Permit rp! CITY OF TIGARL ' PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00446
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/3/2007
PARCEL: 25111 BD -01801
SITE ADDRESS: 14850 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: ALDERBROOK FARM LOT: 005 JURISDICTION: TIG
PROJECT: ODELL
Project Description: Connect existing house to sewer service, approximately 110'. Septic tank is to properly
abandoned.
CLASS OF WORK: ALT 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: 110 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ODELL, ROBERT CHARLOTTE
14850 SW 100TH Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/3/2007 $101.40
[TAX] 8% State Surcha 10/3/2007 $8.11
Phone : Total $109.51
Contractor:
A AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -9548
FAX 503 -570 -0779
Reg #: LIC 158246
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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.
Issue By: A C is ■4 L Permittee Signature:
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 FOR OFFICE USE ONLY
Received
Date/By: X J Permit No.: 7.... ,
City Of Tigard
I TS n 13125 SW Hall Blvd., Tigard, OR 97223 y:
I Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: ! Other Permit No 4/y_. 0,509
Inspection Line: 503.639.4175 Date Read /B I 0 Pa e 2 for
T 1 G A R D Internet: www.ti and -or. ov Ready /By: B
g g Notifed/Method: / Supplemental Information
TYPE OF WORK FE SCHEDULE
0 New construction ❑Demolition For special information use checklist
Description I Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 -2- family 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
❑ Accessory building ID 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: / y S50 5 W l0 d Catch basin or area drain 16.60
City /State /ZIP: en ? 6.y4 Q it , / �/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: SQ C t ,y a � e Footing drain (no. linear IL: ) 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 /lo -f--
Storm sewer (no. linear ft.: _) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
N,vec. f ei?C1 i 2 np tAse Backwater valve . 16.60
5 ewer I we.s 4 m0.. se Wei' Clothes washer 16.60
I ; ofC 1" c r G 4 Dishwasher 16.60.
4PROPERTY OWNER • ID
Drinking fountain 16.60
�
C� � y �.. Ejectors /sump 16.60
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Name: t 6, r - - I. /'�G.' 1 i, 0 &Q 1/ Expansion tank 16.60
Address: / 1 8'Sb M j c / 113. Fixture /sewer cap • 16.60
City /State /ZIP: .v d De_ q '1 y Floor drain/floor sink/hub 16.60
- _ Phone: - (5703)_ 3_9 � 3_?,,.1.1 " - Fax: -( ) ! _ Garbage disposal 16.60
CI 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: - 4.46,' 12 a 6 / Water heater 16.60
Address: PO ) 13( Other:
City/State /ZIP: sOA,t)1 /A 0 k q 1 l9'7 0 Subtotal
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Phone: ( 53) 6 g� - 19 x, Fax: ( ) Residential backflow minimum permit fee: $36.25 , , VeS
CCB Lic.: / CS 02 I/ Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) '
Authorized signature:
• TOTAL PERMIT FEE i IQe],5/
Print name: IR C lc �o � th S Date: /a' 3- 0 7 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.
P\ Building \Permits\PLMF- PermnApp.doc 12/27/06 440- 4616T(I0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard _,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
° Utilities ., . ' " Qty. ; ' Fee(ea) Total Square, Footage: • • Permit Fee,:; ' '' " '
Footing drain - li 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
Q ty. Fee (ea) 'Total additional $100.00 or fraction thereof, to and • Fixture'Or Item " 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
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.
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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 ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined iii 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- 78 -0040.
-Drive Thru ,
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher -Commercial . .
, . , . , - .
- Domestic
Drinking Fountain Isometric or Riser Diagram , .
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial _
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be `paid before the
Swimming Pool Filter plumbing permit can be issued., • • • •
Washer - Clothes '
Water Extractor • , .- .
Water Closet - Toilet
Urinal
Other Fixtures: .
i. \Building\PermitsU'LM- PermitApp doc 12/27/06
AAFFOALE = .
r sErric sE v cE
RO.BOX 1130
WILSONVILLE, OR 97070
d (503) 821929 FAX (503D 57 , ;0779
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CUSTOMERS ORDER NO. PHONE DATE 0 —y
NAME .9 .
0 110 ODe L
ADDRESS
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT
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TAX
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All claims and returned goods MUST be accompanied byahis bill.
(mmuI To Reorder: • • • • ' THANK YOU
800- 225.63SO or nelmoQm.
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CITY OF TIGARD - :.
BUILDING DIVISION A PERMIT #: PLi 0117 -0041
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3/2007
Phone: (503) 639 -4171 / 0�l
Inspection Requests (24 Hrs.): (503) 639 -4175 A I..
INSPECTION WORKSHEET FOR DATE: 10/11 /2007 TIME: 7 :01AM PAGE: 13
SITE ADDRESS: 14850 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 005 TYPE OF USE:
PROJECT NAME: ODELL
DESCRIPTION: Connect existing house to sewer service, approximately 110'. Septic tank is to properly abandoned.
OWNER: ODELL, ROBERT CHARLOTTE, PHONE #:
CONTRACTOR: A AFFORDABLE SEPTIC SERVICE PHONE #: 603•969-9648
Inspection Request Scheduled For: Date: 10/11/2007 Pour Time:
Code # . Inspection Description Confirm # Contact # Message
(06 Sanitary sewer 05'7443 -01 50:- 969.8548 V
Corrections /Comments/ Instructions:
Go.,r,L 1:::-i r✓F 9,t))
0` PASS ❑ PARTIAL APPROVAL n CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION (l ADDITIONAL FEES ASSESSED
Inspector: ( " A ‘' \ -- Date: iyJ10 Phone #: (503) 718-