Permit h�»
1 ; t- CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00127
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/30/2007
PARCEL: 2S 103CD -00300
SITE ADDRESS: 13575 SW 115TH AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TRAPP
Project Description: Line work to connect sewer. Septic system to be pumped and filled or removed.
•
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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TRAPP, RUSSELL W + TAMARA S
13575 SW 115TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/30/2007 $72.50
[TAX] 8% State Surcha 3/30/2007 $5.80
Phone : 503- 639 -9249 Total $78.30
Contractor:
AAFFORDABLE 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 o4 copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. - -�
Issued B Permittee Signatur- / i ��
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.
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Plumbin Permit A licat MINI IlS
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C ity of Tigard � AR 3 Q 2007 D 3 3 % 7 36 Permit �j�7 _z�U /a),7
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q 13125 SW Hall Blvd, Tigard, OR 972R'3
Phone: 503.639.4171 Fax: 503.598AM O►��
Plan Review Daze113Y Other Permit No.:
G.. K U" Inspection Line: 503.639.4175
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t B , `�� " CM Date Ready/By. uru ® 1: See Page 2 for
Internet: www.tigard - or.gov v Notified/Method
�, r�+.,r• :,� :, • „r•ris ° °- :� _ ,, ..,, , - Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
j] Addition /alteration/replacement ❑ Other: New l- 2- family dwellings (includes 100 ft. for each utility connection)
�' ?' , -' , °yes ; ' �. r CATECORYjOI COIVSTRIJcTIO ,itc,: ` „' °:
= ..: ,.. - .:,a, , .,�,w,.�,�'�'�y��ck i' SFR (I) bath 4 and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
.4 ,arg.., '» �a, ,. : :: -� ::.- N,1., -: - . Fire sprinkler ( sq. ft.) Page
r,N. , :i I' ';JOBSITE> � INFORMATI NJ + ° V^ `- , '•� °- :T=°
rnr : •.r.r . ..;:v�.•• . U .,, AND IsOCATIONr,k , « -r ` • }=
* �- r ���" �' rc�?� ��"� �`�'' Site utilities
Job site address: / ? � / _ 42 7/57' Catch basin or area drain 16.60
City / State/ZIP: ? ei/,er / ed e. 9 727 7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no 1 Project name: Footing drain (no. linear ft.: ) Page 2
�j/ / Manufactured home utilities 110.00
Cross street directions to job site /�,� � �VV�Cj� -
��/; � Manholes 16.60
//c -� - �y� e.)..--..- Rain drain connector 16.60 l
1 • - <./ e.e -- Sanitary sewer (no. linear ft.: ea) O e Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
' 4` cr, r. Ft,a;.� �,_ , "'r ar , ' Absorption valve
16.60
4 , D jRTION OF .WORKi ` ' M "
e ,ma . rv, ' '6 W -7y,, ,
��. �I ��•,., �.�-'- �, �.��,�, ,e .�>�� ..•.�.�., .o. , ��, ,,:k �� ��� " � .. .;^ :'�. : ,` :is;, N `� > Back flow preventer Page 2
�told�j /�S /GA-- C/� //C % �5 Z 'QL /,,t//` / Backwater valve 16.60
,,, Clothes washer 16.60
.f/ - - 'L es' i_ _,,,d
Dishwasher 16.60
"` , 'p Pit OPERTY UVV kl f t " ' • "'i nR t '' , :q ,t ' `• _� "",�`" ` " 1; Drinking fountain 16.60
x ,..�":w»�° ; `� �...�. �a �.k... i'E�.�F�. v , "tp`'�: , s�'.,: �' >� ® rx`wx'
�_ Ejectors/sump 16.60
.� ,r � :r.
Name:, s� '/7 ) 7 4 ' Expansion tank 16.60
Address: 43575 L,..." //g /L. Fixture /sewer cap 16.60
City / State/ZIP: / /? Ie i 72� Floor drain/floor sink/hub 16.60
( ) Fax: ( ) /
Phone: Garbage disposal 16.60
a (.� =, ; :: , ®. :,,,,,,,,,,,;,,,a,,,,, N �a .„ W;2 ,,,: .,3+; E x.:1,, 1 , Hose bib 16.60
: w , " w •A i.' E LNr :, ;ti-- ,:�,..tte�.r -. . 5:,;4: 7, ❑ GONI ACT PE RSON , r �. a .'
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: ( ) I Fax:: ( ) Sink/basin/lavatory • 16.60
Tub/shower/shower pan 16.60
E -mail:
a+ ,. r is .. Y •. Urinal 16.60
"� ... I. s r . t. ° .' CONTRACTOR. .- _ -.. -: , N , ,., p ' �'� v
n ,- .1• ° < ,,. u - . . ' 1 - 9 M . .�' " :. . n , ' Water closet 16.60
Business name: A� /�,,.G /C- a m t -P7 /6 � // ;2 Water heater 16.60
Address: , e, ,,R // 30 Other:
City /State/ZIP: /, ��/SDY /!`a (O, 9 7C/ 70 Subtotal
Phone: (503 ) o,cY, - /9;29 e Fax: �V � _ e777q Minimum permit fee: $36.25
( ) 7 /e/ / Residential backflow minimum permit fee: $36.25
CCB Lie.: /5 2!{( PI bin • Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee)
TOTAL PERMIT FEE n 36
-
Print name: j c OA S Date:' _ $ _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.
L\ Building \Permiu\PLM- PermitApp.doc 06/26/06 440- 4616T(IO/02/COM/WEB)
Plumbing Permit Application - City of Tigard ' -
Page 2 - Supplemental Information
' Fee Schedule: Residential Fire Suppression Systems:
7 ''" - `Qty `; F4CI(ca) Total , x'.s -s,�s N z^c_.`• e + k ."'"
Footing drain - 1' 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 ° N. . s °
Valuation i m, , P [w v.m - ,
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
additional $100.00 or fraction thereof to and
' l llesQl ItCffi s ` � ^sx tQty ": Fee.(ea)' "?Total..
s i:rAe, x. '.:.� 3*,m• 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 Back flow 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
specially requested inspections - per hour 72.50 and including $50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof
Fixture Work: x,,, PlantRevew forrPl m ><n " Insta llations
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
I . - t �. greater, except systems designed and stamped by licensed
ya .`� y ���,`���,, �,� ;F= QuaotitY 6y�( FizfurejfiWork , P.e "r form`ei17.��.
.,ty �- t. ,, * _ r a�. engineer.
F rerT4ype ` „- - 4 . Pre ioas % Cd � nu ' d a ' Ei" ;' " ""`
���"�"`�'�' �, -� � � ff paed�r;. _ n,� ¢ . ❑ 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 -0040.
- Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic a = �•�.� k-
Ti , �,�� �yt .. w. , .'�. :v i �t'xY r'. ".r^7U ` .:Y..�',X»
Drinking Fountain IS
t± ., Y, I s O ICtT'1Cx O' R D11agranl ,
Eye Wash • ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Pennits\PLM- PetmitApp.doc 09/22/06
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AAF0DA3LE
SEPTIC SERVKE
P.O.BOX 1130
WILSONVILLE, OR 97070
- ■
(503) 6824929 FAX MOM sm-ons
CUSTOMERS ORDER NO. PHONE DATE
-3-0
NAME
— ,
, 4
'-, ADDRESS
S )1?
4111, e C/ S (.)
-0 dr - 7227
SOLD BY' '''-CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT
-/API2
( f
/n, CC/0/0
. ,
. •
TAX
RECEIVED BY
TOTAL
All claims and returned goods MUST be accompanied by this bill.
Atimi To Reorder: THANK YOU
800-225-6380 or nebz.com
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PL12007 -00127
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2007
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/3/2007 TIME: 7:00AM PAGE: 56
SITE ADDRESS: 13575 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TRAPP
DESCRIPTION: Line work to connect sewer. Septic system to be pumped and filled or removed.
OWNER: TRAPP, RUSSELL W + TAMARA 5, PHONE #: 503 - 639 -9249
CONTRACTOR: A AFFORDABLE SEPTIC SERVICE PHONE #: 503-969
Inspection Request Scheduled For: Date: 4/3/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final "045893 --01 503.969-9548 Y
Corrections /Comments /Instructions:
U" 3039 Y'VC Sc. wc�
• � 1 04-1 i '� - V tp , 4 , - , 194-41. a- F � ` I L i , • IC i4
ti
car- c, 1 9.1)
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FALL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (roll pi—, Date: �/ /o 7 Phone #: (503) 718-