Permit � CITY Y OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE
COMMUNITY PLM2008 -00221
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/16/2008
PARCEL: 25101 DC -02400
SITE ADDRESS: 07630 SW CHERRY ST ZONING: R -3.5
SUBDIVISION: ROLLING HILLS PLAT 2 LOT: 032 JURISDICTION: TIG
PROJECT: MEMOVICH
Project Description: Connecting existing house to sewer. Septica tank to be pumped and filled. Reimbursement #44.
Fees paid 5/16/2008.
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
ROBERT & B MEMOVICH
7630 SW CHERRY ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/16/2008 $72.50
[TAX] 12% State Surch 5/16/2008 $8.70
Phone : 503- 639 -5884 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 B Permittee Signature:
•
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
�
_ Date /B : / 710 u 1S �! ' Lm f/vv����he�
City of Tigard Permit No.:
IN
n 13125 SW Hall Blvd., Tigard, OR 1 - � - V - Plan Review
Phone: 503.639.4171 Fax: 503. ` ='8. 960 t , '� ��` ` Date /B Y v c -v, `
Other Permit No.: � ,2��(� ?!
T I GA RD Inspection Line: 503.639.4175 t ` °' 1" Date Ready /By: Juris 65 See Page 2 for
Internet: www.tigard- or.gov .. '" Q1�
.ax il.� ,� ,� 4 i lzlotified/Method: Supplemental Information
T YPE O W O RK , 't.:: "V ' ' FE,E *' SCHEDULE ;
l-O6 t
El New construction ❑ De i lixion 4 - 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)
' ' - CATEGORY OF CONSTRUCTION' ' SFR (1) bath 249.20
X 1- and 2- family dwelling ❑ CommerciaUindustrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
'JDB.Igr " I / TION:.AND LOCATION„ , . -. Site utilities
Job site address: 76,3p 5 e +"� e r nt.j 1) r Catch basin or area drain 16.60
City /State /ZIP: "T, Uc,e y , d 0 / (7 7.2- A 3 Drywell, leach line, or trench drain 16.60
-
r� / Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: )I-e rn uil, (�1/l
/ 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 o0) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
- - DESCRIPTION r•u 3 : , , r,, Backflow preventer Page 2
5 e e- Coy/ye � -C h Backwater valve 16.60
7J 4)c _ Clothes washer 16.60
..VV r JV l Dishwasher 16.60
Drinking fountain 16.60
- . , 01 PROPERTY 'OWNER I _ ❑ TENANT ' .
Ejectors /sump 16.60
Name: I -.b a ( Ke-ww / t_f.i-- - 1 - V'a-5 Expansion tank 16.60
Address: 7 6 3 p s tic) Ckk r r `3 I- Fixture /sewer cap 16.60
City /State /ZIP: - T - ' 1 q & (9 p., 9 7 2 3 Floor drain/floor sink/hub 16.60
) Garbage disposal 16.60
Phone: (am 3) 6, 3 9- s c-{ Fax: ( )
- " H ose bib 16.60
.i❑.=- APPLICANT ; .. AD , 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: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
a < ' CONTR ACTOR, ; ' Water closet 16.60
Business name: r Lle.>ti O stir p ClUpON Water heater 16.60
'
Address: b `50A U y tti-
Other:
City /State /ZIP: (� /� r 7 0 7 0
p Subtotal
"v /SY� t J Minimum permit fee: $72.50
Phone: (S'� ? ) G ---QL1 7), 5
CCB Lic.: SO 7 Plumbing Lic. no.: 2 _� 7/c Plan review (25% of permit fee)
State surcharge � ge (12/a .7-, of permit fee) , 70
Authorized signature: NGF . p / ctc 'I �HN ,,„,_3_,L TOTAL PERMIT FEE
Print name: r� v fr(e u 6 v , Date: _ (( - d c' This permit application expires if a permit is not obtaine
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) F( 9 i, t do
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities} = Qty. *Fee(ea) 'Total S quare:Footage 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; ° a . Peirmit' Fees
Storm & Rain Drain - I st 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
Q ty.,,, "Fee ea tal additional $100.00 or fraction thereof, to and
F1Xtl1)r'E Or Item. '� u ) ' ` To 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
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: - • �P1ain:Review for P
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 r •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 : :.Jsometric O 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:
1:\ Building \Permits\PLM - PermitApp.doc 12/27/06
S
• a Community Development
TicAxD Reimbursement District Payment Worksheet
Planning/Engineering to� complete:
/ / f
Site Address: •St-t 1 L
Parcel No.: 9 -S r o I D -c1.
Reimbursement District No.: c f -C t Amount Due: $ l '4
Date: By: 5, - 4
Note: Amount due is as of date shown above.
Deferred Accounts: /� //� ,,,
Name: /- M / O
Phone Number:
Legal:
Amount paid: $ LP O3O
Remaining to be paid; deferred amount: $ ; f � 1 1 4 702 , G (�
Building Division to complete: •
Reimbursement amount paid: $ cic./CD
Received by: _ _ ."111111111/10
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.
J. \CURPLN \M asters \ReimburseWorksheet.doc 2/23/07
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008-00221
13125 SW Hall Blvd., Tigard, OR 97223 A DATE ISSUED: 5/1612008
Phone: (503) 639-4171 &
Inspection Requests (24 Hrs.): (503) 639-4175 !J' IL.
INSPECTION WORKSHEET FOR DATE: 6/11/2008 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 07630 SW CHERRY ST CLASS OF WORK:
SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 032 TYPE OF USE:
PROJECT NAME: MEMOVICH
DESCRIPTION: Connecting existing house to sewer. Septica tank to be pumped and filled. Reimbursement #44.
Fees paid 5/16/2008.
OWNER: MEMOVICH, ROBERT & BARBARA PHONE #: 503-639-5884
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 071234-01 503-1349-7607
Corrections/Comments/Instructions:
_ 1/LA • C_
PASS n PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
El FAIL LI CALL FOR INSPECTION E] ADDITIONAL FEES ASSESSED
Inspector: 0 - 6 V".I Date: I 11 t 0 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -00221
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6 /16 /2008
Phone: (503) 639 -4171 . /o w l��ii �l 11r
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/30/2008 TIME: 7 :01AM PAGE: 3
SITE ADDRESS: 07630 SW CHERRY ST CLASS OF WORK:
SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 032 TYPE OF USE:
PROJECT NAME: MEMOVICH
DESCRIPTION: Connecting Existing house to sewer. Septica tank to be pumped'and filled.', Reimbursement 4.
Fees paid 5/16/2008. :
OWNER: MEMOVICH, ROBERT & BARBARA PHONE it: 503. 633.6081
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC ' PHONE #: 603 --682- 0420
Inspection Request Scheduled For: Date: 5/30/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
ti05 Sanilary sewer 070610-01 503 -819 -7607 Y
Corrections /Comments /Instructions:
�u ►..�o �..�. -1-1 r, �a �V�. �� �� I k��n v din CO u► P ��e.�T
Sizt, LA AT"
rk„t.
PASS [PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v Date: c3-b I A% Phone #: (503) 718-