Permit t s
CITY OF TIGARD PLUMBING PERMIT
° ' 1 COMMUNITY DEVELOPMENT PERMIT #. PLM2008 -00449
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/9/2008
PARCEL. 2S103DC -00817
SITE ADDRESS: 11225 SW FAIRHAVEN ST ZONING: R -3 5
SUBDIVISION: VIRGINIA ACRES NO 2 LOT 019 JURISDICTION. TIG
PROJECT: BURMAN
Project Description: Connect existing house to sewer service Reimbursement District #38 fee paid
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
RAY & JUDY BURMAN
11225 SW FAIRHAVEN ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/9/2008 $72 50
[TAX] 12% State Surcha 12/9/2008 $8 70
Phone • 503 639 - 0134 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 OU NC by calling 503 246 6699 or 1 800 332 2344
Issued By s Permittee Signature: 66.2 r-yyL-FA.ft/
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.
1 Plumbing Permit Application
Building Fixtures FOR OFFICE.USF ONLY. .
City of Tigard Received Date /By �, 4 O8 Permit No P „ e
`i q 13125 SW Ball Blvd, Tigard, OR 97223
in Phone D an Review G `n59 . 4o/63
• 1 Phone 503 639 4171 Fax 503 598 1960 Other Permit No j
Date /By
71 G AR D Inspection Line 503 639 4175 Date Ready /By Juns la See Page 2 for
Internet www tigard - gov 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 (I) bath 249 20
❑ I- and 2- faintly dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multifamily SFR (3) bath 399 00
Each additional bath/kitchen 45 00
❑ Master budder ['Other
Fire sprinkler ( sq It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address / j z L s - a) l Ed ,a-- ha ye s f Catch basin or area drain 16 60
City /State/ZIP 767 oe C273-a3 Dry well, leach line or trench drain 1660
Suite/bldg /apt no Project name /24440„44 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 4A2_) Page 2
Storm sewer (no linear ft Page 2
Subdivision Lot no
Water service (no linear ft ) Page 2
Fixture or Item
Tax map /parcel no
Absorption valve 16 60
DESCRIPTION 'O'F” rWORK Bocktlow preventer Page 2
n A- AA-Le-.1- S-u t/-Pii Backwater t aloe 16 60
'f1 Clothes washer 16 60
Dishwasher 16 60
G PROPERTY OWNER ❑ TENANT Drinking fountain 16 60
/� � � Ejectors/sump 16 60
Name j�(d� l/ -
�, k l -1 '� ,,,,,74,„ Expansion tank 16 60
�� Address / / �i S 3 ) FQ M1 2 4t-P i 5f Fixture/sewer cap 1660
City/State /71P 77 / l A o7e % 7a--c)_5 Floor drain /floor sink/hub 1660
r -Phone (503) ( C -0/3 / Fax ( ) Garbage disposal 1660
El 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/71P Roof drain (commercial) 16 60
Phone ( ) Fax ( ) Sink/basin /lavatory 1660
Tub /shower /shower pan 16 60
E-mail Urinal 16 60
CONTRACTOR Water closet 16 60
Business name ' Water heater 16 60
Address ilia r i ( t , Other
City /State /Z • " Subtotal
Minimum permit fee $72 50
Phone ( ) Fax ( ) Residential backflow minimum permit fee $3625 7.2
CCB Lic ----5 Plumbing Lie no
Plan review (25% of permit fee) -0
/ State surcharge (12% of permit fee) 1
Authorized sg»a re 411 G 1i1 . ---/ TOTA PERMIT FEE g
Print name J e( d Li L,3 £de /7-1 Date /, /g /Qt This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
`Fee methodology set by I ri-County Building Industry Service Board
I'BwldwgPermm■PI NIF- PemntApp doc 12/27/06 440- 4616T(I0i02 /COMA6 EB)
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 - 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 - 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 fiacton 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
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: $50.001 00 and up $742 00 for the first $50,000 00 and $1 20 for
each additional $100 00 or fraction thereof
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 *. CI 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 Ertsting ❑ 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 Isometric or Riser Diagram
Drinking Fountain
Eye Wash - ❑ Isometric or riser diagram is required for new buildings
Floor Dram /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
VBuddmgWenmi9PLM- PermlApp doc 12/27/06
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' SOLD BY CASH C 0 0 ' CHARGE ON ACCT MDSE RETD PAID OUT
QTY DESCRIPTION _
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All claims and returned goods MUST be accompanied by this 6tll 1 1
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CITYtF TIGARD -- - in
BUILDING DIVISION PERMIT # PLM2008 -0N49
13125 SW Hall Blvd , Tigard, OR 97223 . DATE ISSUED- 12J9/2008
Phone (503) 639 -4171 ,r1 1l /p v ��
4
Inspection Requests (24 Hrs.): (503) 639 -4175 !i / O
INSPECTION WORKSHEET FOR DATE 12/11/2008 TIME 7.00AM PAGE 14
SITE ADDRESS. 11225 SW FAIRHAVEN ST CLASS OF WORK
SUBDIVISION VIRGINIA ACRES NO. 2 LOT # p19 TYPE OF USE
PROJECT NAME: BURMAN
DESCRIPTION Connect existing house to sewer service. Reimbursement District #38 fee paid.
OWNER BURMAN, RAY & JUDY PHONE # 503. 639 -Q134
CONTRACTOR LOVETr EXCAVATING INC PHONE #. 503. 504 -2847
Inspection Request Scheduled For. Date: 12/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Mes A vr
399 Plumping final 078978-01 503 -317 -5358 Y I`!
Corrections/Comments/Instructions:
In I z -I del C-0
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PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
I I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector ✓ v' V Date 1 v/ ‘ V Phone # ��(J
(503) 718 - — 1
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