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Permit
F., CITY TIGARD PLUMBING PERMIT i' I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00146 VI 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 4171 DATE ISSUED: 4/13/2005 PARCEL: 2S 112BC -00100 SITE ADDRESS: 14537 SW DEKORTE TERR ZONING: R -4.5 SUBDIVISION: DURHAM ACRES LOT: 069 JURISDICTION: TIG Project Description: Sewer connection. CLASS OF WORK: NEW 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: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KNOWLTON, BROOK Description Date Amount 14537 SW DEKORTE TERR TIGARD, OR 97224 [PLUMB] Permit Fee 4/13/2005 $72.50 [TAX] 8% State Surchari 4/13/2005 $5.80 Phone : 503- 639 -1465 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 or 1- 800 - 332 -2344. Issued By: Permittee Signature: s 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 App irr EGEIVE 'FOR OFFICE' USE' ONLY t City of Tigard DateByd ( 7 / / C.% - - 2 6 - 1 _ Permit No ` ( 26 -- 6;›0 % yt 13125 SW Hall Blvd., Tigard, OR 97223 APR Pl Review _ �/3 / Phone 503.639 4171 Fax: 503.598.1960 20 � e view ✓ Other Permit No � \` ✓ `` J 24 Hour Inspection Line. OF TIG'�s= e. 503 639.4175 ■1 ` ` ' Date/By. W Date Ready/By. Juns El See Page 2 for Internet. www.ci tigard or us Nohfied/Method IV! Supplemental Information 3:;!LD!N D!V!SIO TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total III Addition/alteration/replacement LI Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249 20 JF-'- and 2- family dwelling ❑ Commercial/mdustrial SFR (2) bath 350.00 El Accessory building [II Multi-family SFR (3) bath 399 00 Each additional bath/kitchen 45.00 LI Master builder El Other. Fire sprinkler ( sq ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: N LA 3'7 5 �) -T_ Catch basin or area drain 16.60 City /State /ZIP. —\---, C•«O� T) (2- a'l @---""t Drywell, leach line, or trench drain 16.60 Suite/bldg /apt. no.. U I Project name. 'K ^ ` 'p � ^ Footing drain (no. linear ft : ) Page 2 yam ` Manufactured home utilities 110 00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16 60 • Sanitary sewer (no. linear ft V ) 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 DESCRIPTION OF WORK Backflow preventer Page 2 Co iN r■4A - mac c .4 Backwater valve 16.60 Clothes washer 16 60 Dishwasher 16 60 Drinking fountain 16.60 PROPERTY OWNER ❑ TENANT Ejectors /sump 16.60 Name. Brook_ K re Expansion tank 16 60 Address. i 3 7 S ( 3 \L), .� \ i , - t - - c c Fixture /sewer cap 16.60 City/State /ZIP: k., �„,, C ( 7 ',�� Floor drain/floor sink/hub 16 60 ` Garbage disposal . 16.60 Phone. 50) (03`1'01�s Fax ()`1 )t .s _ -3 \ El APPLICANT ❑ CONTACT PERSON Hose bib 1'6 60 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 ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail Urinal 16.60 CONTRACTOR Water closet 16 60 Business name: ©w„.„,,,,c.C' Water heater 16 60 Address Other: Subtotal City/State /ZIP. Minimum permit fee. $72.50 �-6 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36 25 Plan review (25% of permit fee) S CCB Lic.: Plumbing State surcharge (8% of permit fee) d Authorized signature S t 4 um } b-ing � Ltc. no.. TOTAL PERMIT FEE -72(.,y0 Print name \` t ,.c l ->, Date _T-( - This permit application expires if a permit is not obtained within „ �S �J 180 days after it has been accepted as complete. *Fee methodology set by Tn- County Building Industry Service Board. i \Buddmg\Pernuts\PLM- PenmtApp doc 12/03 440- 4616T(i0 /02 /COM/WEB) Plumbing Permit Application - City of Tigard t , Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square 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: Permit Fee: Storm & Ram 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 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: $50,001 00 and up $742 00 for the first $50,000 00 and $1.20 for each additional $100 00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved Existing Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" - 4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total -Bradley Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service — Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures i \Building\Pennits\PLM- PeamtApp doe 3/03 / 7 . 1 ---- iz-` c r invoice GlIIFF'S SEPTIC SERVICE .. . -, - -, • ,,,,-, .."...", , ,,, ..,, • -, A ,,C ,, ". t Name '''- ' — ,+"- .-- -- Date , .. ,. ..: i c:\ -'- - \ ; 0' . . :, ) '1 ( ,(' '• i ) l'-,. k''":,;2(/ - "'i 4 % 4;' 1.-a Address -.,-., Phone • City ,-7 .,-=:1,-,,,,--'i, P. 'v.,,.. , ., ,,. „ Initial On Acct. . , ..i.: , ■ - ''''e. ,,, ■' .4" y 4 ,,,..'' 7, ' 1' ' , ' 1 ' , 7 , ..., . `" , . ,I3 4! ?, e t- State ,----'' ''' ' Zip Code „ ; l '-`,'"; % ..- " ft. , Price Amount ( i i ( , ,,,, 1 4 "(:•.:) ,, „1 ) 4 1 , 3 ..•_, it. j , , kii , ( . - ,s...: p„ i t . 4 . 1 CC -' r\ ,'--,,,,,', .-•—• ---• ,, (.,„. :.,;(..,.,' ?: ff 4„,,,, , / „.P23 m ) 1:: 1,4 ' ,;'' -/ / ' c , ,4 1: ti F qe' PD ;'1:,6a:::: :!'---.'.. i ' i - . a . . r l . . l ' ' '. • . ' , . . , t ■; ''' - • ,'. - • , . , r , .. . . .. 4 1, '.1 ., k i i t i i NOT RESPONSIBLE FOR DAMAGES PAST CURB LINE OR LANDSCAPING , ..k • A service charge of 1.5% will be levied on all past due accounts. Total: • Returned check fee is $20.00. • In case suit, action or arbitration is instituted by either party for breach or to enforce any provisions herein, the court shall award reasonable attorney's fees and actual costs to the prevailing party at trial or arbitration, or upon any appeal taken therefrom. Approval . . , . Customer Signature P.O. BOX 1136 • Canby, OR 97013 DEQ# 37464 ri'hank You (503) 263-2087 or (503) 632-6138 CCB# 104320