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CITY F TI OA D PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00457
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/9/2007
PARCEL: 2S 1108 D - 01500
SITE ADDRESS: 11670 SW BULL MOUNTAIN RD ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: ORFIELD
Project Description: Line work to connect sewer to lateral. Septic to be pumped and filled or removed.
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 •
TAMARA/KEL ORFIELD
14728SW 117TH Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/9/2007 $72.50
[TAX] 8% State Surcha 10/9/2007 $5.80
Phone : 503-598-3911 Total $78.30
Contractor:
NW HOME SERVICES LLC
6941 SE BIXEL WAY
MILWAUKIE, OR 97267 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 722 -9599
FAX 503- 722 -9779
Reg #: LIC 172358
PLM PB216
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.
Iss ed By: , / ���� Permittee SignatuT6
Call 503.639.4175 by 7:00 a.m. for an inspection p -t 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 ,
Building Fixtures r FOR OFFICE USE ONLY ,
City of Tigard Received t 0 Permit N `
lig e 13125 SW Hall Blvd., Tigard, O 3 Date /By: � C, / €2 4 3_6 �J 7
- R�� 11 9 2007 Plan Review /
_ Phone: 503.639.4171 Fax: 503. 19 Other Permi
DateBy: Gt/27 - (Jd.1 w
Inspection Line: 503. 7" d �
T, 1 GA RD Cal_ Y Ur I.VA Date Ready/By: tu s- la See Page for
Internet: www.tigard - Notified/Method: I Supplemental ental I nformation
' I G DIVISION 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 (1) 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: I I ( , 7O 5V VwI I M. get, Catch basin or area drain 16.60
City /State /ZIP: ^! 9 DE. 1 7 2 . f 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.: / l 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
DES RIPTION OF WORK
/ Backflow preventer Page 2
g , - d■ • _ _ IP ` - 4 . Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER Drinking fountain 16.60
❑ TENANT
r.
Ejectors /sump 16.60
r Name: L ` O r �� Expansion tank 16.60
Address: 14'1 s W I (-7 ?I • Fixture /sewer cap 16.60
City /State /ZIP: I I j / QE. I 1 224- Floor drain/floor sink/hub 16.60
Phone: 60') g- .jaj I I Fax: ( ) Garbage disposal 16.60
❑ APPLICANT Hose bib 16.60
❑.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
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: A J - .L) . , 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 Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature, `_ (j--t,(
State surcharge (8% of permit fee)
�����////// TOTAL PERMIT FEE 7 nam . L 8 ( U-. Date: This permit application expires if a permit is not obtain d within
7
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 12/27/06 440-4616T( I 0/02/COM/WEB)
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 - l' 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 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 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 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 ofplans 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"
-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 -Perm tApp.doc 12/27/06
To: North West home services Page 1 of 1 2007 -10-10 20:29:28 (GMT) 15039075991 From: Raisa Koreski
Pro -Pump Sanitation Solutions Invoice
(503) 753 -1418 -
Date Invoice #
(503) 358 -4316
30245 E Woodard. Rd. 10;1012007 1306
Troutdale, OR 97060
Bill To Ship To
11670 Sw Bull Mountain Rd
Tigard, OR 97224 -2752
P.O. Number Terms Rep Ship Via F.O.B. Project
10/10/2007
Quantity Item Code Description Price Each Amount
Septic Pumping Septic Pumping and disposal of the liquid waste water 250.00 250.00
Credit Credit - 50.00 -50.00
Thank you for your business.
Total $200.00
CITY OF TIGARD
BUILDING DIVISION PERMIT #: pLIVI2007-004.67
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2007
Phone: (503) 639-4171 tti it
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/12/2007 TIME: 7:01AM PAGE: 13
SITE ADDRESS: 11670 SW BULL MOUNTAIN RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ORFIELD
DESCRIPTION: Line work to connect sewer to lateral. Septic to be pumped and filled or removed.
OWNER: ORFIELD, TAIVIARNKELLY PHONE #: 503-590-3911
CONTRACTOR: NW HOME SERVICES LLC PHONE #: 503-722-9599
Inspection Request Scheduled For: Date: 10/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 057541-01 971-409-8077
Corrections/Comments/Instructions:
• 1r, LA • IA -12 ./ 1/Q t-ci • /T
C r c
PASS 0 PARTIAL APPROVAL n CANCEL I NO ACCESS
FAIL fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: (1 - 6\14 ( 1 " \VCA-- 4 -- Date: / Phone #: (503) 718-
CITY OF TIGARD = _
BUILDING DIVISION PERMIT #: PLM2007 -004 7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2007
Phone: (503) 639 -4171 w 11i M
Inspection Requests (24 Hrs.): (503) 639 -4175 j�
INSPECTION WORKSHEET FOR DATE: 10/11/200 TIME: 7:01ANi PAGE: 35
SITE ADDRESS: 11670 SW BULL MOUNTAIN RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ORFIELD
DESCRIPTION: Line work to connect sewer to lateral. Septic to be pumped and filled or removed.
OWNER: ORFIELD, TAMARA/KELLY PHONE #: 603.598 -3911
CONTRACTOR: NW HOME SERVICES LLC PHONE #: 503- 722 -9599
Inspection Request Scheduled For: Date: 10/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 057426.01 971-4098077 Y
Corrections /Comments /Instructions:
N, 1 ∎ C �Qa.:au,� 'e k41 sL• c (--)a% i e errhri Puw.„
Jv k A • LJ , Pu. , c t., Se • - I--i` ci i,( ! u d- rt! ■ [;
(l PASS X PARTIAL APPROVAL U CANCEL ❑ NO ACCESS
I FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: 1,1 �1..�,dti 1 d"" — Date: /0////67 Phone #: (503) 718-