Permit CITY TIGARD PLUMBING PERMIT
4, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00530
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/10/2005
PARCEL: 2S 103CA -00209
SITE ADDRESS: 13050 SW HOWARD DR ZONING: R -4.5
SUBDIVISION: WOODCREST NO.2 LOT: 027 JURISDICTION: TIG
Project Description: New sewer connection.
CLASS OF WORK: OTR 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: 0 OTHER FIXTURES:
TUB /SHOWERS: 0 SEWER LINE: 50 ft
WATER CLOSETS: 0 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JOANN KISH
13050 SW HOWARD Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 10/10/200E $104.80
[TAX] 8% State Surcha 10/10/200E $8.38
Refund - [PLUMB] Pere' 10/10/200E - $104.80
Phone : 503-524-2034 Refund - [TAX] 8% Sta 10/10/200E -$8.38
[PLUMB] Permit Fee 10/10/200E $72.50
Contractor: [TAX] 8% State Surcha 10/10/200E $5.80
TED RIEHL EXCAVATING Total $78.30
15858 S REDLAND RD
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Phone : 503 -631 -7634
Reg #: LIC 133234
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: � it p er/ Permittee Signature: yi &
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 FOWOFFICE USE ONLY . -
City OCT Permit
131 SW Ha of Tigard and Blvd., Tigard, OR 97223 ®�� 20 Date/B �p f(� �� "� P it N 73 \`� [ 015 - ' A° g0
Plan Review
P hone: 503.639.4171 Fax: 503.598.1960 CITY OF TIG � r ° d 1jIH :- "11I "�� Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 .; > I Date Ready/By: ' Yuri ' . ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING D = -- Notified/Method: ilf Supplemental Information
TYPE OF WORK FEE* SCHEDULE •
❑ New construction • El Demolition For special information use checklist
Description I Qty. I Ea. I Total
A Addition/alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY.OF CONSTRUCTION. • . SFR (1) bath 249.20
A and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
CI Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / ,S J9 No 1 L) J7,. Catch basin or area drain 16.60 '
City /State /ZIP: 7 G 6 , e 97 q , 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: /C.471:%. Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: 79'al ., �ae .ti -
Manholes 16.60
(hr; /�f 42¢ - 74 _ it? Rain drain connector 16.60
�� /p� /0 :4 ,. Sanitary sewer (no. linear ft.: 5 ) Page 2 5 - 6 --"--
r-" -
li.d ,1 7, ,„..Aff,,,, . �f� Storm sewer (no. linear ft.: ) Page 2
Subdivision: /�� (� ¢ a Lot no.: ..Q.7 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: a S 1 0 r�ic Oda 0 9 Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
O / / � //f Backwater valve 16.60
/-&/�r" Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER f 0 TENANT
Drinking fountain 16.60
9 ') Ejectors/sump 16.60
,
Name: Jd /v 1s
/ Expansion tank 16.60
Address: i ,c2 _s• .... II2 ,P��l /2 ,1%)f Fixture /sewer cap 16.60
City /State/ZIP: g% �77 Q,49 9ws.. Floor drain /floor sink/hub 16.60
Phone: ,_.5-A9 aa3 LL Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ' $CONTACT PERSO ` Hose bib 16.60
Ice maker 16.60
Business name: / 4111 ~4) C.,,, UG72 , ;7 Interceptor /grease trap 16.60
Contact name: ,1' // /����49., / Medical gas (value: $ ) Page 2
Address: 66- eO ___Sti2 ��� /4,6. Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
�Z�v O � 9 ��� i --'- 16.60 ��7�----rr--��
Phone: ) SlO -,.5-67'7‘,, I Fax:: , -1557 Sink/basin/lavatory L1 "
Tub /shower /shower pan 16 .60 -
E -mail:
Urinal 16.60
CONTRACTOR Water closet -fa• -- 16.60 /6. Z
Business name:. ti / 1 C0yJ / /7 �j�!i�l, Water heater 16.60
Address: )) �Lf Other:
City /State /ZIP:
Subtotal
Minimum permit fed $72.50. , -, d�-
Phone: (6p3) 8'/. - 5 , Fax: - (5 2 2) X 7,,3 - $5 Residential backflow minimum permit fee:
Pl review (25% of permit fee)
CCB Lic.: i.:3? 7� � Plumbing Lic. no.: 1��07� v . ' '
State surcharge (8% of permit fee, �'p
Authorized signature: J �
TOTAL PERMIT FEE �
Print name: Date: This permit application expires if a permit is oot o:narncu f vr r n
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
is \Building\Perm its\PLMF- PermitApp.doc 06/05 440-4616T(10 /02/COM/WEB)
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 F ee :' ., `
Footing drain - I' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 55.00 u; 3,601 to 7,200 $220.00
7,5 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 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
Fixture 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 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
• Fixture Work: Plan Review for Complex Struct - .
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture {Type: Replace ❑ Any new exterior plumbing site utilities.
Previous ' Capped Added Existing ❑ A commercial building with installation, alteration or addition
. Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
4' . ,
• Car Wash Drain Isometric or Riser Diagram -
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service .
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building\Permits\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006 -00630 .
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2005
I Phone: (503) 639- 4171u� @° (,��
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' =� I .
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 4:11PM PAGE: 49
SITE ADDRESS: 13050 SW HOWARD DR CLASS OF WORK:
SUBDIVISION: WOODCREST NO.2 LOT #: 027 TYPE OF USE:
PROJECT NAME: KISH
DESCRIPTION: New sewer connection.
OWNER: KISH, JOANN PHONE #: 503 -52A -2034
CONTRACTOR: TED RIEHL EXCAVATING PHONE #: 503631 -7634
Inspection Request Scheduled For: Date: 10/28/2006 Pour Time: I
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 019627 -01 503 624 -2034 V ,,'
Corrections/Comments/Instructions:
O ( 74& .z.z 2_ 4 a 1 _,..■—D
/
2/ ' / 411 /
. C/
c:;d1-PASS PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADD,TIONAL FEES ASSESSED
Inspector:
l ir/A D / �-11 / Phone #: (503) 718-
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: PLM2005.00530
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2005
Phone: (503) 639-4171 ,. tullii�
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' ' "...!
INSPECTION WORKSHEET FOR DATE: 11/8/2005 TIME: 7 :00AM PAGE: 117
SITE ADDRESS: 13050 SW HOWARD DR CLASS OF WORK:
SUBDIVISION: WOODCREST NO.2 LOT #: 027 TYPE OF USE:
PROJECT NAME: KISH
DESCRIPTION: New sewer. connection.
OWNER: KISH, JOANN PHONE #: 503- 524 -2034
CONTRACTOR: TED RIEHL EXCAVATING PHONE #: 503 - 631 -7634
Inspection Request Scheduled For: Date: 11 /8/2005 Pour Time: .
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 020520 -01 503- 524 -2034 N
Corrections /Comments /Instructions: .
- - 0 .,'
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: , Phone #: (503) 718-