Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00472
^` fi 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/11/2006
PARCEL: 2S111CB -02400
�ITE ADDRESS: 14945 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: MURDOCK HILL LOT: 005 JURISDICTION: TIG
Project Description: Line work for sewer connection.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ROBERT WHEATLEY
14945 SW 100TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/11/200€ $72.50
[TAX] 8% State Surcha 10/11/200€ $5.80
Phone : 503- 670 -9648 Total $78.30
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
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 obtai copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: o(l� c%l./�e:e, Permittee Signature: 4 I l
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 s) Le i. ti , p
Plumbing Permit Applicatio FOR R`OFFICi USE. .O.NLY
Cl of Tigard T T �S Received P No. n,� O
131 SW Hall Blvd., Tigard, OR � 2 3 S 2006 Date/By. l D/n /067 IS � T � Ir 1111106 -o 9' 7
` 0 ; Phone: 503.639.4171 Fax: ~ 503.598.1960 , Plan Review Other Permit No.:
Inspection Line: 503.639.4 ° Date/ Ry
T I'G A Ii D p ��` � ° `� �~ ' � J��br•'�� Date Ready/By: luris: HI See Page 2 for •
. Internet: www.tigard- orego . . TI( ' YT ,, Notified/Method: T Supplemental Information
TYPE OF 'WORK - " FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
14 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 12 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler L sq. ft.) Page 2
" : - JOB `SITE: INFORMATION AND :LOCATION .. , _ Site utilities
Job site address: / [ l / ,4,'5 5,4), jaQ fC- Catch basin or area drain 16.60
City /State /ZIP: 7;-, A? r 7 z z y Drywell, leach line, or trench drain 16.60
t € Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: Project name:
Manufactured home utilities 110.00
Cross street /directions to job site: 5T �o)- /Z /z
PM T
Manholes / ("A, - Rain drain connector 16.60
Sanitary sewer (no. linear ft.:/60 ) 16.60
Page 2
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 Back flow preventer Page 2
1"extrioi,sS pX tf it Ss �L ,I. / Backwater valve 16.60
T !g/?A?te- 7 Z/ 4/4 - Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
ROPERTY OWNER ❑ TENANT -
Ejectors/sump 16.60
Name: , tof 4)42 f ey Expansion tank 16.60
Address: /5195'5- _ S 4.,,, /2 f e Fixture /sewer cap 16.60
City /State/ZIP: , 4 , 40 ( �� • 7224/ Floor drain/floor sink/hub 16.60
Phone: u F
(. 3 ) � / / CJ _ ,p 7 ( ) Garbage disposal 16.60
Hose bib 16.60
rAPPLICANT ❑. 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
Sink/basin/lavatory 16.60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: / 1 /1 / 7 . /G 1U Water heater 16.60
Address: / 7 e , / 34i i /7 a Other:
City /State / ZI / U/ Q�� 5:74177 Subtotal
/
Phone: (�3) /0 82 _ /92 / Minimum permit fee: $72.50
2 9 Fax. ((3 ) S 70 _ p7 7? Residential backflow minimum permit fee: $36.25
CCB Lie.: 454%2 Yl Plumbing Lic. no.: Plan review (25%ofpermit fee)
State surcharge (8% of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: �� 027.. � Date:40 - /f -0" 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 04 /06/06 440 -4616T( 10/02/COM/WEB)
' A
Plumbing Permit Application - City of Tigard - 3 : ,..
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression System s:
'-f Site:Utilities` - ` ' ° . - " Qty Fee (ea) T � ' ` S quare v Footage: Pe art Fee: ° . r_ ° . "
Footing drain - I'` 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer 3,601 to 7,200 $220.00
ewer - l st 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: a . 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
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 &action 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 Struc _ "
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 fixtures could result in increased sewer fees *. Please check all that apply.
• y ,�. ❑ Any new commercial building.
Quantity_ b fixture) Work Performed.
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 sprinkl'er•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 s
- Service
Swimming Pool Filter .
Washer - Clothes *Note: If the fixture work unde this permit. results in an
Water Extractor
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
,. . . .
4
CITY OF TIGARD
BUILDING DIVISION
ilk PERMIT #: PLM2006-00472
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/11/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 at41,W IL
INSPECTION WORKSHEET FOR DATE: 10/112006 TIME: 7:01AM , PAGE: 54 . .
SITE ADDRESS: 14946 SW 100TH AVE CLASS OF WORK: .
SUBDIVISION: MURDOCK HILL LOT #: 005 TYPE OF USE:
PROJECT NAME: WHEATLEY
DESCRIPTION: Lin work for sewer connection. ,
OWNER: WHEATLEY, ROBERT PHONE #: 503-670
CONTRACTOR: A-AFFORDABLE SEPTIC SERVICE PHONE #: 503-969-9548
Inspection Request Scheduled For: Date: 10/12/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 038069-01 503-969-9548 Y
Corrections/Comments/ Instructions: Pr 1`
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