Permit 0 ty
n CITY OF TIGARD PLUMBING PERMIT
'. COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00218
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2008
PARCEL: 25101 DB -00608
SITE ADDRESS: 07670 SW CHERRY ST ZONING: R -3.5
SUBDIVISION: ROLLING HILLS LOT: 013 JURISDICTION: TIG
PROJECT: BLAGGE
Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement district
#44. Fees paid 5/15/2008.
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
BLAGGE DIANNE
7670 SW CHERRY DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/15/2008 $72.50
[TAX] 12% State Surch 5/15/2008 $8.70
Phone : 503- 692 -3127 Total $81.20
Contractor:
BRIAN CLOPTON EXCAVATING INC
PO BOX 509
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 682 -0420
Reg #: LIC 50337
PLM 3 -517PB
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: �' P ermittee Signature: k A 2JL. 0,1
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 ��
Building Fixtures FOR OFFICE USE ONLY
City g of Tigard °. Received
r ennit N `
n 13125 SW Hall Blvd., Tigard, OR 97223 �A �� 5 20 Date/By: �D� ' ice/ . . . i 1
: 0 . Phone: 503.639.4171 Fax: 503.598.1960 \vt Plan Review
�� Date/By: Other Permit No.: 5(, ,e ) 7
�S'(��42
TIGARD Inspection Line: 503.639.4175 �`� . ai:' eReady/By: luris El See Page 2 for
Internet: www.tigard- or.gov ON , O 'J \S' otified/Method Supplemental Information
.. :.... ' WTYPE " OF WORK _ 1 1 At i . . . . , . , - FEE *'.SCHEMULE 7 . • .
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
a,,`-_.'"a ` `; -,CATEGORY. OF.'CONSTRUCTION4:',." ' _, 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: 7670 Sw Cf(.er -j P� ' Catch basin or area drain 16.60
City /State /ZIP: ( (. 50. ( d 0� tt ?2.2_3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: K I 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.:1t.O ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
' •, *`'_ `'DESCRIPTIONOF'WORK'`" .
Backflow preventer Page 2
('O n e c -0 se (- [( (4 e-- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
TYr�:OWNER=� t ' ' Drinking fountain 16.60
' ■,PROPER
H .:,.TENANT .
� Ejectors /sump 16.60
Name: AY 0_, r , 13 L4 C Expansion tank 16.60
Address: '7 (. f co Scno Y) I ct I A � C rcJ .e- Fixture /sewer cap 16.60
City /State /ZIP: 1 -\-` - a . 970 co Z Floor drain /floor sink/hub 16.60
Phone: (563) ip - 3 ( o.,, Fax: ( ) Garbage disposal 16.60
�� .: Hose bib 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:
16.60
Urinal
', 5 rra ' :3 - ''CONTRACTOR 4 `..' Water closet 16.60
Business name 6.--i Ci ,e' heater 16.60
/ V 1 n u ,b,
Address: g(e 'v� �` „�►�
l Subtotal
City /State /ZIP: C,(/t brut- . ( k 1 ci2 i-
Minimum permit fee: $72.50
Phone: (5 ) 66 _-- r)/-a-) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 5"- 3-S-17 Plumbing.Lic. no.: 3-S-17 review (25% of permit fee)
�/� State surcharge (12% of permit fee) N
Authorized signature• i i s nA e,tE) acv TOTAL PERMIT FEE
�t/U1 i
Print name :7)( N n e Ri j , Date: f o d 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.
I Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
l ! 1 / '
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
Qt y., . ,:Fe (ea):. ` .Total
: Sitew ftilities. , Squa e,Footage:' _
Footing drain - 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:" "Perm 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 Q ty .. (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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100 00 or fraction thereof.
Commercial Fixture Work: Plan Review'for. P,lumbin °g "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 P,erformed • greater, except systems designed and stamped by licensed
Fix ure 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
Drinking Fountai -Domestic , Isometric Or' Riser Magtam. ` `
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
Si \ Ir. AFQDAL
SEPTIC SE' VOCE
P.O.BOX 1130
WIL SONVILLE, OR 97070
(503) 682.1929' FAX 15031 57 779
CUSTOMER'S ORDER NO. PHONE DATE
/ c°3 _ 1111 67 o 1 t.�
NAME / /.1/ L. /s (� �6!' f ‘'.1( e M I
ADDRESS
7. 670 5tJ iltiZZy P
te e. '2.,z3
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D PAID OUT
zedy 5
QTY: DESC PRICE 1:r AMOUNT',
it
9a0 �L 4S l`2c & '2Z ` 3Z5 "d
icele
GL
JOB A/ 1" / IF
r1 6 - 41 s E 5
TAX
RECEIVED BY
TOTAL 7 p
All claims and returned goods MUST be.aCcompanied by this bit.
/' / TO Reorder: THANK YOU
800- 225.6380 or nebs.com
III a • Community Development
Tt cA Kn Reimbursement District Payment Worksheet
Planning /Engineering to complete: �
Site Address: l (7 ) Cb r2te- l �/ 6E.
Parcel No.: �J l0/ 68 -0
Reimbursement District No.: `i c/ Amount Due: $ ll, 3 K. CO
Date: 57 1 S/D B • Tee
Note:
Amount due is as of date shown above.
Deferred Accounts:
Name: Nt-tA ISL_A0(O(.
Phone Number:
Legal:
Amount paid: $ 4, 0
Remaining to be paid; deferred amount: $ S. Y. az)
Building Division to complete:
Reimbursement amount paid: $
Received by:
Return completed worksheet with copy of receipt to planning /engineering permit technician.
Planning /Engineering to complete: •
Enter "paid" parcel tag.
Enter "deferral" parcel tag, if applicable.
Route copy of receipt and parcel information printout to Finance Department.
1: \CURPLN \Masters \ReimburseWorksheet doc 2/23/07
-. • -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLIvI2008-00210
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/15/2003
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/11/2000 TIME: 7:00AM PAGE: 1
SITE ADDRESS: 07670 SW CHERRY ST CLASS OF WORK:
SUBDIVISION: ROLLING HILLS LOT #: 013 TYPE OF USE:
PROJECT NAME: BLAGGE
DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement district
#44. Fees paid 5/15/2008.
OWNER: DIANNE, BLAGGE PHONE #: 503-692-3127
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420
Inspection Request Scheduled For: Date: 6/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 071234.03 503-849-7607
Corrections/Comments/Instructions:
NA.L4 t, p, &t,c, ose,
94,1
PASS 0 PARTIAL APPROVAL 0 CANCEL LII NO ACCESS
I I FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: di) Date: C, t 1 O Phone #: (503) 718-
_ , •
CITY OF TIGARD
BUILDING DIVISION
t , PERMIT #: PLM2008-00218
D ATE 13125 SW Hall Blvd., Tigard, OR 97223 E ISSUED: 5/15/2008
Phone: (503) 639-4171 , 7 11 0,91t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/10/2008 TIME: 7:01AM PAGE: 3
SITE ADDRESS: 07670 SW CHERRY ST CLASS OF WORK:
SUBDIVISION: ROLLING HILLS LOT #: 013 TYPE OF USE:
PROJECT NAME: BLAGGE
DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement district
#41. Fees paid 6/16/2008.
OWNER: DIANNE, BLAGGE PHONE #: 603-692-3127
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420
Inspection Request Scheduled For: Date: 6/10/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Saniialy sewer 071162-01 503-W19-7607
Corrections /Comments / Instructions:
t.- e, Co A-44-01.,/ 2cae
El PASS PARTIAL APPROVAL [I CANCEL El NO ACCESS
FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: cTil Date: Cot \ Phone #: (503) 718-