Permit r,� '' „ C IT�Y OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00192
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2007
PARCEL: 2S 102C D -02100
SITE ADDRESS: 09530 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 020 JURISDICTION: TIG
PROJECT: WHITEMAN
Project Description: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. Sewer
Reimbursement District #28 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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TEX WHITEMAN
9530 SW EDGEWOOD Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/15/2007 $72.50
[TAX] 8% State Surcha 5/15/2007 $5.80
Phone : 503- 639 -5632 Total $78.30
Contractor:
INNOVATIVE LANDSCAPING
9630 SW OMARA ST
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 670 -7632
Reg #: LIC 173432
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 rule.: ••rect questions to OUNC by calling 503.246.6699 or 1.800.332.2344
Issued :. �I I ' • P ermittee • S f � �� ���
Call 503.639.4175 by 7:00 a.m. for an inspection that busine-s 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
CI
R eceived
7 Permit No.:
v '131 SW of Tigard and Blvd., Tigard, OR 97223 Plan Re : ® � . ( , Q) 14 `1-
Plan Review ,2 � (�
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: fi r,,
Inspection Line: 503.639.4175 /
T I GA RD Internet: www.ti ard or. ov Date Ready/By: j,,�;� See Page 2 for
g g Notified/Method: S iii Supplemental Information
' TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
7 KLAddition/alteration/replacement gpther: Q,,„xe4 60,5 4" New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSSSTRRUCTION SFR (I) bath 249.20
1- and 2- family dwelling ` 4.,` \-. ❑ Commercial /industrial SFR (2) bath 350.00
/ 0 Accessory building El 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 Site utilities -
Job site address: q 5J0 _t../..) ea °Ot Catch basin or area drain 16.60
City/State /ZIP: ‘ S u .. r d ` O (' 043 -12-3 Drywell, leach line, or trench drain 16.60 -
Suite/bldg. /apt. no.: I Project name: Wyk e4...e,�Q � Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
l Rain 16.60
()Mar CA. R Rain n d draiai n connector 16.60
ok r aw Sanitary sewer (no. linear ft.:�) t Page 2 5-6 -
" Storm sewer (no. linear ft.: ) Page 2
Subdivision: Z 61 0 Z C D O .. ` Lot no Water service (no. linear ft.: ) ?age 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
P �. )e N >k --k-{p Backwater valve 16.60
1 Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER I ❑TENANT Ejectors /sump 16.60
Name: -TEX. A) h t,4 rv'LQ. IJ
Expansion tank 16.60
Address: -153) 5..u.).. ItAf Fixture /sewer cap 16.60
City/State/ZIP: - 1 - " t , t j'd N 0 TQ 0 a -2 Z,3 Floor drain/floor sink/hub 16.60
Phone: (SO ) 6, 5'6p 37, C Fax: ( ) Garbage disposal 16.60
❑ APPLICANT NXCONTACT PERSON Hose bib 16.60
f Ice maker 16.60
Business name: Ntjc0� Wt ` 1, Interceptor /grease trap 16.60
Contact name: z)ej .) Ns, cg, i I �/ Medical gas (value: $ ) Page 2
Address: C ,G, 3 0 5.1.). 0 rv∎c rc.. 5+ Primer 16.60
City/State /ZIP: --1-- A rd CSR- (i---2-2-3 • Roof drain (commercial) 16.60
,..JJ
•
rr
Phone: () (p� �(..73 Z. I Fax: : (533) - ?-S 3Z Sink/basin/lavatory 16.60
/c� N I� ' j ( y oeri La..) , f1[- Urinal pan 16.60
E-mail:
I /U/llthlcL-�'�� d 5�4 tN ivGr Urinal
16.60
CONTRACTOR Water closet 16.60
Business name: 1..)NC)JCe'�' +‘)e, L..R".1d tt N t . 0 - Water heater 16.60
Address: Q,(y 3D SW, P Jel.a.r et.. St. Other:
City /State /ZIP: -T-,, il
4d . v Or -. CO Z Z 3 Subtotal
Minimum permit fee: $72.50 0
Phone: (53) - 9-G3 9 Fax: � 35
3) Gib - 32 Residential backflow minimum permit fee: $36.25 ? ' S
CCB Lie.: 1* 3 9 32 , Plumb' #/no.:`ZTZI Plan review (25 %ofpermit fee)
S tate surcharge (8% of permit fee) y- g0
Authorized signature:
_ TOTAL PERMIT FEE
Print name: V , /
iiie OF Date: S Y/a,. This permit application expires if a permit is not obtained within
"'���jjj 180 days after it has been accepted as complete.
*Fee methodology set by Tri County Building Industry Service Board.
I:\Building\Permits\PLM- 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 Qtr., Fee (ea), Total Square.Footage: Permit Fee:
Footing drain - l S 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 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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) WorkPerformed ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S as defined in OAR918- 780 -0040.
-Jacu zzi/Whirlpool irlprlp ool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash
-Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water. Thru ❑ 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" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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:
i:\Building\Permits\PLM- PermitApp.doc 12/27/06
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CITY OF TIGARD e 6 - , 0 d 161 v
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 4 Ab �� ii����i� •
Inspection Requests (24 Hrs.): (503) 639 -4175 _ �
INSPECTION WORKSHEET FOR DATE: c/?js10 TIME: PAGE:
SITE ADDRESS: 4s - v CA, kNf V v ,c: CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:.
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
X4 4 eI i c< .,e
Corrections /Comments/ Instructions:
te-cA-:, v ,4
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I Date: (1(1-- - 7 2 ' / 7 Phone #: (503) 718 - - 2.■Y L
1 .
CITY OF TIGARD ,
BUILDING DIVISION - ' ' PERMIT #: PLM2007.00192
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5//612007
Phone: (503) 639 -4171 �iq �I I �
Inspection Requests (24 Hrs.): (503) 639 -4175 # _,
INSPECTION WORKSHEET FOR DATE: 5/23/2007 TIME: 7:00AM PAGE: 59
, SITE ADDRESS: 09530 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 020 TYPE OF USE:
PROJECT NAME: WHITEMAN
DESCRIPTION: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. Sewer ,
Reimbursement District #28 fee paid this date.
i OWNER: WHITEMAN, TEX PHONE #: 503. 639.5632
CONTRACTOR: INNOVATIVE LANDSCAPING PHONE #: 503-670-7532
Inspection Request Scheduled For: Date: 5/23/2007 Pour Time:
Code # Inspection De Confirm # Contact # Message
■ 350 Septic tank v 048876-01 503 -936 -6047 N
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i PASS PARTIAL APPROVAL n CANCEL n NO ACCESS
I I FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V() (✓' - `j Date: ' 1 T5 I CI 3 Phone #: (503) 718- 2�1-1-."