Permit C ITY OF TIGARD CARD PLUMBING PERMIT
'' COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00209
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/21/2007
PARCEL: 2 S 103 DA -01700
SITE ADDRESS: 10785 SW DERRY DELL CT ZONING: R -3.5
SUBDIVISION: DERRY DELL PLAT 2 LOT: 017 JURISDICTION: TIG
PROJECT: TIPTON
Project Description: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. Sewer
Reimbursement District #29 fee paid 5/21/07.
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
TROY & MICH TIPTON
10785 SW DERRY DELL CT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/21/2007 $72.50
[TAX] 8% State Surchart 5/21/2007 $5.80
Phone : 503 620 - 351 1 Total $78.30
Contractor:
THE EXCAVATORS LLC
PO BOX 690
YAMHILL, OR 97148 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 649 -5354
Reg #: LIC 152333
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 b . 03.246.6699 or 1.800.332.2344.
/''
Issue By: ' ►. i 1 4 Li Permittee Signature: >C' V f (
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
, FOR OFFICE USE ONLY
City of Tigard Received / nn A Permit e rmit No }/ ^ n p
Date/By- ^ 7 i1/4._„449 46 l d� 049,0 j
v 13 125 SW Hall Blvd., Tigard, OR 97223 Plan Review s� _ n ^ ?_�`��
- .. : . Phone 503.639 4171 Fax 503 598 1960 Other Permit No OIWI�pI(.10
Date /By
Inspection Line 503 639 4175 D ate Read /B mr ®See Pa
T IGARD Y Y' ge 2 for
Internet: www tigard -or gov Notified/Method , Supplemental Information
` TYPE OF WORK. FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty 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
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building III 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 s Site utilities
Job site address: /02 g' St,.) t Q(r �Ii eT Catch basin or area drain 16.60
City /State /ZIP: 1 6 si 0 g 9 I22_ 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: M ( N Footing drain (no linear ft ) Page 2
�. Manufactured home utilities 110.00
^
Cross street/directions to job site: K- I tj S ii U- ' Manholes 16 60
_ Rain drain connector 16 60
Sanitary sewer (no linear ft /'Ogi) Page 2 5: '�
Storm sewer (no linear ft ) Page 2
Subdivision: 1l LA. •\ —2 Lot no.: ®( • � Watet service (no linear ft • _) Page J
Fixture or item
Tax map /parcel no.: i 7 5 1 p 2 J 0 A - t� J -7 (j 0 Absorption valve 16 60
DESCRIPTION OF WORK , Backflow preventer Page 2
t'.'-Al 2 .Vt- (40o k f Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16 60
PROPERTY OWNER I Drinking fountain 16 60
❑ TENANT
Ejectors/sump 16.60
Name: - 'L M1 C („ -1I , t P - 1-LyilJ f s 40 y) Expansion tank 16 60
Address: / p 7c) 1 ,St,,,,/ 6_.z. r ®., j I C •r ((1 Fixture /sewer cap 16 60
City /State /ZIP: e 4 U a_ 41 1- ZZ Floor drain/floor sink/hub 16 60
Phone: (S26 -S) 620 - - 35 / 1 Fax: ( ) Garbage disposal 16 60
❑• APPLICANT ' ❑ CONTACT 'PERSON Hose bib 16 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
Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16 60'
Tub /shower /shower pan 16 60
E -mail:
Urinal 16 60
CONTRACTOR Water closet 16 60
Business name: 1 die Pied UM-Ore / l_ t Water heater 16 60
Address: F i b a., 6 4 0 Other
;
City/State /ZIP: � p� Subtotal
� � t �) � ` ) "' iy v Minimum permit fee $72 50 50
Phone: ( 9,3) '70s .._-Z O 6 Fax: ( ) Residential backflow minimum permit fee. $36 25 7a"
CCB Lie.: 151:133 Plumbing Lic. no.: Plan review (25 % of permit fee)
State surcharge (8% of permit fee) 67 TO
Authorized signature: : TOTAL PERMIT FEE 7g
Print name: -�� C I 4- Date: �� 12 ( 1 0 This permit application expires if a permit is not obtained within
`� d ( ^ , 180 days after it has accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
1 \Bwldmg\Permas\PLM- PermeApp doc 12/27/06 440- 4616T(10/02 /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 Footage: Permit Fee:
Footing drain - 1s 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 & 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. Fee (ea) T 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
specially requested inspections - per hour 72.50 and including $50,000 00.
Subtotal: $50 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, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
-Tub/Shower 11:1 New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S owerlpool as defined in OAR918- 780 -0040.
CI Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Dave Thru ID Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" Cl Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-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 *Note: If the fixture work under this permit results in an
- Bradley
- 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•
\Buddmo \Permits \PLM- PermttApp doc 12/27/06
r r
CITY OF TIGARD
BUILDING DIVISION : ,. - 1 PERMIT #: PLM2007 -00209
13125 SW Hall Blvd., Tigard, OR 97223 U/1 'f DATE ISSUED: 5/2112007
Phone: (503) 639 -4171 'N��� �'�I
Inspection Requests (24 Hrs.): (503) 639 -4175 _�
INSPECTION WORKSHEET FOR DATE: 6/7/2007 TIME: 7:00AM PAGE: 44
SITE ADDRESS: 10785 SW DERRY DELL CT CLASS OF WORK:
SUBDIVISION: DERRY DELL PLAT 2 LOT #: 017 TYPE OF USE:
PROJECT NAME: TIPTON
DESCRIPTION: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. Sewer
Reimbursement District #29 fee paid 5/21/07.
OWNER: TIPTON, TROY & MICHELLE PHONE #: 503.620.3511
CONTRACTOR: THE EXCAVATORS LLC PHONE #: 503-649'5354
. 64P-IM
Inspection Request Scheduled For: Date: 6/7/2007 Pour Ti Ai m
Code # Inspection Description Confirm # Contact # M sa e
3 5 0 Septic tank 049784 -01 503 -780 -9112 Y
Cor ctions /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
[ I FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: /` Ci 7"' 1 d
nsp tor: " ( Date: _� Phone #: (503) 718 -