Permit CITY OF TI
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00406
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/5/2007
PARCEL: 25111 CB -01600
SITE ADDRESS: 15025 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: THE MARGUERITE OCHS TRACTS LOT: 001 JURISDICTION: TIG
PROJECT: KALLSTROM
Project Description: 170' of lateral sewer line for connection.
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: 170 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KALLSTROM, EVELYN LOUI SE
J E Description Date Amount
15025 SW 100TH [PLUMB] Permit Fee 9/5/2007 $101.40
TIGARD, OR 97224 [TAX] 8% State Surcha 9/5/2007 $8.11
Phone : Total $109.51
Contractor:
GREG SCHROEDER ENTERPRISES INC
9812 SE WICHITA AVE
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 654 -4734
Reg #: LIC 99733
•
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: ignomm .11//1/1// Permittee Signature: V' / 0
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
FOR 'OFFICE USE ONLY - ,
R eceived c " C - ^^
City of Tigard /5 03 J L.A.) Permit No.: [J(J
. Dan Review n
13125 Phone: SW Hall 503.639. 417 1, Tigard, 1 Fax: 503.598.1960 OR 97223 Plan Re Other Permit No.: S G
417x: Other �_
Inspection Line: 503.639.4175 D ate Read /B 7 ur s: S ee Pa e 2 for
TIGARD Y
Y
Internet: www.tigard - or.gov Notified/Method: Supplement S al Inform ation
;TYPE OF WORK . - FEE* SCHEDULE
❑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
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: /S 5 IV /ew A I/ Catch basin or area drain 16.60
•
City /State /Z1P: f j. C . O j O l / - q-72.2-4 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 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.: LID) 2.- Page 2 ' n ( .40
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
- A-- wC7l • Q t.;,1 Backwatervalve 16.60
` f2. 0±014-Q. Clothes washer 16.60
Dishwasher 16.60
tgLPROPERTY OWNER; Drinking fountain 16.60
0. TENANT
Ejectors /sump 16.60
Name: i✓V r i k / ) L . I(4 1-L6 rI � IA Expansion tank 16.60
Address: / / $''0 2 C /V A J Fixture /sewer cap 16.60
City /State /Z1P: - i G1 , j42.01 ,i`� ‘1 7.2_,2.11 Floor drain/floor sink/hub 16.60
Phone: � ) [p 0 q- --sq� Fax: ( ) Garbage disposal- 16.60
'❑ APPLICANT Hose bib 16.60
. ' -
❑` 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
E -mail:
Urinal 16.60
. , CONTRACTOR Water closet 16.60
Business name: s _ •-- GreA S�r r -� heater 16.60
Address: - : -t
q 5C °l, l� [ �t I� Cam`' Other:
L
City /State /ZIP: ti ,� 7_) lf' . 7 2.,2 j Z
Subtotal
Minimum permit fee: $72.50
Phone: (5`1,3) (o -� 1,17 -3 !-f Fax: (j/)3 ) 6 - q 4s Residential backflow minimum permit fee: $36.25 I �I . 41)
CCB Lic.: 6 /7 1 3 ( Plumbing Lic. no:: Plan review (25% of permit fee)
State surcharge (8% of permit fee) O . �
Authorized signature: !
TOTAL PERMIT FEE I.
Print name: ! -• 1f5 ip ,- . HAL _ 5 Date: This permit application expires if a permit is not obtaine lithig,
180 days after it has been accepted as complete 0 , 5 J *Fee m set by Tri- County Building Industry Se e oard.
I \Building'Permits\PLM- PermitApp doe 1 2/27/06 440- 4616T(10/02/COM/WEB) i a' / 9 44 ,/ 1
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 - ls` 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
5S. Da 7,201 and greater $309.00
Sewer - each additional 100' 46.40 419 . b
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
and including 00 ot the first 5 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
101. each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for ; Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by(Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type:. Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash Each Stall 1=1 Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain •
Eye Wash - Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 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 *Note: If the fixture work under this permit results in an
- Bradley
- 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\Perm ts\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Fri -M2007 -00406
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/7007
Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 J
INSPECTION WORKSHEET FOR DATE: •10/31 /2007 TIME: 7 :00AM PAGE: �
SITE ADDRESS: 15026 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: THE MARGUERITE OCHS TRACTS LOT #: 00 i TYPE OF USE:
PROJECT NAME: KALLSTROM
DESCRIPTION: 170" of lateral sewer line for connection. -
OWNER: KALLSTROM, EVELYN LOUT SE, PHONE #:
CONTRACTOR: GREG SCHROEDER ENTERPRISES INC PHONE #: 503051-4734
Inspection Request Scheduled For: Date: 10/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 Plumbing final 059727 -02 503- 7t114734 N
Corrections /Comments/ Instructions:
Cart.
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
fl FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CrbIlfrt ' Il( - Date: /0 pi W7 Phone #: (503) 718-
~ -
CITY ��������������% -
��uo m ��n nn�m�mnn�� . '.'
BUILDING DIVISION PERMIT #: PLh42007-0f1406
13125SVV Hall Blvd, Tigard, ORO7223 DATE ISSUED: 9/50.OU7
Phone: (503) 639-4171
Inspection Requests (24Hm.):(503)030-4175
INSPECTION WORKSHEET FOR DATE: 10/31/2807 TIME: 7:00AM PAGE: 56
SITE ADDRESS: 15V258W1DDTMAVE CLASS OF WORK:
SUBDIVISION: THE MARGUERITE OCHS TRACTS LOT #: 001 TYPE OF USE:
PROJECT NAME: KALLSTROM
DESCRIPTION: 17CV of lateral sewer line for connection.
OWNER: KALLSTROM, EVELYN LOUI SE, PHONE #:
CONTRACTOR: GREG SCHROEDER ENTERPRISES INC PHONE #: 603-054-4734
Inspection Request Scheduled For: Date: 10/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
350 Septic tank 058727'01 503-780-4734 Y
Corrections/Comments/Instructions:
y� x~�
� � F—
/NA-
`~ � n
PASS U PARTIAL � ��EL � NO ACCESS
u u u
El FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
\
|nopgctor |\ \�v~�� Date: /0 Phone #: (503) 718-
•
•
"JP:NALL F. C,-80fg JOB r VOCE
EfFP
5141,,,
tDRE:0 ON" OREGON TP 5
• CUSTOMERS ORDER NO DATE ORDERED
ORDER TAKEN BY DATE PROMISED
AM
P.M.
,
BILL TO
PHONE
ADDRESS
MECHANIC •
CITY
HELPER
JOB NAME AND LOCATION
; DAY WORK
DESCRIPTION OF WORK
D EX7RA
OUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
11 I
•-""
•
•
•
HOURS LABOR AMOUNT
TOTAL
MECHANICS MATERIALS
HELPERS TOTAL
LABOR
•
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
•
SIGNATURE DATE COMPLETED
•
TOTAL
•