Permit ^a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00111
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/20/2007
PARCEL: 2S102CD -02606
SITE ADDRESS: 09670 SW HILLVIEW CT ZONING: R -4.5
SUBDIVISION: TWALITY HILL LOT: 006 JURISDICTION: TIG
PROJECT: WILSON
Project Description: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. Reimbursement
District fee paid this date.
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
LELAND WILSON •
9670 SW HILLVIEW CT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/20/2007 $72.50
[TAX] 8% State Surcha 3/20/2007 $5.80
Phone : 503-968-2115 Total $78.30
Contractor:
J & C EXCAVATING INC
39590 GARY ST
SANDY, OR 97055 -7316 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 318 -8075
Reg #: [IC 167000
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 m o• ain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued Permittee Signatur:. I _ J Z. %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.
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Plumbing Permit Application ' 1 - 10K' rlci ` �isr 0 NL ) E '
,
114 City of Tigard Received • 4 DateBY �, 7 < Permit No.. N tC//
n 1 3125 SW Hall Blvd., Tigard, OR 97223 ���5429/�,,, 7�< 7
Plan Revie ,
Phone: 503.639.4171 Fax: 503.598.1960 �� Other Permit No . (4
7
' Inspection Line: 503.639.4175
LC A K D Date By.
Sec
Internet: www.tigard or.gov Notified/Method: / ® Su
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❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. I Ea. I. Total
❑ Addition /alteration/replacement XI Other: cyetd"..IQ'. /A New 1 dwellings (includes 100 ft. for each utility connection)
� 9:,,'..g.:.-.,-,-,,,' O CON , �:T I
:4'. - ,;;K,4 <• � � ' 'CATEGO[tY' F ; STRUGT[ON: ;;, ""`.: t-- ,.,,,, ` , '„ z; bath 249.20
.. _ ...... �" �...,.: � -- ..:,;. � .�;:' ,,�.,. , w, ".�..;a ,<,r� . SFR (I) b th
❑ 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder �I � ; �� _/ Each additional bath kitchen 45.00
A l , �Tle�( n Fire sprinkler ( sq. ft.) Page 2
:_Y:: .F .. :IOBc ITE' * :,. , , , . M r. - -., • -:; ._ .,,,,;`
= 4 F,' '4_.4 fi S I NF RM TI LOCAT O -+ �-` m ` : ' %3
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:'.. •x �.. � 'i• . =tF �' -. r - = . - � , ..� � s r � , a `°.,}�r`"t°, v Site utilities
Job site address: f‘ 7 51-0 .,- 1 t U lm Catch basin or area drain 16.60
City /State/ZIP: ) ; ,'& ? ' 9 2 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: " f Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
A i‘4/r r Rain drain connector 16.60
Sanitary sewer (no. linear ft.: %1iY4 - f 1 Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
s',�'''''' a .. ; - .
A .. ''.,: k 7''' ,, ,.. :C :"..,d „ ,t;,',< .,. ^ „.
Absorption valve 16.60
- .-4DESCRIRTI _, ON -OF,• WORK - 1, , s t ,..:,
..,m " S , r, ..•, ,. +• �r s ...,. i ' xR, a , Yr'• ' � e , «n,..,...•a< BackftOWpreVenter Paget
( _ wt - 4 - ) r Backwater valve 16.60
/1 Clothes washer 16.60
• ' Dishwasher 16.60
. -4' . _µ, _, . :,,. •, µ u' -V" f, N > Drinking fountain 16.60
�" ;' M�(]``PROPERTY, (JWIVER ` : w S�i:)'�I' x, °'TEN o ' , •
° . .E. o.' . FP E }ectorslsump 16.60
Name: // 4 J / v✓
/LG� '¢•s / sir' Expansion tank . 16.60
Address: ' 4) //, //we, ) 6 ) ' Fixture/sewer cap 16.60
City/State/ZIP: �"l 4i /i ( .e 2 4 7, Z, Floor drain/floor sink/hub 16.60
Phone: (703 ) t �, //� ) Garbage disposal 16.60
, ` ' ,; =: r,.,, _ , . , , ' Hose bib 16.60
::.', * , . , . ',. CAIV'f',, `.. Y., . , ❑ CONT PER ' 4
a ,;; .
� y 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: ( ) - I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E -mail:
Urinal 16.60
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q,' -° = . , ', l', --ra ; v , �,.. .4. `
`' t ' Water closet 16.60
Business name: 7 ,s�.��r �(c. Water heater 16.60
39 590 � i ft2y �
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Address: Other:
City/State/ZIP: !� 9 j ( 7 O 3 - 73/6 Subtotal
. � ff L Minimum permit fee: $72.50 -7
Phone: ( o 3) 3 R- Fax: ( ) Residential backflow minimum permit fee: $36.25 L ot JO
CCB Lic.: /4 �J�� /o .2 . , 7/ Plumbing Lic. no.: Plan review (25% of permit fee)
/ � ! / State surcharge (8% of permit fee) r ,8
Authorized signature:
!�- ftiawi ' TOTAL PERMIT FEE ? . 39
Print name: Date: 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.
L\ BuildingPPamin \PLM- PermitApp.doc 06/26/06 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
F ee: ea t o ta l. � ,.a��•� ,a*:�� ,a�.� ti .�:� a:,; , r 3t + ' d {
Site UtihtieS: .w.' .s Qt,' _ () q g e .
.xs ;,* hm ffz :.a S uace „FO,OtaC aPerinitFee „ .,M
Footing drain - l 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
Storm & Rain Drain - 1st 100' 55.00 , aluatl_on ', � w;,k�,i' PCCM 1t_ Fee •M �',1� ? 51�
$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
•
Fee.(eer Total ,.
additional $100.00 or fraction thereof, to and
' e,
Fix >:;s ,.{ ,::, fy1.. .H :..
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 Back flow 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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Vv. ew•for Plurib>mg,I "stal laitious
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
, ., , u , 4,, ; � ;k . .,; ;.,.� �•, greater, except systems designed and stamped by licensed
:R:_ engineer. plieet c YP i , •
^ r� ry A;14 ,.inr -' C•A- M. i ' � Previous`r• 'x.Capped7A ': Added i? OEiistioav . ❑ 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 :: P. ;o rWserrl z ,744
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 Comments regarding fixture work:
Garbage - Domestic _
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
-Bradley fees assessed for the sewer increase must be paid before the
- Commercial
_ - Service plumbing permit can be issued,
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
_ Urinal
Other Fixtures:
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It_tmi_.# To Reorder: THANK YOU
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00111
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2007 I
Phone: (503) 639 -4171 V Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/26/2007 TIME: 7:00AM PAGE: 12
SITE ADDRESS: 09670 SW HILL.VIEW CT CLASS OF WORK:
SUBDIVISION: TWALITY HILL LOT #: 006 TYPE OF USE:
PROJECT NAME: WILSON 1
DESCRIPTION: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. Reimbursement
D.Jistrict fee paid this date.
OWNER: WILSON, LELAND PHONE #: 503.968.2115
CONTRACTOR: J & C EXCAVATING INC PHONE #: 503 - 318.8075
Inspection Request Scheduled For: Date: 3/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 045388 -02 503- 318 -8075 N
Corrections /Comments /Instructions:
,pp\,,
- Ai
__,,,,,.,-.2. ..e.e.__
e,- 741":-1/1/
0 ' , _S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
a FAIL ❑ CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: 114 I Date: 3 Phone #: (503) 718 -
CITY OF TIGARD . .
BUILDING DIVISION PERMIT #: PLM2007 -001 1 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/20/2007
Phone: (503) 639- 4171 dii rybl�nll6ll`
Inspection Requests (24 Hrs.): (503) 639 -4175 _ ''I
INSPECTION WORKSHEET FOR DATE: 3/2612007 TIME: 7:00AM PAGE: 13
SITE ADDRESS: 09670 SW HILLVIEW CT CLASS OF WORK:
SUBDIVISION: TWALITY HILL LOT #: 006 TYPE OF USE:
PROJECT NAME: WILSON
DESCRIPTION: Connect existing house to sewer lateral. Septic tank is to be pumped and filled. Reimbursement
District fee paid this date.
OWNER: WILSON, LELAND PHONE #: 503 -968 -2115
CONTRACTOR: • 41& C EXCAVATING INC PHONE #: 503- 318 -8075 I
Inspection Request Scheduled For: Date: 3/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 045398.01 503 -318 -8075 Y
Corrections /Comments /Instructions:
.1A ❑ PARTIAL APPROVAL CEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: Ki_pi
{ Date: - , / ' Phone #: (503) 718-