Permit • CITY OF TIGARD PLUMBING PERMIT
" DEVELOPMENT SERVICES PERMIT #: PLM2005 -00463
Ali DEVELOPMENT
SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/15!2005
PARCEL: 2S 103B D -02300
SITE ADDRESS: 11760 SW CARMEN ST ZONING: R -4.5
SUBDIVISION: CARMEN PARK LOT: 008 JURISDICTION: TIG
Project Description: Line work for sewer connection.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SMITH, ROSS JAY Description Date Amount
11760 SW CARMEN ST
TIGARD, OR 97223 [PLUMB] Permit Fee 9/15/2005 $72.50
[TAX] 8% State Surcharl 9/15/2005 $5.80
•
Phone : 503- 644 -5501 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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 1- 800 - 332 -2344.
Issued By: { , �/ Permittee Signature: X / j<0
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.
Building Fixtures c --�,c (. `ia(
,r
Plumbing Permit .,alb• ip.itu i D FOR OFFICE USE ONLY
City of Tigard Received /5 j o 6 p 74 /71.2006 '� J
Date/By: // IOa Permit No.:
13125 SW Hall Blvd., Tigard, OR 9 15 2005 Plan Revie
Phone: 503.639.4171 Fax: 503.59 0 / /nn y:fil, . T \ O Permit No .
24- Hour Inspection Line: 503.639.4175 "kPa`lI' D ate/By. / � /
- ,„i
Internet: www.ci.tigard.or.us. CITY OF TIGARD Notifi od: ( Supplemental Information
8161111l6P lg FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
• Description I Qty. I Ea. I Total
NI Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 10,0 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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: // 7 7 _S, W. CA -,z-t (/ -sr Catch basin or area drain 16.60
City /State /ZIP: / / ,9 pet? , Oil q 7_2.21 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: I Project name: S't�/2 `���ir U Footing drain (no. linear ft.: ) Page 2
✓
•
i Manufactured home utilities 110.00 •
Crss street/directions to job site: en' t/ . , v_ ---- Manholes 16.60
Zr L !' _
FT J/ ( 77/ `- - /464 a- / Rain drain connector 16.60
C /-;*0,e/Pty S.7 . 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
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
4 /NE wood( g SE u- i c ommgcr. Clothes washer 16.60
Dishwasher 16.60
® PROPERTY• OWNER .❑ TENANT Drinking fountain 16.60
,/� Ejectors/sump 16.60
Name: / C 05 5 7 , & /I/ n-' Expansion tank 16.60
Address: JJ .7 ® c w, C /_f2/'iE,v 37---, Fixture /sewer cap 16.60
City /State /ZIP: - 7 " /t ', n/9 , a n q7...2...23 Floor drain/floor sink /hub 16.60
( o 3 ) �o� �� Garbage disposal 16.60
Phone: 1�j- S,So/ was2 // � Fax: (563) G ?� P
. CI APPLICANT 5.2/ -,072 7 ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
(He -t e)
Interceptor /grease trap 16.60
Contact name: 3 R-MF As l �J 9 /l ,C Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) l Fax::( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR Water closet 16.60
Business name: Ot,J NEB Water heater 16.60
Address: Other:
City /State /ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7,p/ , 5
CCB Li Plan review (25% of permit fee)
�// State surcharge (8 %ofpermit fee) 6,
Authorized P Lic. no.: d signature: `L� j. TOTAL PERMIT FEE 7 .30
Print name: PO .5..S T. S / j „ Date: 9 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.
• 1: \ Building \ Permits\ PLMF- PermiiApp.doc 06/05 440-4616T(I0/02 /COM/WEB)
Plumbing Permit Application =' City of Tigard .. .
Page 2 - Supplemental Information r
Fee Schedule: Residential Fire Suppression Systems:
. - Site. :Utilities "= • Qty: • .Fee . ' T o tal Square Footage: x. - .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.
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
SS - 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 & 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
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: Plan Review for Complex 'Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by (Fixture) Work Performed CI Any new commercial building.
Fixture Type:.' Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing' . ❑ A commercial building with installation, alteration or'addition
Baptistry /Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic
Drinking Fountain dwelling units.
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain • Isometric or Riser Diagram. ,
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
• - Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
• - Commercial
- Service
Swimming Pool Filter •
Washer Clothes *Note: If the fixture work under this ermit results in an
Water Extractor p
water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued. •
i:\ Building \Permits\PLM- PermitApp.doc 07/06/05
ORVALL T. CADE Wants earl yJOB INVOICE
BYER'S SEPTIC TANK SERVICE, INC. Call W# lhr inadv. .
P.O. BOX 549 _if after 8:45-
. ,
i
OREGON CITY, OREGON 97045 CUSTOMERS ORDER Na DATE ORDERED
(503) 656 -3326 10-24-05
ORDER TAKEN BY DATE PROMISED ❑ A M
BILL TO Grace 10-28 i
❑ P.M.
Ross Smith PHONE
ADDRESS 521-0727
11760 SW C St. MECHANIC
j CITY , W- 644 -5501
Tigard 97223
JOB NAME AND LOCATION
BRIM ' I
I
DESCRIPTION OF WORK ❑ DAY WORK
• .. . _ _ ❑ CONTRACT
❑ EXTRA
I I
OUANT. _ - - I
DESCRIPTION OF MATERIAL USED
AMOUNT
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• _ Wil b > to I
I
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-_ I
__
__
-_ II
__
I I
__ I
__ II
IIIII
HOURS - -... _ _ __ f
LABOR AMOUNT
TOTAL
MECHANICS
-■ MATERIALS
I TOTAL I
-■ _
- LABOR
MIN I
. I hereby acknowledge the satisfactory
completion of the above described work. TOTAL LABOR ■
SIGNATURE TAX
DATE COMPLETED
TOTAL _ I
I
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CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM2005-00463
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/15/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/12/2005 TIME: 7:04AM PAGE: 17
SITE ADDRESS: 11760 SW CARMEN ST CLASS OF WORK:
SUBDIVISION: CARMEN PARK LOT #: 008 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Line work for sewer connection.
OWNER: SMITH, ROSS JAY, PHONE #: 503 -644 -5501
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Salutary sewer 018102-01 503 -521 -0727 N
Corrections /Comments /Instructions:
s - �
I
r
4, „ _
(PASS ARTIAL APPROVAL CANCEL n NO ACCESS
I I FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '7 Date: / / We e s Phone #: (503) 718 -