Permit CITY OF TIGARD PLUMBING PERMIT
11: COMMUNITY DEVELOPMENT PERMIT# PLM2008 - 00445
TIGARD 13125 SW Hall Blvd , Tigard, OR 97223 503.639 4171 DATE ISSUED. 12/3/2008
PARCEL' 2S103DC - 00805
SITE ADDRESS• 11415 SW FAIRHAVEN ST ZONING: R -3 5
SUBDIVISION VIRGINIA ACRES LOT 003 JURISDICTION: TIG
PROJECT. JAMES
Project Description: Connecting existing house to sewer Septic tank to be pumped and filled Reimbursement #38
Fees paid 12/03/2008
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:
TUBISHOWERS• SEWER LINE: 100 ft
WATER CLOSETS WATER LINE ft
DISHWASHERS: RAIN DRAIN. ft
Owner FEES
SUZANNE JAMES
11415 SW FAIRHAVEN ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/3/2008 $72 50
[TAX] 12% State Surch 12/3/2008 $8 70
Phone 503 - 319 -0631 Total $81.20
Contractor:
LOVETT EXCAVATING INC
PO BOX 86280
PORTLAND, OR 97286 REQUIRED ITEMS AND REPORTS
Contact # PRI 503 -504 -2847
FAX 503- 288 -1630
Reg #. LIC 125507
PLM 26 -773PB
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
Issued By� ��7 � I Permittee Signature: � � y ; h ycC � xap
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 , ' Phone 503 639 4171 Fax 50Y598 19 . Foa.ofFICE USE -Orrry �
City of Tigard v ae "ea _
t}' Date/B) Pennn No 1 9 ,� / L h` /'
n 131255W hall Qlvd, TlgardO q OQ� DaieB ! 2 - lD i! // �'7- /'r ✓u/ '�'`'s -1 %
° ' 6Vc Q f• Plan Rermw ' fir
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TIGARD
Inspection WW a rdor 4175 � ate ed/Me June S Date /By Other Pernut No See Paget for d ti
Interne[ www tigard-or gOV otll /Meth •P/ supplemental Information
TYPE OF W . ,`S FEE* SCHEDULE
❑ New construction Win `^ For special information use checklist
Description I Qty I Ea I Iota)
❑ Addition /alteration/replacement ❑ Other New 1- 2 -family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249 20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building El Multi-family SPR (3) bath 399 00
❑ Master builder ❑Other Each additional bath/kitchen 45 00
Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address ///7
! /S L t) �.� i ve Syi.., Catch basin or area drain 16 60
City /State /ZIP - , Drywell, leach line or trench drain 16 60
Suite/bldg /apt no Project name W 0-1 g s Footing drain (no linear ft } Page 2
Manufactured home utilities 110 00
Cross street/directions to job site
3i ' q' Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft (_) / Page 2
Storm sewer (no linear ft ) I'age 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 Backflow preventer Page 2
C0 / s )t'i 7 '' 5 E ttl £/2 Backwater valve 1660
Clothes washer 16 60
Dishwasher 16 60 •
(WI - PROPERTY 'OWNER ❑ TENANT Drinking fountain 16 60
Ejectors /sump 16 60
'Name _ // 2 , -- Expansion tank 16 60
Address i
` ice -- r � / VeCJ ' Fixture/sewer cap 16 60
City/State /ZIP / 7 _w ' en-70€97r2� t7 Floor drain /floor sink/hub 16 60
Phone c--/t/� / Fax ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 6 60
Ice maker 16 60
Business name
Interceptor /grease trap 16 60
Contact name Medical gas (value $ _) Page 2
Address Pruner 16 60
City/State /ZIP Roof drain (commercial) 16 60
Phone ( ) Fax ( ) Sink/basin /Iavatop 1660
Tub /shower /shower pan 16 60
E -mail
Urinal 16 60
i CONTRACTOR Water closet 16 60
Business name h0 0 Q i Eke 4 0 Il 77 jJcp Water heater 16 60
Address
P rl . Sox of
Qty /State /ZIP fihr-Hr, X12 q 7 O Subtotal
( Minimum permit fee $72 50 ��
Phone (5', ) 50t-( --- 7 Fax ( . 5(j)) ;8 (e ,, 3 f ) Residential backllow minimum permit fee $3625
CCB Lic a 5 > `� -ri-7 Plumbing Lie no —77)303 Plan review (25% of permit fee) -®--
7 Stale surcharge (12% of permit fee) r?, 70
'Authorized signature �- P..0 _.l r _-a- / TOTAL PERMIT FEE g1
Print name h , s Vl-9/n-fg-re Date /2/' / ' This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
I U3widingVPermnoPLMr PermnApp doe 12/27/06 440-46161 UW0]2OMM'FR) 1 9 d\I
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information v -
r
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I" 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 - I st 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 lamely 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
Subtotal: $50,001 00 and up $742 00 for the first $50 000 00 and $1 ' _0 for
each additional $100 00 or fraction thereol
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following
please indicate work performed by fixture. Failure to Please check all that apply
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2 and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry /Font as defined in OAR918- 780 -0040
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040
-Drive 'I hru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2 that meet the qualifications above
-3 --
-4
Car Wash Dram
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial _
- Industrial
Ice Mach /Refs$ 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
\ Budding \Pcrmrts\PLsi- PermnApp doe 12/27/06
LLPUM? .SA PP S 'RVICES '
t - Dalko Corp, i
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(360) 887 -2969 Pte, (503) 285- 5838 {, // �!
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SOLD BY CASH COD CHARGE ON ACCT I MDSE RETD PAID OUT
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AMOUNT
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Coliechon fees will be assessed it necessary TA -4.)-,
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AN claims and returned goods MUST be accompanied by this � bi � l ll l /y��g� fv y�
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- CITY OF TIGARD -
BUILDING DIVISION PERMIT # PLM200t3 -00445
13125 SW Hall Blvd , Tigard, OR 97223 DATE ISSUED 12/3/2006
Phone (503) 639 - 4171 , 1 a ��
Inspection Requests (24 Hrs ). (503) 639 -4175 s 2 F
INSPECTION WORKSHEET FOR DATE 12J3112008 TIME. 7.00AM PAGE 21
SITE ADDRESS 114 IS SW FAIRHAVEN ST CLASS OF WORK
SUBDIVISION. VIRGINIA ACRES LOT # 1103 TYPE OF USE
PROJECT NAME. JAMES
DESCRIPTION Connecting existing house to sewer. Septic tank In be pumped and Celled. Reimbursement #38.
Fees paid 12/03/2006
OWNER JAMES, SUZANNE PHONE # 503319 -0031
CONTRACTOR. LOVE H I EXCAVATING INC PHONE # 503 7
Inspection Request Scheduled For: Date V `�
Ins Pour Time:
P 9 12f:t112008 0 c
Code # spection Description Confirm # Contact # Me .
399 Plumbing final 079297-01 503-504 -2847 Y
Corrections/Comments/Instructions: >��^ V , , (I ,t L D .I (Lee-AcK--
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PASS ❑ PARTIAL APPROVAL (4 CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector V Date �� /�� Phone #: (503) 718- � 7 ' / Yr
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CITY OF TIGARD ( ' •
BUILDING DIVISION P
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13125 SW Hall Blvd., Ti 9 lL 1713/2t10 ard, OR 97223 /iID SU D. I M ?008 t 3
0014,
Phone (503) 639 -4171 pall q
Inspection Requests (24 Hrs.): (503) 639 -4175 " I-
INSPECTION WORKSHEET FOR DATE 12/10/2008 TIM 7 01AM PAGE 21
SITE ADDRESS. 11415 SW FAIRHAVEN ST CLASS OF WORK
SUBDIVISION VIRGINIA ACRES LOT # 003 TYPE OF USE
PROJECT NAME. JAMES
DESCRIPTION Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #38.
flees paid 12/0312008.
OWNER. JAMES, SUZANNE PHONE # 503. 319.0631
CONTRACTOR LOVETT EXCAVATING INC PHONE # 503 - 504 - ?847
Inspection Request Scheduled For' Date: 12/10/2008 Pour Time.
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 078937 -01 503117-5358 N
Co ections /Comments /Instructions: rw �' os ,S ( ja So e 1 n ,^ ^' ai
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I PASS ► . PARTIAL APPROVAL ❑ CANCEL 7 NO ACCESS
❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector. \/(` Date 1 0 /G Phone #: (503) 718 -