Permit CITY OF .TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00158
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/17/2008
PARCEL: 2 S 102 D D - 01604
SITE ADDRESS: 08860 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 007 JURISDICTION: TIG
PROJECT: LASNIEWSKI
Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Sewer
Reimbursement District #31 fee paid this date.
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
WILLIAM & LASNIEWSKI
8860 SW EDGEWOOD Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/17/2008 $72.50
[TAX] 12% State Surch 4/17/2008 $8.70
Phone : Total $81.20
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 239 -8801
FAX 503- 669 -9568
Reg #: LIC 49418
PLM 26 -533PB
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: f Permittee Signature: A *J i
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 of Tigard R eceived i�� /�� ^^ / 5 —p
U /7 €::
Permit No j5 CJ�
Date/By u 13125 SW Hall Blvd ,Tigard, OR 97223 Plan Review :?
- - = Phone 503 639 4171 Fax 503 598 1960 Other Permit No B
DateBy
T I GA R D, Inspection Line 503 639 4175 Date Ready /By �lu ' ® See Page 2 for
Internet www tigard - gov Notified /Method (/( Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El New construction ❑ Demolition For special information use checklist.
Description Qty I 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
El 1- and 2- family dwelling El Commercial /industrial SFR (2) bath 350 00
1=1 Accessory building 1=1 Multi-family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
El Master builder ❑ Other:
Fire sprinkler ( sq ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: aglo Si') �'y `-�^'
� /� �Si � - Catch basin or area drain 16.60
--7
City /State /ZIP: Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: a Project 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 f ) Page 2 S� �t>
Storm sewer (no. linear ft ) Page 2
Subdivision: I 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
x'77/' e /t: 5p _14.)`C, / t Backwater valve 16.60
Clothes washer 16 60
Dishwasher 16 60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16 60
16.60
/ / Ejectors/sump Name: /, f ` 7— G� /�' r
� / l l / �/�F# �/ PL � S(5 / Expansion tank 16 60
Address: g' g, D sw E'( e s / Si , Fixture /sewer cap 16 60
City /State /ZiP: re a 0r 97, 3 Floor drain/floor smk/hub 16 60
Phone: ( E27.) `3 ) 6 U r-. ,p t 3 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: r Pb s 0 -D I , a � J Water heater 16 60
Address: flog A - -/ �V �� 41 Others
City /State /ZIP: a� 25ffftlt1 6 '!d J?v Subtotal
Minimum permit fee $72 56 �n ,50
Phone: (6 3) a 39 - 9 gd / Fax: ( ) Residential backflow minimum permit fee $36 25 c
CCB Lic.: 4/9 y ( Plumbing Lic. no.: p ,53)?R— Plan review (25% of permit fee) —�—
�/� State surcharge (12% of permit fee) g . 70
Authorized signature: z ; (7 ),,,„, ova „ ' TOTAL PERMIT FEE g1,
Print name: Date: 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 \Permns\PLMF- PermitApp 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
additional $100 00 or fraction thereof, to and
Fixture or Item Q ty. Fee (ea) Total 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: $50,001 00 and up $742.00 for the first $50,000 00 and $1 20 for
each additional $100 00 or fraction thereof
Fixture Work: Plan Review for Plumbing 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 Performed greater, except systems designed and stamped by licensed
Fixture 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
- Domestic
Drinking Fountain Isometric or 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•
\Buildmg\Permns\PLM- PermttApp doe 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -00l' 8
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/17/2O011
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/24/2008 TIME: 7:01AM PAGE: 7
SITE ADDRESS: 08f360 SW ED EWOOD iT CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 007 TYPE OF USE:
PROJECT NAME: LASNI
DESCRIPTION: Counect existing hou :<s tr3 :,ewer sewwice. Septic tank is to be pumped and filled. Sewer
Reimbursement District #3 I fete paid this date.
OWNER: L.ASNIEWSt<I, WILLIAM & TERESA PHONE #:
CONTRACTOR: APOLLO DRAIN ROOTER SERVICE PHONE #: 303.239.1'3801
Inspection Request Scheduled For: Date: 4/24/2003 Pour Time:
Code # Inspection Description Confirm # Contact # Message
360 Septic tank 068856 -01 5(3 N
Corrections/Comments/Instructions:
Se <i. w.� Q ✓ e c ; e ��,
C O % p e 0 J,/k(, C o v, f ∎e, Net Ctr J i -1" a N 13 c A.
C ,4-/5 1 u Ot i p a 4-w.e:, 1 ` - 6 S- t et �G V.► t/ Lz. � l.. 1 4-� A 5-� -a v�l ► �5.
We ✓) U t o Prvv A c j fa 110 �✓a 3 �..
•
PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: Date: t d Phone #: (503) 718 -
AALLPUMP SANITATION SERVICES
; Corp,
•t. 191
13023 NE Hwy. 99 #7
Vancouver, WA 986
(360) 887-2969 Port. (503) 285 -5838
CUSTOMER'S ORDER NO. PHONE DATE ,IJ 7 . y
NAME
ADDRESS
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. ALTO. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT
1 y
4, 1 9
—Payoff . ti
�' . ,.... ._._... _. _._
NET 30 S. A '�Ifi finance charge of' 11/296 per month
(1.-896 per will bechiwge.d .T3ni mpaid..b*nce ,
Colection fees will be assessed if rrece s_sary TAX
RECEIVED BY
TOTAL
All claims and returned goods MUST be accompanied by this bill.
362b �or nebs.corn `?hank`You
L