Permit •
CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00034
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/2/2007
PARCEL: 2S 103DA -01500
SITE ADDRESS: 10725 SW DERRY DELL CT ZONING: R -3.5
SUBDIVISION: DERRY DELL PLAT 2 LOT: 015 JURISDICTION: TIG
Project Description: Line work to connect to sewer. Septic system to be pumped and filled or removed.
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
FRAINEY, BRIAN A + ABIGAIL J
11155 SW GARRETT ST Description Date Amount
TUALATIN, OR 97062 [PLUMB] Permit Fee 2/2/2007 $72.50
[TAX] 8% State Surcha 2/2/2007 $5.80
Phone : 503- 612 -0033 Total $78.30
Contractor:
EARL WISDOM
3966 NE GARFIELD
PORTLAND, OR 97212 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -528 -9551
Reg #: LIC 122960
PLM 26 -801PB
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
Q k .
Issued By: ✓ i / /� Permittee Signature: � I
� 1 it
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.
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Plumbing Permit Aliplicatio
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y, i C ity of Tigard Received Permit N �3
7.
n 131 25 SW Hall Blvd, Tigard, OR 97223'7 7 2007 �� �� ��
Plan Review ® r 5
Phone: 503.639.4171 Fax: 503 598.1960 D a t e/By. Other Permit 1415 top ate d
u t " Inspection Line: 503 639.4175 (Writ' a il�r�y; [ Da te Read B ® See Page 2 for
:7 TI G AKD � f , � Ready /By. g
1 :,i „A.,r , Internet: www.tigard - or.gov 1 OaiV Notified/Method. Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. I Ea { Total
❑ Addition /alteration/replacement ❑ Other: New I - 2 - family dwellings (includes 100 ft. for each utility connection)
"`at i,,, "�.�4 N ',', SFR (1) bath 249.20
5 a
,* �, * k ,,, CATEGORY OF ON ,' , "'" x
❑ 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 ft.) Page 2
j ;' ' JOB SITE INFORMATION ANDC I:OCATION ` - I Site uti li ties
a E � dn.c• �.. -- rr = I � 1 � an _� cv`�ce:.- ...�er•....� = �''- 3 5
Job site address: I 0 7 2-6 6v0 Dcv V 0. �,%�, (�'{', Catch basin or area drain 16.60
City / State/ZIP: � ( + c rA __ 4 72 �3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I roject name: 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.: ,Uki loo Page 2
Storm sewer (no linear ft.: ) Page 2
Subdivision: I Lot no . Water service (no. linear ft.: ) Page 2
Tax map/parcel no.: Fixture or item
: ^: e^
i . l' ; = n .. ,. - _. fix;, Absorption valve 16.60
�i, :',' ,; "DESCRIPT
.. ION � iva';i C ,,,,::','"7,-,,,,,,, ka a;" "'� , v* ',' i `• o-: '
."7, :,," -;>' ar',r ;`Fkf ,r„ri r .. ,,x . _ 4: ,„ ; ,1 ;. �. •R .,;: I Back flow preventer Page 2
/r _ �1..1__ \v 1 . _ Backwater valve 16.60
-TO . Al 1 A-0 ,121u -b `KC h,€ Clothes washer 16.60
Dishwasher 16.60
1 • Drinking ountain 16.60
t,t1 i . ti".1tOPERT 44 . .ER ", :.- ti • ,T EIV ANT s 5 4# Y1' .' g
of A %r&- x u - .. .. yr _ .d,xr , a.«:rre x - ", s "� :�Sxa "E' ` " s ^ ,/ b ®
4°;3�' = t •,r, ... - �x ro ' . ' + M .
ii,^� Ejectors/sump 16.60
Name: No �k \ F'( d1.\ Y � Expansion tank 16.60
Address: \`V J SW (yak V ( + S\ . Fixture /sewer cap 16.60
City/State/ZIP:` - u OL,t, er4 i CL-- q-70(.41--- Floor drain/floor sink/hub 16.60
Phone: (�J31 Lp1.'7.- 0(.7" Fax: ( ) Garbage disposal 16.60
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iii' " lk . ,. wAl'PI:IGi1N'T ::: ' ,` 4 . . ' 4= � P ERSO., , A/
.L '� -, , , . -r • a . �.. ,rf:+,� , ,kw -.,x «xM�`t ' , 4Z - V.'4=4 , ,, , _- aas:.w ., w-. a .., t ?,4<' 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
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_ r - a4 ...4 - - � Fk . _rr� a� t�`�,,..: •� ",4. - Feat n � -. .:I . 'vraw ! Water closet 16.60
Business name: -Fad \ \ \OiY1 N u �� 1 J c ; '' Water heater 16.60
I
Address: .... ( � N E. U ut -�Gt � ,. Other•
it ' Subtotal
City / State/ZIP: - c1. . C.•^� C - 7 2 12
i K i Y ei . Minimum permit fee. $72.50
Phone: ( t3.l�) 5 2g ' -qss 1 i Fax: ( ) I , V G� Residential backflow minimum permit fee: $36.25 "IA _ co
`Z I ` 0 `1 '' Pl
V Plan review (25% f permit f
o permt ee)
CCB Lic : 12 (p 7,,,�
. ✓ Plumbing Lic. no • /� O\ G
Authorized signature: Cal �,��" (\i State surcharge (8% of permit fee) ,.q U
TOTAL PERMIT FEE /V, 50
Print name' AAN\ e f( (n Date "a,\ a l,,,-, This permit application expires if a permit is not obtained within
J 180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
I \Building\Pennka\ PIN - PennktApp doe 06 /26/06 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Feel ea Total ` r v .P °mss : '`F
, r�. -.,.,, x q 1; � �;Perm><tFee. �_?
•.. "�.,�s :�, =�v��� , .� � ,�, . ` �aFs.���,x.� .S Ual'e��00ta C.u$R� °� �a��.,��z,;..r.��n:,
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
Water Service - each additional 10 Medical Gas Systems:
Storm & Rain Drain - 1st 100' 0' 46.40 Valuation m ���d I,C><'QLI� Fee `" v as �° a
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
F1Xtl1 a OY''Iteill �" x Q F F ee(e)s " ' 'Toter^ additional $100.00 or fraction thereof to and
._ .x = ��., 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 Back flow 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.
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:
��,,,; , Plan =_Revievr�> for<. Plia`mbing�Iri "stallatioi%s,,�.� 3
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
;�y• , , eater, except systems designed and stamped by licensed
rk
(FistureYWo Pei
P Y P Y
. •a. fg :' ��'fi n, - -�,. � w,
.5�`, a �t�e�d: �
^ Replace� en neer.
. ` � '
�£ � * w °.• �: n 'x: A :' r Pievious Catiti y "Add a `.:. v xi ti ¢ ❑ 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 `,P�
Drinking Fountain a� n, > soetric" OrItISCI aglI1<l_°
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 Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
1Bwldmg\Permrts\PLM-PermuApp doc 09/22J06
,-
Scheduled .` .:Y
�'t Da e I �_ G 2
Work Order # 7 c,
z
River City Environmental, Inc.
P.O. Box 30087 503 -252 -6144 Complete Industrial
Waste Removal
Portland, OR 97294 OR CCB# 147355 • WA CCB# RIVERCE981BT Septic Tank Cleaning
Sump
/H12 e 42 Line Cleaning
R Site Information
FEB •
1 007 / o 7 2 s s Lki / /i // ..
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ut
3TptigpfrotirroinvoN Units Amount 14i
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Instructions: di-4- � Driver Notes
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River City Environmental, Inc. is in no way responsible for damage to the septic tank or lids on the system.
Terms: Net 10 days. 1.5% per month will be charged on past due accounts. (18% per annum).
Terms and Conditions
The customer agrees to pay all invoices arising out of pumping services, and any other special services herein within 10 days
The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered, over and above the
normal servicing schedule, on behalf of the customer.
The customer agrees to assume responsibility damage to customers real or personal property arising from pumping services which take place
on customer's premises, where the drivers and vehicles of River City Environmental have been instructed to enter.
This includes, but is not limited to driveways, trees, power lines or poles and building structures.
If River City Environmental, Inc finds it necessary to add liquid to the tank on jobsite, customer will be charged for the additional gallonage resulting
from these condidtions.
Customer agrees to reimburse River City Environmental, Inc for all reasonable attorneys fees court costs and other expense incurred by said
company to enforce collection or to serve their rights under this agreement.
Customer agrees to the above cond'tions. Redeemable in Multnomah County
Work Authorized by A / Date ;C /1 l
4.
Driver Signature „4 Date /� ( -?/G7 Time
---,,,---.,.:,-- .
CITY OF TIGARD
BUILDING DIVISION -- y -, PERMIT #: PLM2007-00034
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2./2/2007
Phone: (503) 639-4171 *NAPA I ill'
Inspection Requests (24 Hrs.): (503) 639-4175 ll 11.
INSPECTION WORKSHEET FOR DATE: 2/1312007 TIME: 7:02AM PAGE: 6
SITE ADDRESS: 10725 SW DERRY DELL CT CLASS OF WORK: '
SUBDIVISION: DERRY DELL PLAT 2 LOT #: 015 TYPE OF USE: '
PROJECT NAME: FRAINEY
DESCRIPTION: Line work to connect to sewer. Septic system to be pumped and filled or removed.
OWNER: FRAINEY, BRIAN A -I. ABIGAIL n.l, PHONE #: 503-612-0033
CONTRACTOR: WISDOM, EARL. PHONE #: 503-528-9551
Inspection Request Scheduled For: Date: 2/1312007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 043351-01 503-380-9850 N
Corrections /Comments/ Instructions:
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A / '
_ .....„..t.. ■ .At ..,,,111,,,r
__■( 9 -Ir
MI/
/
- - - - 5
-
rj • A S S rARTIAL APPROVAL 0 CANCEL 1 I NO ACCESS
I I
I I FAIL in CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
• , .24,:i
Inspector: Pi 117 ' Date: Phone #: (503) 718-