Permit we
■' • CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00208
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/13/2008
PARCEL: 25101 DC -02600
SITE ADDRESS: 07660 SW FIR ST ZONING: R -3.5
SUBDIVISION: ROLLING HILLS PLAT 2 LOT: 050 JURISDICTION: TIG
- PROJECT: POWELL
Project Description: Connecting existing house to sewer, septic tank to be pumped and filled. Reimbursement district
#44. Fees paid 5/13/2008.
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:
TUB /SHOWERS: SEWER LINE: 72 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JAMES POWELL
7660 SW FIR ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/13/2008 $72.50
[TAX] 12% State Surch 5/13/2008 $8.70
Phone : 503- 624 -9308 Total $81.20
Contractor:
BRIAN CLOPTON EXCAVATING INC
PO BOX 509
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 682 -0420
Reg #: LIC 50337
PLM 3 -517PB
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 B. • ` / `j / Permittee Signature: 46
ry `
Call 503.639.4175 by 7:00 a.m. for an inspection tha.:usiness 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.
;: PlLlmbi;lg Permit Application .M%
-* Site Utilities e*,,_- ,, FOR OFFICE USE .ONLY
� � e i �' ' R eceived , /1
City of Tigard ) o. Tom' " F ( I 11 [ice zi Permit No ?ale e
IN _
V 13125 SW Hall Blvd , Tigard, OR •7223 �.� � . r. Date/By ( , /V _ii ��
_; Phone 503 639 4171 Fax 503 598 1960 C > „ off ' n < .Plan Review _ t a1Jcii� —ck
Inspection Line 503 639 4175 hh' *y\ b ate /By
Other Permit No
T I GA RD
Internet www.trgard -O 639 �e Date Ready /By runs Supplemental See Page for
,,,,,16 _.,,‘C, Notified/Method Supplemental l Information
- TYPE OF WORK,. �� ` �. . FEE* :SCHEDU
❑ New construction ❑ DeVmolition For special information use checklist
Description I Qty Ea Total
i Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
' ” , ..,. -* : CATEGORY".OF ' " 5 '- . • - —:. SFR (1) bath 249 20
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ 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; "
b. , -. - . Site utilities
Job site address: , -7Gdi7 ,r,'
' % , 4- Catch basin or area drain 16 60
City /State /ZIP: "7/j• �L�,e g 7/2.-- Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: P l / 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 ft 7 24 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
Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
,. Drinking fountain 16 60
z;® OilEOPERTY`'OWNER, s` - l' - " ❑ TENANT
Ejectors /sump 16 60
Name: ,� o9 s' I€' j :giaee,,- Expansion tank 16 60
Address: 716 /9 5 eL `` r),,t e Fixture /sewer cap 16 60
City /State /ZIP: �/ g .1: 7 y Z Floor drain /floor sink/hub 16 60
Phone: ( V`O* ‘ �y...., 3 fl S Fax: ( ) Garbage disposal 16 60
Hose bib 16 60
`: '❑. APPLICANT;' w „ °❑" CONTACT PERSON " ,.,' -','•
�/ ` Ice maker 16 60
Business name: � (- z. " Interceptor /grease trap 16.60
Contact name: 5 / y C ( _ rte) Medi gas (value $ ) Page 2
Address: • (/. ` 1vf _ Primer 16 60
City /State /ZIP: 5 fi r' - Roof drain (commercial) 16 60
r Sink/basin/lavatory 16 60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16 60
E -mail: Urinal 16 60
_ ,_ ', CONTAAC OR : , , r ` , - , Water closet 16 60
Business name: �y cici � f
n � q L'� Water heater 16 60
Address:
!7// 0,4-9, Other
✓ Subtotal
City /State /ZIP: �; , ef L . , 7 L%
Minimum permit fee $72 50
Phone: ( 3) 6 if 2. D .i 0 Fax: ( ) Residential backflow minimum permit fee $36 25 - 7 - d-
S / 37 M Plan review (25% of permit fee)
CCB Lic.: , Plumbing Lic. no.: `3�� � / J ��
Authorized signat ,/ State surcharge (12% of permit fee) �� p
��� TOTAL PERMIT FEE o v
Print name: 44 Lt! , e/1 Date: 0 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
I \Buddmg\ Permits \PLMU- PermnApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB) ^J-- �% 1— G I (� Q /r • q
( WO / p ` jS !*Old
Plumbing Permit Application -.City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
'Site Utilities , Qty' ' Fee (ea) ..- ° Total' - Square Footage: Pe>rmif
Footing drain - 1 100' 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: Fee:,, -`. °m
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 ol';It _ 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
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 * . ❑ 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 Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain z 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 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
1: A Building \Permits \PLMU - PermitApp.doc 2
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11 1. C Community Development
°f 1 GAat[� Reimbursement District Payment Worksheet
Plannin• En•ineeerin_ to complete:
- 4,46
Site Address ' S
Parcel No. 61-G I 1 L U: (c c7)
Reunnbursement District No 1 4 4- {" Amount Due• $ z G %( ( (- 60
Date: r '/'t - 3 B __ (�32�/��
Note Amount due is as of date shown above
Deferred Accounts:
Name ',TPA t-t (4.) t-t Lam - f v/) I -i
Phone Number
Legal
Amount paid (k' (O 6 U. L�
-6'
Remaining to be paid, deferred amount $ C � w , l� L4-U7
Building Division to complete:
Reimbursement amount paid $ (0 CAA
Received by
Return completed worksheet with copy of receipt to planning /engineering permit technician
Planning /Engineering to complete:
Enter "paid" parcel tag
Enter "deferral" parcel tag, if applicable.
Route copy of receipt and parcel information printout to Finance Department
J
\CURPLN\Masters\ReimburseWorksheet doc 2/23/07
FROM BRIAN OLOPTON EXCAVATING 503 682 0967 (WED)MAY 14 2008 10:06 /ST 10'05 /No 680 P 2
CITY OF TIGARD
s COMMUNITY DEVELOPMENT
T I G ` (fin 13125 SW Hail Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
BRIAN CLOPTON EXCAVATING INC
PO BOX 509
WILSONVILLE, OR 97070
Permit #: PLM2008 -00208
Date Issued:
Parcel: 2SI01 DC -02600
Site Address: 07660 SW FIR ST
Subdivision: ROLLING HILLS PLAT 2
Lot: 050
Jurisdiction: R -3.5
Zoning: TIG
Project Name: POWELL
Description: Connecting existing house to sewer, septic tank to be pumped and filled.
Reimbursement district #44. Fees paid 511312008.
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
JAMES POWELL BRIAN CLOPTON EXCAVATING INC
7660 SW FIR ST PO BOX 509
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone #: 503 -624 -9308 Phone #: 503 -682 -0420
Reg #: LIC 50337
PLM 3 -517PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Aut rizlyd Plumber Name (printed)
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CITY OF'TIGARD _
, .
BUILDING DIVISION
PERMIT #: PLM2008-00208
13125 SW Hall Blvd., Tigard, OR 97223 A
DATE ISSUED: 5/13/2006
Phone: (503) 639-4171 .. g#841101111'\
Inspection Requests (24 Hrs.): (503) 639-4175 0414■ '
INSPECTION WORKSHEET FOR DATE: 5/21/2008 TIME: 7:00AM PAGE: 27
SITE ADDRESS: 07660 SW FIR ST CLASS OF WORK:
SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 050 TYPE OF USE:
PROJECT NAME: POWELL
DESCRIPTION: Connecting existing house to sewer, septic tank to be pumped and filled. Reimbursement district
444. Fees paid 5113/2008.
OWNER: POW1-.7.LL, JAMES PHONE #: 503624-9308
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420
Inspection Request Scheduled For: Date: 5/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070208-02 503-849-7607 N
Corrections/Comments/Instructions:
R .A. , „,,,,. Rp...c; el( Piro \J ALA
. e 9A- 1
IA PASS n PARTIAL APPROVAL 0 CANCEL n NO ACCESS
I I FAIL [7 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: (3b kevm--/ Date: Si 21 1 0 Z\ Phone #: (503) 718-
CITY OF TIGARD - I
BUILDING DIVISION PERMIT #: PI_M20t)t 00208
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1312008
Phone: (503) 639 -4171 A m lfj
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/162006 TIME: 7:00AM PAGE: 2
SITE ADDRESS: 07660 SW FIR ST CLASS OF WORK:
SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 050 TYPE OF USE:
PROJECT NAME: POWELL
DESCRIPTION: Connecting exii-Aing house to sewer, septic tank to be pumped and filled. Reimbursement district
#14. Fees paid 5/13/2008.
OWNER: POWELL, JAMES PHONE #: 503- 624 -9308
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420
Inspection Request Scheduled For: Date: 5/16 /2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 07001002 503-U9-7607 . Y
Corrections /Comments /Instructions:
P i,ro..., \ AR (orP� PU` (Q (Lc $ t 1 ,t 4_ Ce \ Fv✓ ` - i,✓,,,1. 3a9
V ] PASS ❑ PARTIAL APPROVAL I CANCEL I 1 NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: "Cr5 A1v D, ..+� Date: c 1 1 /0T Phone #: (503) 718-