Permit C ITY OF TIGARD PLUMBING PERMIT
4 . 0 0 1 1 , 41k lk DEVELOPMENT SERVICES PERMIT #: 10/31/ 5 -00611
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/31/
PARCEL: 2S 102 D C -00402
SITE ADDRESS: 09215 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 016 JURISDICTION: TIG
Project Description: Line work for sewer connection. Septic system to be pumped and filled or removed.
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: 85 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BUNGER, ROBERT MANFRED + Description Date Amount
BONNIE JEAN TRUSTEES
9215 SW EDGEWOOD ST [PLUMB] Permit Fee 10/31/200: $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 10/31/200E $5.80
Phone : 503 639 - 4825 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 qu- .tions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: J_ /L�/.P� 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.
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Plumbing Permit A �>< tan `w ' OR Or NIGI '' - r O,�LI
City of Tigard OCT ived / �`� r �' 1n
, �oo � ` / //1 ' Permit No( 5,� cv &/ t
13125 SW Hall Blvd., Tigard, OR 97223 O 1 J J Plan Review (/
Phone. 503.639.4171 Fax 503.598.1960 / /a�,ll�� l . - \ D �� y. Other Permit No. ► 357
24- Hour Inspection Line: 503.639.4175 CITY OF TIGAR -- s ''''.J... ' I I . Date Ready/By- Juns El See Page 2 for
Internet www.ci tigard.or.us , /i - Notified/Method: Supplemental Information
TYPE OF WORK - FEE* SCHEDULE . -
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty I 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
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
1:1 Accessory building CI Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder la Other:
Fire sprinkler ( sq ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: CM 4 5 5 ( A ) E a o 1, , o d ' t ' ' Catch basin or area drain 16.60
City /State /ZIP: - Ft C,AW D ®R 9 i 12 3 5°1 1,1 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I 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. - Page 2
Storm sewer (no. linear It: ) 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 preventer Page 2
V‘t0 r a ? FAZ LAO E. eia-i \Y1.P L� Backwater valve 16.60
-C� r� l Lz4'-`F 1-�+ --( Clothes washer 16.60
C� i T ` Dishwasher 16.60
Drinking fountain 16.60
OPERTY OWNER El
� ��`_ ,� Ejectors/sump 16.60
{
Name. , C�� C^ 3 y�/,4„p� Expansion tank 16.60
C( Address: � 1. E S ` �� t5.C.(9A ! Fixture/sewer cap 16.60
City /State /ZIP: 11,61A.(10 t,1R , c( ij, Ci w Floor drain /floor sink/hub 16.60
Phone: ( 0 Ce, Ci .. 7 . �"-- Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
- ❑ APPLICANT • ❑ 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 ( ) Fax::( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR - . Water closet 16.60
Business name: (7 /�j�, Water heater 16.60
Address: G•^ Other:
Subtotal
City /State /ZIP: Minimum permit fee: $72.50 yy
Phone ( ) Fax: ( ) Residential backflow minimum permit fee: $36 25 Z �� „30
CCB Lic.: Plumbing Lic no.
Plan review (25% of permit fee)
,, ; �y State surcharge (8% of permit fee) 5--„,53-e) Authorized signatur;
_ TOTAL PERMIT FEE 7 g
Print name: 1 h e YA - LL e e t Dater' a 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.
1 \Bwlding\Per mits\PLMF- PermitApp doc 06/05 4404616T(10/02/COM/WEB)
1. - J .
Plumbin Permit Application - City of Tigard
Page 2 - Su c 1 lemental 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 additi a nal 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 110' 46.40
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$1 00 to $5,000.00 Minimum fee $72.50 .
Storm & Rain Drain - each additiona• 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 Devi 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 : nd $1.45 for
Inspection of existing plumbing or each additional $100.00 or fr. Ion thereof to
and including $50,000 00.
specially requested inspections - per hour 72 50
$50,001 00 and up $742.00 for the first $51 ;00.00 and $1.20 for
Subtotal: each additional $101 ;1 or fraction thereof
•
Fixture Work: -- Plan ' eview for Complex Structures ,
Are you capping, adding or replacing fixtures? If es ", A "compl- structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure t, syste at meets any of the following criteria
accurately report fixtures could result in increased se . r fees*. PI- ...e check all that apply.
Quantity by (Fixture) Work Perform.., Any new commercial building.,
Fixture Type: Replac ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing , ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings..
Car Wash -Each Stall ❑ Plumbing installations,alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area. ' •'
Dishwasher -Commercial Aild \ Any new residential building containitig three (3) or more
- Domestic • welling units.
Drinking Fountain
❑ A NFPA 13 - multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" bmit 2 sets of plans with any of the above.
-3 „
Car Was Train ' 1 metric or Riser-Diagram
Garbage -Do tic in Isometric or i ser diagram is required for new buildings
Disposal .mmercial three (3) or mo - stories in height.
- Industrial
Ice Mac . /Rcfrig. Drains
Oil Separator (Gas Station) Comments regardin: lxture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory 1
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued. -
i .
i \Building\Pertnus \PLM- Perm.tApp doc 07/06/05
�'F�rcnn� PLM2oo5 -c,o& t t ....
A LOHA SANITARY : E VICE
INVOICE NO
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 10250
503 -644 -2797 503 -648 -6254 503 -639 -5188
NAME: :,fi; 5= /i7(?.) 0
ADDRESS: .1 '� L. 5067
CITY: / STATE: .<--) - ` ZIP:
HOME: - `�i - %f d .�' WORK: CELL:
JOB SITE: P.O. #:
PAID BY CHARGE ❑ CHECK a CASH ❑ CREDIT CARD ❑
DATE ° - % - _ ') J" DRIVER )) _ 4' 742<d; vleu/ AMOUNT
®" PUMP SEPTIC TANK
❑ INSPECTION FEE
❑ SERVICE CALL
❑ LABOR, LOCATIN IGGING, BACKFILL
/
REPORT r
- - THIS is NOT A SEPTIC SYSTEM INSPECTION R TOTAL
- - REMARKS - -
TYPE OF TANK: STEEL ❑ CONCRETES - PLASTIC ❑ HOMEMADE ❑
HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ®- ❑ OTHER
SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 1000=0' 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑
LID LOCATION: INLET "C:7 OUTLET ❑ MIDDLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD-CF FAIR ❑ POOR ❑
FITTINGS: BAFFLES ❑ CONCRETE ❑ CAST IRON- PLASTIC ❑
NEEDS NEW LID? YES ❑ SIZE
GROUND COVER OVER TANK
COMMENTS ON CONDITION OF DRAINFIELD ETC.
SIGNED BY DATE / 5'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00611
13125 SW Hall Blvd., Tigard, OR 97223 "--- A DATE ISSUED: 10/31/2005
Phone: (503) 639-4171 *mittooli?
Inspection Requests (24 Hrs.): (503) 639-4175 .124 ■ i
_-_-_-_-. --.
INSPECTION WORKSHEET FOR DATE: 12/5/2005 TIME: 7:00AM PAGE: 21
SITE ADDRESS: 09215 SW EDGEWOOD ST CLASS OF WORK: .
SUBDIVISION: EDGEWOOD LOT ft: 016 TYPE OF USE:
PROJECT NAME: BUNGER
DESCRIPTION: Line work for sewer connection. Septic system to be pumped and filled or removed.
OWNER: BUNGER, ROBERT MANFRED +, PHONE #: 603-639A625
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 022934-01 503- N
I;
Corrections/Comments/Instructions:
•
PARTIAL APPROVAL Ti CANCEL fl NO ACCESS
I FAIL EI CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: lil Date: / Phone #: (503) 718-
L .
CITY OF TIGARD .
BUILDING DIVISION , s •.
PERMIT #: PLM2005-00611
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2005
Phone: (503) 639-4171 :111te
Inspection Requests (24 Hrs.): (503) 639-4175 .. .......
INSPECTION WORKSHEET FOR DATE: 11/30/2005 TIME: 7:09AM PAGE: 46
SITE ADDRESS: 09215 SW EDGEWOOD Sr CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 016 TYPE OF USE:
PROJECT NAME: BUNGER
DESCRIPTION: Line work for sewer connection. Septic system to be pumped and filled or removed.
OWNER: BUNGER, ROBERT tvIANFRED +, PHONE #: 503-639-4825
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 022669.01 503-629-4825 N
Corrections/Comments/Instructions:
----
Al - re -me"' -daeLme
_............r" - ------
/4 / /
1I . z/APe r
/f K
/
./. '
PASS L O ( WITIAL APPROVAL Ill CANCEL 7 NO ACCESS
I I FAIL I I CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: '970 Date: Je ) Phone #: (503) 718-
/
, .