Permit C ITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00231
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/4/2007
PARCEL: 2S 102CC -01700
SITE ADDRESS: 10285 SW HILL VIEW ST ZONING: R -3.5
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT: 020 JURISDICTION: TIG
PROJECT: BRITTAIN
Project Description: Connect existing house to sewer service. Septic tank to be pumped and filled. Sewer
Reimbursement District #39 fee paid on 5/17/07.
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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PAUL & ANI BRITTAIN
10285 SW HILL VIEW ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/4/2007 $72.50
[TAX] 8% State Surcha 6/4/2007 $5.80
Phone : 619- 934 -0480 Total $78.30
Contractor:
PIPE REPAIR SERVICES
PO BOX 5603
PORTLAND, OR 97228 -5603 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 723 -3110
Reg #: LIC 168991
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 • may ob .•■ copies of
thes- -• es or sir- . ues ins '. e UNC by calling 503.246.6699 or 1.800.332.2344.
.sued By: • t�' Permittee Sig ure:
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
( ' FOR OFFICE USE ONLY
Received /, /
City of Tigard Date/By: (.Q 4 0 7 ' Permit No.: poQ? ,0a 3/
' . n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read /B lur See Pa e tal 2 for
TIGARD, and -or. ov Y o
Internet: www.ti g
g g Notified/Method: pi's Supplemen Information
•
TYPE OF WORK FEE* SCHEDULE
❑ Ne onstruction ❑ Demolition For special information use checklist
Description I Qty. I Ea. 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
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 . Site utilities
Job site address: / t 2. - 5 5 (, / //L G (,/ /4 Catch basin or area drain 16.60
City /State /ZIP: rim, I, Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 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 55.00
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I 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
$ 7--/-• (/ 47. G G ,- "v - Backwater valve 16.60
S"� 4.-. 4W /-pcJ O tip Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ❑ TENANT
��_ Ejectors /sump 16.60
Name: (f3 t Ky.j Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑, APPLICANT ' j�!CONTAACT PERSON ` Hose bib 16.60
,,,GGG Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: ,9 0 `L/ Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
( 5 5 e)7' 96 2 Fax: ( ) Sink /basin/lavatory 16.60
Phone: //
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: //, i" /".% (W,e2 ,S/5i / 1.5 Water heater 16.60
Address: pX 5645 Other:
City /State /ZIP: Po (Z'r4�� eL agg' -5 60 5 Subtotal
F Minimum permit fee: $72.50 •-7,2 Phone: (5' ) 7?3 - g Fax: ( ) . Residential backflow minimum permit fee: $36.25
CCB Lic.: / i 8 ?/ / 3 a `, Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) . .. gD
� ` TOTAL PERMIT FEE 7 $ ' SU
Print name: - 71 y 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.
P \Building\Permits\PLM- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information f
Fee Schedule: Residential Fire Suppression Systems:
Site Utilitie's ` - . Q. • Fee:(ea) ° Total • .Square Permit
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
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
FixtUte. Or' Item 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
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:
Are you capping, adding or replacing fixtures? If "yes ", Plan. Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing' engineer.
Baptistry/Font
Bath - Tub /Shower - ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash Each Stall El Medical gas and vacuum systems for health care facilities.
Drive Thru El Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain •
Eye Wash isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 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 asses 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\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007700231
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/4/2007
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/16/2007 TIME: 7 :02AM PAGE: 11
SITEEADDRESS: 10285 SW HILL VIEW ST CLASS OF WORK:
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT #: 020 TYPE OF USE:
PROJECT NAME: BRITTAIN
DESCRIPTION: Connect existing house to sewer service. Septic tank to be pumped and tilled. Sewer
.. Reimbursement District #39 fee paid on 5/17/07.
OWNER: BRITTAIN, PAUL & ANITA PHONE #: 619-93404811
CONTRACTOR: PIPE REPAIR SERVICES PHONE #: 503-723 -3110
Inspection Request Scheduled For: Date: 6/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 050318 -02 503 - 701 -9625 N
Corrections /Comments /Instructions: /6
�'' ( l/
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: N ° Date: i P9 Phone #: (503) 718-
_ . .
CITY OF TIGARD
BUILDING DIVISION •A
PERMIT #: PLM2007-00231
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/4/2007
Phone: (503) 639-4171 144
.1 4)I
Inspection Requests (24 Hrs.): (503) 639-4175 to
INSPECTION WORKSHEET FOR DATE: 6/15/2007 TIME: 7:02AM PAGE: 12
SITE ADDRESS: 10285 SW HILL VIEW ST CLASS OF WORK:
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT #: 020 TYPE OF USE:
PROJECT NAME: BRITTAIN
DESCRIPTION: Connect existing house to sewer service. Septic tank to be pumped and filled. Sewer
Reimbursement District #39'fee paid on 5/17/07.
OWNER: BRITTAIN, PAUL & ANITA PHONE #: 619-934-0480
CONTRACTOR: PIPE REPAIR SERVICES PHONE #: 503
Inspection Request Scheduled For: Date: 6/15/2007 Pour Time:
Code # Inspection Description Confirm # ; : Message
505 Sanitary sewer 050318.01 503-701-9625
•
Corrections/Comments/Instructions:
eati (Si
If PASS 0 PARTIAL APPROVAL 0 CANCEL fl NO ACCESS
I I FAIL El CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: , A Phone #: (503) 718-
: •
, •