Permit L' w CITY OF TIGARD PLUMBING PERMIT
i sq
COMMUNITY DEVELOPMENT
PERMIT #: PLM2008 -00330
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/6/2008
PARCEL: 2S 103BA -00102
SITE ADDRESS: 12010 SW ANN ST ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS LOT: 002 JURISDICTION: TIG
PROJECT: ZARR
Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #40.
Fees paid 8/6/08.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
JAMES & DO ZARR
12010 SW ANN ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/6/2008 $72.50
[TAX] 12% State Surch 8/6/2008 $8.70
Phone : 503 -524 -3666 Total $81.20
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: ` it `_ P ermittee Signature: /!
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a, - �1 i/P5411P° — ' I'""w" —
Call 503.639.4175 by 7:00 a.m. for an inspection .J - . usiness day.
This permit card shall be kept in a conspicuous place on the job site until completion of th• • •sect.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures x FOR OFFICE, USE ONLY
City of Tigard co //-- /� L "�
III �,. ri etmn No.: � a� �� ` � (�O `cti S<,
a 1'3125 SW Hall Blvd., Tigard, ' OR 7' 3 O � Plan Review • � /J � �,�
Phone: 503.639.4171 Fax:. J8 ' '0 �� Date/By: Other Permit No.:. /��Je(�O - .ICJ
TIGARD P
Inspection Line: 503.639.417 S•' G �® Date Read B Y orr is. El See Page 2 for
` ®� Ready
/By:
www.tigard or.gov v Notified/Method: CA Supplemental Information
TYPE OF WORK ,A G '� FEE* SCHEDULE..
['New construction ❑ f1 For special information use checklist
Description I Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ i•;,� +�� New 1- 2- family dwellings (includes 100 ft. for each utility connection)
V CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
PI - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 1=1 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: Catch basin or area drain 16.60
/ cam/ / l
City /State /ZIP: r /Cr�i42 n� ?�7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: / I Project name: � II LC e_ Footing drain (no. linear ft.: _) Page 2
v Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: itA)) Page 2
Storm sewer (no. linear ft.: .) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: J ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK - Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
ROPERTY OWNER I . ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: �4.�5 "Z /7�7 Expansion tank 16.60
Address: /2 C /O ' / ` d6'v r S Fixture /sewer cap 16.60
City /State /ZIP: 7 -CP, /7 ) //� 6 41 Floor drain /floor sink/hub 16.60
Phone: ( D 5� 7 - ,7‘. / �`' / Fax: ( ) Hose bib Garbage disposal 16.60
� . 16.60
❑ APPLICANT ❑ 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: --- /c.-/�a 1,•it / 3 Water heater 16.60
Address: % /367),.. // 30 Other:
Subtotal
City /State /ZIP:
00 '- z< <I' af I Minimum permit fee: $72.50 5v
Phone: ( r ..... ` ` Fax: ( ) Residential backflow minimum permit fee: $36.25
C CB Lic.: Ai , Plumbing 'c o.: Plan review (25% of permit fee)
_ State surcharge (12% of permit fee) r".
Authorized signature:
_ _ _ Tit - TOTAL PERMIT FEE f • X0
Print name: • L . .4P amm This permit application expires if a permit is not obtained within
- _ - - - 180 days after it has been accepted as complete.
*Fee methodology set by Tr County Building Industry Service Board.
LABuilding \Permits \PLMF- PermitAppdoc 12/27/06 440- 4616T(10 /02 /COM/WEB) �� 31.Z( ( t
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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 , Permit Fee:.
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
Valuation: Permit Fee:
Storm Sc 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 500.
specially requested inspections - per hour 72.50 $50 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal:
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 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above:
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or R D .
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
- 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
- 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. \ Building \ Permits \PLM - PermitApp.doc 12/27/06
A Ern 1, 1 r
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\it i6alL
SEPTIC SEMM'CE
PO.BOX 1130
WILSONVILI.F., OR 97070
- (503) 682.1929 FAX (503) 570-0779
I CUSTOMER'S ORDER NO. PHONE DATE
gi-c /4 70 0g /3 0
NAME
AO 5 kci 4 , - - c / 5 r riG-figd
ADDRESS
9 , e 2
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
6
QTY. DESCRIPTION PRICE AMOUNT
0 0& 6 I • 7 s
I TAX
RECEIVED BY 3Z-5 ci
TOTAL -
All claims and returned goods MUST be accompanied by this bill.
AWN/ To Reorder. THANK YOU
800-r.45-15380 ornbs .com
•
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #: PLM2008-00330
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
8/6/2008
Phone: (503) 639-4171 ANSA i #
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 0/13/2008 TIME: 7:00AM PAGE: 14
SITE ADDRESS: CLASS OF WORK:
12010 SW ANN ST
SUBDIVISION: LOT #: TYPE OF USE:
LERON HEIGHTS 002
PROJECT NAME: ZARR
DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #40.
Fees paid 8/6/08.
OWNER: ZARR, JAMES & DONA PHONE #: 5a5243666
CONTRACTOR: A AFFORDABLE SEPTIC SERVICE PHONE #: 503 8
Inspection Request Scheduled For: Date: 8/13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 074133-01 503-969-9548 Y
Corrections/Comments/Instructions:
Ca r-e. f L. 94.)
X PASS I I PARTIAL APPROVAL 0 CANCEL I I NO ACCESS
fl FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: 6-b-V.v4.A..A\ tovv.4_ Date: ? 1 3 O Phone #: (503) 718-
• A . , . . .