Permit a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00332
T IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/26/2007
PARCEL: 2S 103BA - 00106
SITE ADDRESS: 11770 SW ANN ST ZONING: R - 4.5
SUBDIVISION: LERON HEIGHTS LOT: 006 JURISDICTION: TIG
PROJECT: PARSONS
Project Description: Line work to connect 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: 70 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PARSONS, JOE P MARLYNN
11770 SW ANN ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/26/2007 $72.50
[TAX] 8% State Surcha 7/26/2007 $5.80
Phone : 503 -590 -5905 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 obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � �_ ��� . Al Permittee Signature: J
\ '��
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
U : ,- w „... L FOR OFFICE USE ONLY
City of Tigard JUL Date/By 3+1 1 86 PermitNo.:PA 24•201 , €:1255,A.
11111 a 13125 SW Hall Blvd., Tigard, O w a 7.223 111 Plan Revie
1 Phone: 503.639.4171 Fax: 5 1598z1Q60' I 1 „� �.y Date/By: Permit /� Q� r y: W
Inspection Line: 503.639.4178tJ#E 5 +e D " fd
T I G A R D «L � t ,11 c 6�� Date Ready /By: furis% i F. See Pagel for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
- TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
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 (I) 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: / / 77v So) ArvN 5 j i Catch basin or area drain 16.60
T
City/State/ZIP: i C%�,�d �,e�go 7 �
Cit y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: r Project name: `J 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.: 7!J) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: J 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
_41 _ l.Ocrt.X/1 )�- ,1 �a1,. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
g,PROPERTY. OWNER I. ❑I TENANT Drinking fountain 16.60
`� Ejectors /sump 16.60
Name:�A f� �7'� 5�t s Expansion tank 16.60
Address: / / 7 D SCE A"1m,c SI Fixture /sewer cap 16.60
I -/
City /State /ZIP: 7 r �A� c71 �� - -qe„ 4' 7�7 3 Floor drain /floor sink/hub 16.60
Phone: 503) 5- /O ` 57v"s ' - ` a ( ) Garbage disposal 16.60
CI 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
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: ` / � // � e7M , &_ _, / ,k/,L41 C / Water heater 16.60
Address: / Other:
Subtotal
City /State /ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature :� / 7 p Y TOTAL PERMIT FEE ' g.
Print name: Milkij vw ��[O �j' �/l!S Date: 7/ ?�� This permit application expires if a permit is not obtained within
J "J 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits\PLM - PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) pC, G -3.0e,
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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 - I s 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
,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 $50,000.00.
specially requested inspections - per hour 72.50 $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:
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
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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 \Permits \PLM -Perm tApp.doc 12/27/06
AUG -03 -2007 04:55 PM P.02
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SEPTIC PERMIT NO.
S, R E, Section � _, Tax Lot(s)
I certify that the existing I : ptic tan . drywall I cesspool (circle one or more)
was properly abandoned • • ndards The sewage contents were
removed by
(Company Name)
a licene .• • e disposal pumping service. The unit was then backfllled with
rocit and th • y e, sewer promptly capped or.re moved.
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`Signature Date
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CITY OF TIGARD •
BUILDING DIVISION PERMIT #: PLM2007-00332
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/26/2007
Phone: (503) 639 -4171 A.. ,,4Mipyll jIl
Inspection Requests (24 Hrs.): (503) 639-4175 __..
INSPECTION WORKSHEET FOR DATE: 7/31/2007 TIME: 7:07AM PAGE: 36
SITE ADDRESS: 11770 SW ANN ST CLASS OF WORK:
SUBDIVISION: LERON HEIGHTS LOT #: 006 TYPE OF USE:
PROJECT NAME: PARSONS
DESCRIPTION: Line work to connect sewer. Septic: system to be pumped and filled or removed.
OWNER: PARSONS, JOE P MARLYNN, PHONE #: 503. 590 -5905
CONTRACTOR: A AFFORDABLE SEPTIC SERVICE PHONE #: 503-969-9548
Inspection Request Scheduled For: Date: 7/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 053076 -01 503 - 969 -9548 Y
Corrections /Comments/ Instructions:
q/7 363 q PvG � wc✓,
lit , , I i) I ✓V V t v IAA oe✓ N. C " 1
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PASS 1:4 PARTIAL APPROVAL I CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Thl Date: -7 1 3* Phone #: (503) 718-