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Permit
(:1 C ITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00119 DATE ISSUED: 3/21/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103CA 00213 SITE ADDRESS: 13170 SW HOWARD DR ZONING: R -4.5 SUBDIVISION: WOODCREST NO.2 LOT: 023 JURISDICTION: TIG PROJECT: WILLIS Project Description: Connecting existing house to sewer, septic tank to be pumped and filled. Reimbursement #22. Fees paid 3/21/08. Installing (2) rain drain connectors to curb. 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: 2 TUB /SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES RICHARD & WILLIS 13170 SW HOWARD DR Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 3/21/2008 $88.20 [TAX] 12% State Surch 3/21/2008 $10.58 Phone : 503 -579 -0831 Total $98.78 Contractor: JIM SAUBLE CONSTRUCTION LLC. 23405 SW MOUNTAIN HOME RD. SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 -544 -1415 FAX 503 -628 -0748 Reg #: LIC 163459 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 ! =' Permittee Signature: , 4 s . Call 503.639.4175 by 7:00 a.m. for an inspection that • siness 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. .-]p.rr_ ng Permit Application Site Utilities FOR OFFICE USE . ONLY ' t ceived City of Tigard lr p Permit ' ,, d ¢ 1114 V 13125 SW Hall Bl T OR 972 �� Da /B a� UO iii P it N / � e..may� lOp(,U '"' cow 503 639.4171 Fax: 1 ' Plan Review Fax: 503.598.1' i i' DateBy: Other Permit No.:S dy ' __ i ' 3 Inspection Line: 503.639.4175 {�nq Date Read Juris: See Page 2 for wc� TIGARD Internet: www.tigard- or.gov M AR 2fl� No[ified/Method B ® Supplemental Information ® . TYPE OF WORK T " 4 v liG AR® FEE* SCHEDULE ❑ New construction El DemQi,tbit' iviSION For special information use checklist `� ® _ Description I Qty. I Ea. Total ❑ Addition / alteration /replacement /�'Ot m1 , 0 9 New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY. OF CONSTRUCTION SFR (1) bath 249.20 01- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 0 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: f 31 T.0 i Catch basin or area drain 16.60 City /State /ZIP: 01 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: U 11.1-? , Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 �I� j1 I Rain drain connector z 16.60 3 d l Sanitary sewer (no. linear ft.:[ _F t Page 2 S"' --- Storm sewer (no. linear ft.: , ) Page 2 Water service (no. linear ft.: _ ) Page 2 Subdivision: W GR - N 0 2, I Lot no.: 2 3 Tax map /parcel no.: S I 03 CA ( t) a 3- Fixture or it em Absorption valve 16.60 DESCRIPTION OF� WOR Backflow preventer Page 2 (? ©7.3 V El'e.- 7 so,o' (p-i Avt,1, S C „ ) Backwater valve 16.60 • 2 ae-4•ri 7"3s /Aro CL4IE,& Clothes washer 16.60 Dishwasher 16.60 APROPERTY OWNER ❑TENANT Drinking fountain 16.60 * Ejectors /sump 16.60 Name: . U.flt ais Expansion tank 16.60 Address: 131 70 s,u, ' I v vv h Ab biz_ Fixture /sewer cap 16.60 City /State /ZIP: . V ® .., cj%7 2 2.,,3 Floor drain/floor sink/hub 16.60 Phone: (5503) g ® ci 3 2 Fax: ( ) Garbage disposal 16.60 MAPPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: MAA 5A-A c-' yr- Lt.,G Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: 3 *-05 ,v /14,7-j y e- kb Primer 16.60 City/State/ZIP: fl , KuJ 0- 0 Qom' • 1'7 I V.o Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ($ ,3) 514 1 4 / 5` Fax:: (5-®3) 62 ( 0 l its Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 . CONTRACTOR Water closet 16.60 Business name: IN Water heater 16.60 Address: ( Dal, N6) Other: \ Subtotal CitylState /ZIP: ____P S Q t e. ''T) S fl &) Minimum permit fee: $72.50 c 0 CCB Lic.: t� F. at) ( ) Fax: ( ) 3 (F .(l P� Residential backflow minimum permit fee: $36.25 _3 41�' Plumbing Lic. no.: �tl/ 77 �� Plan review (25% of permit fee) ��PP A _A` State surcharge (12% of permit fee) /0, � Authorized signature: w ¢ TOTAL PERMIT FEE R • 7r Print name: /mil , S' 4.1 Date: 3 -a 0 8 a- 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'\ Building \Permits\PLMU- PermitApp doc 12/27/06 440- 46t6T(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 Fee:, Footing drain - 1 t 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 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 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 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 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: R eplace 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. - 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 - To ilet Urinal Other Fixtures: is\ Buildin g'Permits\PLM- PermitApp.doc 12/27/06 4), - A AFFCDAL r . • SEPTIC SEOlygCE P.O.B 11aO WILSONVI OR 97070 (503) 68201929 FAX (603)_ 6 a 0=077 CUSTOMER'S ORDW NO. PHONE DATE •: 5'3 544 14 /5 al =4 g" NAME ADDRESS . SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT L B • 5 �. QTY. - • DESCRIPTION PRICE . AMOUNT • /C EPTZ C Lc 2atce`".• (91' o 5' Vi.r e, e 4 L - A/5 Pi i - • .51 3 l 7' 5 -✓ HDW/6;tZD Op • ft • 5 iv A-57 3$05 .hdv. /ri4T4/ • 5 ht we o° o9 R r TAX RECEI ED BY TOTAL 307 7 a €_ All claims and returned goods MUST be accompanied by this bill. • //law) To Reorder. THANK YOU 800 -225 -6380 or nebs.corn. CITY OF TIGARD '441 BUILDING DIVISION PERMIT #: PI.- M2003- 00119 13125 SW Hall Blvd., Tigard, OR 97223 / DATE ISSUED: • 3/21/2001 Phone: (503) 639 -4171 halIPA Inspection Requests (24 Hrs.): (503) 639 -4175 '1 �.. INSPECTION WORKSHEET FOR DATE: 412512008 TIME: 7:01AM PAGE: 22 SITE ADDRESS: 13170 SW HOWARD DR CLASS OF WORK: SUBDIVISION: W00DCREST NO.2 LOT #: 023 TYPE OF USE: PROJECT NAME: WILLIS DESCRIPTION: Connecting existing house to sewer, septic tank to be pumped and filled. Reimbursement #22. Fees paid 3/21/08. Installing (2) rain drain connectors to curb. OWNER: WILLIS, RICHARD & KELLY PHONE #: 5 -0831 CONTRACTOR: JIM SAUBLE CONSTRUCTION PHONE #: 503-M4 -1415 Inspection Request Scheduled For: Date: 4/25/20013 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Pi rnbing final 0688913 -01 503 - 5441415 Y Corrections/Comments/Instructions: S -Z.,io\i C. 1 t.1\4. A.,k6 -‘04/ a e.0 S\c,. - t�,i Jos. I k • rt,‘,./-4.•J ti [PASS — PARTIAL APPROVAL ❑ CANCEL fI NO ACCESS (l FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C11\evrn.- 4\.,.1 Dater (-11 (AZi71 Phone #: (503) 718- , . . . . .4v CITY OF TIGARD '4 A BUILDING DIVISION PERMIT #: PLM2008-00119 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/21/2008 Phone: (503) 639-4171 l 00\ Inspection Requests (24 Hrs.): (503) 639-4175 1.244. INSPECTION WORKSHEET FOR DATE 3/27/2008 TIME: 7:03Alvl PAGE: SITE ADDRESS: 13170 SW HOWARD DR CLASS OF WORK: SUBDIVISION: WOODCREST NO.2 LOT #: 023 TYPE OF USE: PROJECT NAME: WILLIS DESCRIPTION: Connecling existing house to sewer, septic tank to be pumped and filled. Reimbursement #22. Fees paid 3/21/08. Installing (2) rain drain connectors to curb, OWNER: WILLIS, RICHARD & KELLY PHONE #: 503-578-0831 CONTRACTOR: JIM SAUBLE CONSTRUCTION LLC. PHONE #: 503-544-1415 Inspection Request Scheduled For: Date: 3/27/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 067436-01 503-544-1415 Corrections/Comments/Instructions: ,Sit-LJA./ L i t r T Co"n R AA— v 9 _ct 1 ,04 - 1 c, t<- g c c ( P../V kt co ey c\ -4- • CA. - k1/ P 1 Go`t 'IQ IC) Om-0 rl I PASS % PARTIAL APPROVAL n CANCEL I NO ACCESS I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 07.)11 Date: 3?7) Phone #: (503) 718- _ _