Permit IN ," q CI TY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00203
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/9/2008
PARCEL: 25101 DC -02700
SITE ADDRESS: 07630 SW FIR ST ZONING: R -3.5
SUBDIVISION: ROLLING HILLS PLAT 2 LOT: 049 JURISDICTION: TIG
PROJECT: BRIAN
Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #44.
Fees paid 5/9/2008
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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
THOMAS & J BRIAN
JOENE A Description Date Amount
7630 FIR ST [PLUMB] Permit Fee 5/9/2008 $72.50
TIGARD, OR 97223
[TAX] 12% State Surch 5/9/2008 $8.70
Phone : 503- 639 -1182 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 By:_7_ j +� Permittee Signature: 7 w k i fy-lii tku-r"____--
4
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.
* .D;i in!bing Permit Application
Site Utilities „ FOR O
Received FFICE USE ONLY - „- : . � ]
Date/By Af ,1 OL�I/J( ,0�`codV
- City of Tigard Ree Permit No
IN
V 13125 SW Hall Blvd , Tigard, OR 97223
Plan Review
Phone 503 639 4171 Fax 503 598 1960
Date/By Other Permit No f ,, A l� -.. ua 6/
TI G A R D Inspection Line 503.639 4175 Date Ready /By Juris ® See Page 2 for V
Internet www.ti -or gov Notified/Method Supplemental Information
s . TYPE- OF WORK° 4 ' ' 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)
eCATEGORY. OF CONSTRUCTION, °a' .* SFR (1) bath 249 20
X l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ 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;' NF
IORMATION AND LOCATION, _ , , Site utilities
Job site address: 76,3Q S. VJ - Fir d- Catch basin or area drain 16 60
City /State /ZIP:, TClarQ OR 9 7,9a...3 Drywell, leach line, or trench drain 16 60
J i c� Footing drain (no linear ft . _ ) Page 2
Suite/bldg. /apt. no.: Project name: t `N
Manufactured home utilities 110 00
Cross street/directions to job site:
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft : a() ) 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
- _ n , .. - :DESCRIPTION O F WORK ` . - „ ` '
- Backflow preventer Page 2
(-C.7./10(---C75 \/ • A- r S h0, 7 .5.,„.. } , r ev: Backwater valve 16 60
Se ( '7 7 a l,t (t 2y/ Clothes washer 16 60
,� Dishwasher 16 60
�;(2 1 i • f -e r p t - }� s- y /rr Drinking fountain 16 60
,: '% :' ' . P,ROPERTY"'OWNER ` . ` ,, _ ”` " , " - El TEN
p A ' Ejectors /sump 16.60
Name: "rht9rAtis 'ma Jo Pine. C rt Expansion tank 16 60
Address: - 7103 D S .. it y S4-rree f ' Fixture /sewer cap 16 60
City /State /ZIP: —ns CLr ci DR `j_ r, Floor drain /floor sink/hub 16 60
Phone: ( 503) 4 3 ,j g Fax: ( ) Garbage disposal 16 60
Hose bib 16 60
-1,', _ ` ❑' APPLICANT ; .r ' : ; la ,CONTACT-, PERSON
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
Sink/basin/lavatory 16 60
Phone: ( ) I Fax::( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
_��' " ;CONTRACTOR ° , _ ' Water closet 16 60
Business name: 5K:, tv I v ( Lb f f O JU e , „,,,, A-77 /u( Water heater 16 60
Address: ' P ® ib. 5 b Other
City /State /ZIP: Ilk) I k l ts (t D' - C1 0 -') 0 Subtotal
_ M inimum permit fee. $72 50
Phone: (,5 3) 6 4 _ ( y-1 a1) l Fax: ( 3..09 — (74 �t Residential backflow minimum permit fee $36 25 79)...„5 V
CCB Lic.: 5'03 3 7 Plumbing Lic. no.: $ , •• 57 7107:5 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 0 SAD
Authorized signature: 2¢ A Ual - TOTAL PERMIT FEE Wt
- Print name: J o en t?° A A. Br- f nn Date: g /G0 l0 s) This permit application expires if a permit is not obtained within
f 180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
1 \Bwldmg\Permits \PLMU- PermuApp doe 12/27/06 440- 4616T(10/02/COM/WEB)
01-3s g (, 3-0 1, 9 1 f 4
*'.
Plumbing Permit Application - City of Tigard
•�
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• Si'te Utilities ANY- Fee,(ea) 'Total Square :Footage:.
Permit. Fee: "
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: 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
additional $100 00 or fraction thereof, to and
-:Fixture; OI• Item, r. Qty:. Fee (ea). : Total 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 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 ° ' 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
I:\ Building \Permits \PLMU - PermitApp.doc 2
FROM BRIAN CLOPTON EXCAVATING 503 682 0967 (WED)MAY 14 2008 14 36 /ST 14'35/No.6804641500 P 1
?! CITY' OF TIGARD
- COMMUNITY DEVELOPMENT
13125 SW Hall 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 - 00203
Date Issued:
Parcel: 2S101 DC -02700
Site Address: 07630 SW FIR ST
Subdivision: ROLLING HILLS PLAT 2
Lot: 049
Jurisdiction: R -3.5
Zoning: TIG
Project Name: BRIAN
Description: Connecting existing house to sewer. Septic tank to be pumped and filled.
Reimbursement #44. Fees paid 5/9/2008
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:
THOMAS & J BRIAN BRIAN CLOPTON EXCAVATING INC
JOENE A PO BOX 509
7630 FIR ST WILSONVILLE, OR 97070
TIGARD, OR 97223
Phone #' 503 -639 -1182 Phone #: 503 - 682 -0420
Reg #: LIC 50337
PLM 3 -517PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X Lii-r
Signature ' Cif Authori d P tuber Name (pri ted)
_ ,', —,' ',':" •.,'..:e '
,..,,,,,'.*:: ,r_nitir). A p . ,r,
4iii T - 3 , -,s.,1 siv it-
p.aBoy,,,1
'Wll..;..2=ONVilitE01i— 97070
( 0
3) 4182-144 , 47.4X-442.0,1), 570.0779
I-, CUSTOMER'S ORDER NO PHONE DATE
.44 --, /... '''' :
'-' i i '4C1 , •—•'' ,,, I f .t, ,■•• 4,, .
i NAME .
-,
I. ADDRESS
III .
l'I ,
1 ,
F
SOLD BY CASH C.O.D CHARGE ON ACCT. MDSE. RET'D. PAID OUT
iiggSfy7,4"..' VtriliFtWalkiratifins rg:PR.,A,WW4391,4 .
4.:**.....11,A. 1.. .:, . ■i.r . 'IA ' "..t. '' , .....,--;,-, - ' .i,....10.......... A kiai LituezatTaL.' ...E....L:4 ' ;,...VIEt,,, ' . ,
.- en ,r1 ,, / .. ly ‘,-,- -, / i- .,,,,. ..,...- , ... .
,h..:- O.- , 4 .... .. , / i 4— ( '7C et- i" L-
it
tt
[
--..
i;
1,..
' I
It .
t
7 te - " , f 0 / 41 77 1
i 7
r
1,.
11 7 ''',.:2 /
- 17 .--' 4' i? / /1
I .t. -- , • •.- i c...
.._ ,
i .
1
714 _. 4A
-..,-
[ I
i 4
I
1 .
I
/7,/: .71k. TAX
'I I RECEIVED BY I i'' I I
I qi - s TOTAL
! x / - .1„__ ,„
All claims and returned goods MUST be accompanied bythis bill ,
l „
' " i 'I o Reorder , THANK YOU
i:--:- am-225 :!6;..-f6.a°,111
CITY �~�����U��������
��u m w OF m nn�wmwu����
BUILDING DIVISION PERMIT #: PLh82008'00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/EY2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/31/2008 TIME: 7:00Ah4 PAGE: 28
SITE ADDRESS: 07630 SW FIR ST CLASS OF WORK:
SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 049 TYPE OF USE:
PROJECT NAME: BRIAN
DESCRIPTION: Conncting existing house. to sewer. Septic tank to be pumped and filled, Reimbursement #44.
Fees paid 6/9/20D8
OWNER: BRIAN, THOMAS & JOENE PHONE #: 503-639-1102
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 fina| 070208-01 603849-7607 W
Corrections/Comments/Instructions:
x3 [> _ r o � |
� v�� � | T�o�x���
�^~~�� ��
PASS 0 PARTIAL APPROVAL El CANCEL 0 NO ACCESS
FAIL El CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
'-~ ���) � i
Inspector: (�rD V�~~~~~ Date: �� |07l Phone #: (603) 718-
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: PLM2008-00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/9/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/16/2008 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 07630 SW FIR Si CLASS OF WORK:
SUBDIVISION: ROLLING HILLS PLAT 2 LOT #: 049 TYPE OF USE:
PROJECT NAME: BRIAN
DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #44.
Fees paid 5/9/2008
OWNER: BRIAN, THOMAS & JOENE PHONE #: 503-639-1182
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420
Inspection Request Scheduled For: Date: 5116/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Sanitary sewer 070018-01 503-849-7607
Corrections/Comments/Instructions:
C o \o‘ c 4 e C-di--" r A.-re)
PASS PARTIAL APPROVAL ri CANCEL LII NO ACCESS
I I FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: 1\A/KAil,) Date: c 'cl 1,01 Phone #: (503) 718-
•