Permit l II CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00074
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/27/2008
PARCEL: 25111 CA -15100
SITE ADDRESS: 15040 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: ALDERBROOK FARM LOT: 007 JURISDICTION: TIG
PROJECT: DAVISON
Project Description: Connect existing house to sewer service, approximately 100'. Septic tank is to be pumped and
filled. Reimbursement District #27 fee paid this date.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
STEPHEN DAVISON
15040 SW 100TH Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 2/27/2008 $72.50
[TAX] 12% State Surch 2/27/2008 $8.70
Phone : 503- 639 -7212 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
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.
C_____ .
Issued 1 10 " _, .te i P ermittee Signature: 5( ) Ze.e.--y.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.
Plumbins Permit Application
Building Fixtures FOR OFFICE USE ONLY
Received /� P, v
104 City of Tigard DateBy: i� A% Qg �� Permit No.: N7 p n - 7
a 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
1. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No. 2 orr,- /
T I G A RD Inspection Line: 503.639.4175 Date Ready/By: ]uris. H See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE 'OF WORK ' FEE* SCHEDULE .
❑New construction ❑Demolition For special information use checklist
Description Qty. I 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 ❑ 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: / So 4Lv . w / 0 0 `1 c Catch basin or area drain 16.60
City /State /ZIP: 7X6 i - d /Z 1 ? 0 ¢. / Drywell, leach line, or trench drain 16.60
,
Suite/bldg. /apt. no.: Project name: DA- GrI ON' 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.: /fl ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
D ESCRIPTION OF WORK Backflow preventer Page 2
•
or N /./ I7JJ e rt ' 3'4-4;e - A Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER. I ❑ TENANT' Drinking fountain 16.60
,� Ejectors /sump 16.60
Name: See ;tr 81) ' SW( T Expansion tank 16.60
Address: /s0 4/6 S / C) 't-/ Fixture /sewer cap 16.60
City /State /ZIP: 1xqa- O - R- 9.7 ,224. _Floor drain/floor sink/hub 16.60
Phone: ( 503) . 3 7- 72 / Z Fax: ( ) Garbage disposal 16.60
❑ APPLICANT - ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Pagc 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: Water heater 16.60
Address Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: ' Plu ' g Lic. no.: -
Plan review (25% of permit fee)
Authorized signature: _Ai. State surcharge (12% of permit fee)
,..e./ K�s� TOTAL PERMIT FEE
Print name: STE- •. e Day/sew Date: 2/ �7/D8 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:\ Buitding\Permits\PLMF- PermitApp doe 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:
Site Utilities Qty. Fee (ea). Total Square.Footage:' Permit Fee:, --
Footing drain - 1s` 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:, '
$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
Qty. ';Fee (ea) Total additional $100.00 or fraction thereof, to and
Fi %dire or'Itelll 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
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: 'PlanReview 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 in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool El Any multipurpose fire sprinkler system.
Car Wash -Each Stall El 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
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.
-3"
-4"
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 \Permits\PLM- PermitApp.doc 12/27/06
e t • to ` :L
SEPTIC SE V OE
P O_BOX 1 130
WILSONVILLE, OR 97070
y . (503) 662.192 FAX (5.00 O. 77 •
CUSTOMER'S ORDER NO. . PHONE DATE
f3 ? (')ej
NAME k
ADDRESS
Sb S 100 ave
DMZ
SOLD BY \CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
QTY DE _ PRICE AMOUNT. ,? .
j t eI r
0b up
•
•
TAX
RECEIVED BY
TOTAL
All claims and returned goods MUST be accompanied by this bill.
8:0-225-6330 or nob:Loom
THANK YOU
. .
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2008-00074
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2127/2008
Phone: (503) 639-4171 , :stoliT\
Inspection Requests (24 Hrs.): (503) 639-4175 ,._.-.W■ - -I.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
7/31/2008 7:00AM 29
SITE ADDRESS: CLASS OF WORK:
15040 SW 100TH AVE
SUBDIVISION: LOT #: TYPE OF USE:
Al DERBROOK FARM 007
PROJECT NAME: DAVISON
DESCRIPTION:
Connect existing house to sewer service, approximately 100. Septic tank is to be pumped and filled.
Reimbursement District #27 fee paid this date.
OWNER:
DAVISON, STEPHEN PHONE # 503
CONTRACTOR: PHONE #:
OWNER
Inspection Request Scheduled For: Date: 7/31/2008 Pour Time: .
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073528-01 503-989-9548 Y
Corrections/Comments/Instructions:
_..C.4 l a - k- i 1- . 1 - a•-/‘4 PLAA...-rt...." \ te rr
•
ik PASS PARTIAL APPROVAL n CANCEL n NO ACCESS
I I FAIL 1 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: CD 1 / 4, v-NA-.1+ \ \ ) 1 Date: i 1 \ nct) Phone #: (503) 718-
. '1 , -• .• ''