Permit . CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00322
TIGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/20/2007
PARCEL: 2S 102CC -03600
SITE ADDRESS: 13995 SW 102ND AVE ZONING: R -3.5
SUBDIVISION: FRELEON HEIGHTS LOT: 004 JURISDICTION: TIG
PROJECT: PECK
Project Description: Line work to connect to sewer. Septic system to be pumped and filled or removed.
CLASS OF WORK: NEW 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
PECK, ALAN W Description Date Amount
RATHBUN, ELIZABETH A
10255 SW MCDONALD ST [PLUMB] Permit Fee 7/20/2007 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcha 7/20/2007 $5.80
Phone : 503- 968 -8140 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
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.
Issued By: �r � A � � , Permittee Signatu C
—
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
Buiding`F'i<xtures �� �
FOR OFFICE USE ONLY City of Tigard Received I
Date /By: oZ0 / O� Permit No.tat `'!V � _ t3 G5aZ,
II
Y 1312 SW Hall Blvd., Tigard, OR 9d3_ 2 0 2007 !! (9
Phone: 503.639.4171 Fax: 503.5 Date/By: Review " hiRCd 7 ,
Date /By: Other Permit I b
Inspection Line: 503.639.4175 C8.1960 ET i L A it i BFI® Date Read /B ® See Pa e 2 for
Internet: www. tigard -or.
TIGARD ov LOW DpifiRio , y o g
g � Q 1 Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list
Description I 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
❑ I - 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: / 3 q9 S k2 07 moo( AJC Catch basin or area drain 16.60
City /State /ZIP: 7 - j c."...-) ` �� 72 3 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.: _ ) / 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
g •
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
-
v
ail Clothes washer 16.60
1 Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: it - /Ar , Dee4._. � r* � ..e 177 0 4, (Cn /2 ti. (' c .=-t , Expansion tank 16.60
Address: t -31 9s -- . 5 i) !U? ,^,,4 A_ -c Fixture /sewer cap 16.60
Cit /State /ZIP: -- r - ►�r�tact, l le. � 7 2.2 Floor drain/floor sink/hub 16.60
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: $ ) 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: 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.: i.Vc Plumbing Lic. no.: Plan review (25% of permit fee)
L � i � State surcharge (8% of permit fee)
Authorized signature: i /a
TOTAL PERMIT FEE tl
Print name: ,( ? - r��1c, Date: 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.
('\Building \Permits \PLMF - PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) t es B 5
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information ti
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
-
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2 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
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
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: 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 in 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- 780
- 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"
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 \Bmlding\Permits \PLM- PermitApp doc 12 /27/06
CITY OF TIGARD
BUILDING. DIVISION PERMIT #: PLMM12007 -00322
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/20/2007
Phone: (503) 639 -4171 "AO
'
Inspection Requests (24 Hrs.): (503) 639 - 4175 ! I . .
INSPECTION WORKSHEET FOR DATE: 8/10/2007 TIME: 7:00AM PAGE: 38
SITE ADDRESS: 139% SW 102ND AVE CLASS OF WORK:
SUBDIVISION: FRELEON HEIGHTS LOT #: 004 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Line work to connect to sewer. Septic system to be pumped and filled or removed.
OWNER: PECK, ALAN W, PHONE #: 503. 968.8140
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 053791 -03 503-701-9625 N
Corrections /Comments /Instructions:
Care rd �� 24.^)
Ti •
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ° I/ j/6 Phone #: (503) 718-
CITY OF TIGARD
BUILDING, DIVISION PERMIT #: PLM2007- 00322
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/10/2007 TIME: 7:00AM PAGE: 39
SITE ADDRESS: 13995 SW 102ND AVE CLASS OF WORK:
SUBDIVISION: FIELEON HEIGHTS LOT #: 004 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Line work to connect to sewer. Septic system to be pumped and filled or removed.
OWNER: PECK, ALAN W, PHONE #: 503 - 968.8140
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 053791 -02 503 - 701 -9625 N
Corrections /Comments /Instructions:
4 4" ACC
.A PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:. I I Date: 71 "--? Phone #: (503) 718-
_ • •
CITY OF TIGARD . ,
o.
BUILDING. DIVISION PERMIT #: PLM2A07 ( ?0322
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7120/2007
Phone: (503) 639 -4171 a 4Pli d l
Inspection Requests (24 Hrs.): (503) 639 -4175 -�.±i - —.
INSPECTION WORKSHEET FOR DATE: 8/10/2007 TIME: 7:00AM • PAGE: 40
SITE ADDRESS: 13995 SW 102ND AVE_ CLASS OF WORK:
SUBDIVISION: FRELEON HEIGHTS LOT #: 004 TYPE OF USE:
PROJECT NAME: PECK
DESCRIPTION: Line work to connect to sewer. Septic system to be pumped and filled or removed.
OWNER: PECK, ALAN W, PHONE #: 503.968-8140
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8!10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
350 Septic tank 053791 -01 503 -701- 9625 Y
Corrections/Comments/Instructions: '
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: d5 YV "-,-- Date: TIVO1V7 Phone #: (503) 718-
•
Lil' Stinky
Environmental Service ta COMPLETE SEPTIC SERVICE - '-,
` DATE �
19631 S. Kolar Dr.
Oregon City, OR 97045 v .
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NUMBER
Molalla: (503) 829 -8458 • Oregon City: (503) 658 -0518 , 70 / - ,..56 25
Fax: (503) 722 -7186
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$ PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ S 0
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BALANCE FORWARD 0
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SIGNATURE X PAY LAST AMOUNT
Terms: The 10th of the month following purchase. 2% finance charge on all past due accounts 24% IN THIS COLUMN
annual In the event this invoice is not paid as agreed and the account is placed in the hands of �--�- +/"
attorney for collection, then Lil' Stinky Environmental Service shall be entitled to recover its reason - L/ La/ Lk ou
able attorney fees, in addition to court costs, in any legal action commenced to collect debt l -'/y