVATION LLC
4004 SE GRANT ST REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97214
Phone : 503- 473 -1800
Reg #: LIC 156488
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 -6 9 or 1- 800 - 332 -2344. (1
Issued By: tcZfZb Permittee Signature:.r \ d J _
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 7.l ion� i OIt OFFICE USE ONLY
City of Tigard Deceive ? /
Daze Permit N.. m 4 2_620....- 4 2_620....- ���/
05
13125 SW Hall Blvd., Tigard, OR 97223 ` ( Plan Revie 1 A Phone: 503.6 39.4171 Fax: 503.59' TY 2 3 2005 F TIGARD{,� `_I l � �'\ Date/ By. Re y vZ d Other Permit No.:
24- Hour Inspection ection Line: 503.639.41.5 Date Ready/13y: 0 See Page 2 for
Internet: www.ei.tigard.or.us �' 1 �� nt n(�14,� ®� _� Notified/Method: 7r\ Supplemental Information
' TYPE OF WORK FEE* SCH 'DULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
R Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION` SFR (1) bath 249.20
[ [ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi- family SFR (3) bath 399.00
CI Master builder Each additional bath/kitchen 45.00
❑ O ther:
Fire sprinkler ( sq. ft.) Page 2
. ° ` JOB SITE INFORMATION AND 'LOCATION ' Site utilities
Job site address: / y 7 7,0 S / 00-1- Catch basin or area drain 16.60
•
City /State /ZIP: T t 91.74 i Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 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.: (S ) 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
S 1 e r yt n e Cr (0 %* Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER • I . ., ❑ TENANT Drinking fountain 16.60
' {� Ejectors/sump 16.60
!
Name: 1( J I L L e/ Expansion tank 16.60
Address: 4 41 (• �L��"" `' `.f Fixture /sewer cap 16.60
City /State /ZIP: t C rt f
r .I _ Floor drain /floor sink/hub 16.60
Phone: ( �,) yet t ...- c � ✓ Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT . , ❑ CONTACT PERSON
• 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
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
• Tub /shower /shower pan 16.60
m E -mail:
V I Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: f Ir d - IX ( v t_ /« Water heater 16.60
oo
IM Address: 23 . E � / . i1 ( /�G '<_ Other:
• !--/ Subtotal
City /State /ZIP: 6 r? ), i-"a C' 97 // Minimum permit fee: $72.50
Phone:TO ) z3a - Fax: ( ) Residential backflow minimum permit fee: $36.25
L CCB Lie.: / 6 , fa" Plumbing Lic. no.: Slj3 _c f% Plan review (25% of permit fee)
/ 1 State surcharge (8% of permit fee)
Authorized signature: Jp TOTAL PERMIT FEE ?c/
Print name: �r . 1 �, .e� S Date: 6 .$ This permit application expires if a permit is not obtained within
f v r l 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 06/05 440-46t6T(10/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
S ite Ut1llltieSF „Qty.'- Fee {ea) Total Square,, Footage:. Permit•Fee:
Footing drain - 1st 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 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 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, moving or replacing existing fixtures? If A "complex structure" is defined as an installation of a plumbing
"yes ", 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.
New Moved Existing Capped ❑ 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/Whiripool 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" 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 \Permits\PLMF- PennitApp.doc 06/05
CITY OF TIGARL
BUILDING DIVISION J S• PERMIT #: PLM200S -00281
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/23/2005
Phone: (503) 639 -4171 /moo y p,�p'?
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/24/2005 TIME: 7 :09AM PAGE: 10
SITE ADDRESS: 14720 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: PE1VMBROOK HEIGHTS LOT #: 010 TYPE OF USE:
PROJECT NAME: ' SLEEGER
DESCRIPTION: Line work to connect existing house to sewer lateral. Septic system to be pumped and filled or
removed.
OWNER: SLEEGER, PRESTON A JR AND, PHONE #: 503 - 6844082
CONTRACTOR: ARTS EXCAVATION LLC PHONE #: 503.473 -1800
Inspection Request Scheduled For: Date: 6/24/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 010120 -01 503-473-1800 N
Corrections /Comments /Instructions:
!% G
/ 411.1 ,1 , 10 0 11 /1 11 51 -
- - -
P S PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: P 772--- --g Date: - Phone #: (503) 718-