Permit •
C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00447
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639 4171 DATE ISSUED. 12/9/2008
PARCEL. 2S103DC -00814
SITE ADDRESS: 11345 SW FAIRHAVEN ST ZONING R -3 5
SUBDIVISION VIRGINIA ACRES NO 2 LOT. 016 JURISDICTION TIG
PROJECT. KLUMP
Project Description Connecting existing house to sewer, septic tank to be pumped and filled Reimbursement # 38
Fees paid 12/09/08
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
KENNETH & KLUMP
11345 SW FAIRHAVEN ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/9/2008 $72 50
[TAX] 12% State Surch 12/9/2008 $8 70
Phone . 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 ,,, J
Issued By- t` _L I I r �) Permittee Signature: � �f f/l 0/7/ 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 roil OFFICE USE O
City f Tigard P ermit No
14 • 1 3125 SWHal REC ? 1 2 • �� ��' •I�lYY19f-K?�•�7�1u
ew -^n
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C t - Phone 503 639 4171 Fax 503 598 1960 Other Remit No . 3 Co ) b\
Date/By e2(
TIGARD Inspection Line 503 639 4175 DEC 0 9 200 �ate Ready /By Juns O See Page l for
Internet www tigard -or gm oified /Method 7 I O Supplemental Information
TYPE OF WORK CITY OF TIGARD FEE* SCHEDULE
❑ New construction ❑ Denattin niwn DIVISION 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- famil3, dwelling ❑ Commercial /industrial SIR (2) bath 350 00
❑ Accessory building ❑ Multi -family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
❑ Mastei builder ❑ Other Fire sprinkler ( sq ft ) Page 2
JOB 'SITE INFORMATION AND LOCATION Site utilities
-
lob site address 1 5 5 u) G I r h &den S1 L Catch basin or area drain 16 60
City /Stale /ZI I' ` t A Or J C T (i 7 Z Zsb Drywell, leach line, or trench drain 16 60
Smte/bldg /apt no J Project name I u en p Footing drain (no linear ft ) Page 2
I- Manufactured home utilities 110 00
Cross street/directions to job site
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft I6O) 1 Paget
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 OF WORK Backflow preventer Page 2
5 P lien^ ty Backwater valve 16 60
Clothes w asher 16 60
Dishwasher 16 60
❑ PROPERTY OWNER El TENANT Drinking fountain 16 60
�1 h liL, �/ Electors /sump 16 60
Name YI e p t-Il q SVIQ, J
Vo in l i (u o Expansion tank 16 60
Address 1 / 34 6 - 5 " t o ) rhit Ul°h Fixture/sewer cap 16 60
City /State /ZIP 1-1 a ), i Dic q 7 L z Floor drain /floor sink/hub 16 60
Phone ( 63 b /J g 5 Z.— Fax ( ) Garbage disposal 16 60
El APPLICANT ID CONTACT PERSON Hose bib lb 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 ( ) Fax ( ) Sink/basin/lavatory 16 60
Tub/shower/shower pan 16 60
E -mail Urinal 16 60
CONTRACTOR Water closet 16 60
Business name L O I/ e_-1- f Water healer 16 60
Address 1 -e7 , p.„ — i 7 sr Other
Subtotal
City/State/ZIP j
/ te /ZIP ec \ � 1 2 'R w (O Minimum permit fee $7250 72
Phone v 63 ) SQL.(• 2 4 u 1 Fax \ ) Residential backflo minimum permit fee $36 25
CCB Lie 12 SIM Plumbing Lie no a( -)7 Q `�t� -- Plan review (25% of permit fee)
vim State surcharge (12% of permit fee) 3. -7
Authorized signal e TOTAL PERMIT FEE R1 20
Print name C ] **-et Date 12- 9 0 8 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 InuddmgAermits/PLNF- PermaApp doe 12127/06 440- 4616T(10 /02 /CONI/WLu) + 0 0 O • \ 3S yS
t (, A . 2C)
1 Z1ly- 2 0
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 2000 $115 00
Fooling drain - each additional 100' 46 40 2 -001 to 3 600 $160 00
Sewer . 3 . 601 to 7 200 $220 00
ewer - I st 1 U0' S5 UU • i J,201 and greater $309 00
Sewer - each additional 100 4640
Water Service - 1st 100 55 00 Medical Gas Systems:
Water Service - each additional 100 4640
Storm &Kam Drain - 1st 100 55 00 Valuation: Permit Fee: '
$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
Q ty. Fee (ea) Total additional $100 00 or fraction thereof, to and
Fixture or Item 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 $l00 00 or fraction thereof, to
Inspection of existing plumbing or and including $50 000 00
speclall} 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 traction 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 * . ❑ Any new commercial building with water sei vice 2' and
Qaanhty 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 Dram /sink -2' that meet the qualifications above
-3
-4
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial _
Ice Mach /Refig 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
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(360) t87-2969 Port. (503) 285 -5838
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QTY DESCRIPTION PRICE AMOUNT - •
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t9ET u days A f +r an Li +sr at I' -�z %per month
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Cubed tee, mil be assessvu it tie' essery TAX _ j �-
RECEIVED BY TOTAL ,r 75
f All claims and returned goods MUST be accompanied by this /mo �y� ��'yy� yy
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CITY 'OF TIGARD ..
BUILDING DIVISION PERMIT # PLM2008 -00447
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 121912(108
Phone (503) 639 -4171 ,
Inspection Requests (24 Hrs) (503) 639 -4175 - `: _.
INSPECTION WORKSHEET FOR DATE. 12/12/2008 TIME 7 00AM PAGE: 10
SITE ADDRESS. 11345 SW FAIRHAVEN ST CLASS OF WORK
SUBDIVISION VIRGINIA ACRES NO. 2 LOT # 016 TYPE OF USE
PROJECT NAME: KLUMP
DESCRIPTION Connecting existing house to sewer, septic tank to be pumped and filled. Reimbursement # 38. Fees
paid 12/09/08.
OWNER: KLUMP, KENNETH & SHARON PHONE #.
CONTRACTOR LOVE-IF EXCAVATING INC PHONE # 503.504-28477
Inspection Request Scheduled For Date 12/12/2008 Pour Time: /t
r ,
�y
Code # Inspection Description Confirm # Contact # Me- -- .
399 Plumbing final 079015-01 503 -317 -5358
Corrections/Com nts /Ins ructions e
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PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: t-1/1 1 W Phone # (503) 718-
. /P l ,
CIT Y DF TIGARD , Vi-i Z60 — O d (fin
BUILDING DIVISION PERMIT #
13125 SW Hall Blvd ,Tigard, OR 97223 DATE ISSUED.
Phone • (503) 639-4171 ,1� yFl
Inspection Requests (24 Hrs) (503) 639 -4175 !� ° fL. ' C �/` J.-tiff-4,1r
INSPECTION WORKSHEET FOR DATE l 2... v ie TIME PAGE
SITE ADDRESS T V V( w r � QQ t i �� CLASS OF WORK
SUBDIVISION. LOT # TYPE OF USE
PROJECT NAME
DESCRIPTION
OWNER. PHONE #
CONTRACTOR PHONE #
Inspection Request Scheduled For: Date. Pour Time
Code # spection Description Confirm # Contact # Message
P i dle l
Corrections /Comments /Instructio#s: 41 1 r
4-p 7�7 -
4 )' 5 I
. 5 agne•j
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ci
:. Is' t G ( j S4.. `
[i PASS I I PARTIAL APPROVAL ❑ CANCEL j NO ACCESS
❑ FAIL t 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector t/' " Date. 17 /® Phone # (503) 718-a