Permit �` 0„4.._x CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00362
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/13/2007
PARCEL: 25111 BC - 02100
SITE ADDRESS: 10090 SW INEZ ST ZONING: R - 3.5
SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 020 JURISDICTION: TIG
PROJECT: LITTLETON
Project Description: Connect to sewer and decommission septic.
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
LITTLETON, DAVID A AND WANDA J
10090 SW INEZ Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 8/13/2007 $72.50
[TAX] 8% State Surcha 8/13/2007 $5.80
Phone : Total $78.30
Contractor:
JOLE GALANZA CONSTRUCTION
4318 SW VINO PL
BEAVERTON, OR 97007 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -7319
Reg #: LIC 175940
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 Ty obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
(
Issued By: Ai iiii / %1r `/ Permittee Signatur �'R-,a' = .
`.,
Call 503.639.4175 by 7:00 a.m. for an inspection that day.
This permit card shall be kept in a conspicuous place on the job site com tion •• t e prole
Approved plans are required on the job site at the time o • ach inspect! • .
Plumb jg Permit Application
, = a'; ® lfECEW FOR OFFICE USE ONLY
City of Tigard e p� Date/By. Received ',y D0'?-- s l PermitNo.�LMZ09 _ ZZ
114 - a 13125 SW Hall Blvd., Tigard, OR 9722 AUG 3 2007 Plan Review
Phone: 503.639.4171 Fax: 503.59 0 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 ' Lf i i Y OF TIGARD Date Ready/By: la See Page 2 for
TIGARD Internet: www.ti ard -or. ov BUILDING DIVISION / �- pp
g g Notified/Metho Supplemental
TYPE,OF WORK- ' . " FEE* SCHEDULE . .
❑ New construction ❑ 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 (1) 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: /6c) 96 F __� S Catch basin or area drain 16.60
City /State /ZIP: y70 6 971 z/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 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.: / OQ) 1 Page 2 j . 00
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot m..: 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
l ) 77 2j",4 a j,J p) ,_59 � c ° , , Backwater valve 16.60
C-0 � ,' 5/ fJ / ) cce 7 -7 er - . Clothes washer 16.60
' Dishwasher 16.60
Drinking fountain 16.60
'❑ PROPERTY OWNER . I - ❑ ,TENANT
Ejectors /sump 16.60
Name: 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 ' ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 1 4J C 0057:: Interceptor /grease trap 16.60
Contact name:
%.....) �C (.__- Medical gas (value: $ ) Page 2
Address: /_f 3 \,' c ( V % C-6" Primer 16.60
• `s "' ~
City /State /ZIP: ` J 0 `9 Roof drain (commercial) 16.60
a__ / Sink/basin/lavatory - 16.60
Phone: ca 9 6 7 77/ , Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
-- CONTRACTOR - Water closet 16.60
Business name: C7 Gr( ./� C O/L.Vr -.L1 %6 i'� Water heater 16.60
Address: 3/ f C J V/ ) P4 c Other:
City /State /ZIP: '=AYC ® 9Xad9
S ubtotal 0 0
Minimum permit fee: $72.50
Phone: (56 ) 96 9� 7 Fax: ( ) Residential backflow minimum permit fee: $36.25 TZ. so
CCB Lic.: I'! 0 5 fr' Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) r7
Authorized signature: ' , ` _� TOTAL PERMIT FEE - -- .
e _
Print name: , VIM Date: Ir. 5 0 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.
1 \Building \Permits\PLM - PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
•
Plumbing Permit Application - City of Tigard " -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ' . Qt 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 55 ,OC 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 V aluation:'. 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 Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including
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:
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
Jacuzzi /Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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
3 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 - Toilet
Urinal
Other Fixtures:
i.\Building\Permits\PLM- PermitApp.doc 12/27/06
05/22/2008 23:57 FAX 5032883658 RIUER CITY 0 001
OR CCB# 147355 WA CCB# RIVERCE9$1 BT
River City Environmental, Inc. 1111 1111111
P.O. Box 30087
Portland, OR 97294 IZECEWED
Phone: 503- 252 -6144 11 INVOKE 39859
Fax: 503 - 288_3858 MAY 2 3 ')008
Account 1168770
"tir I li GARD Date 08/28/07
11 To : BUILDING D' ISION
Reference
Wanda Littleton
10090 SW Inez '1 0036
Tigard, OR 97224 L ►,.l a °6 `
ill
Site Address SW Inez, 10090 Tigard
r
Date Service Description Work Order It PO # Units Amount 0.00
[08/28/07 septic Service W062104 -- - _
_ 1.000 2e5.00 ..... __ 2e5.00
08/31/07 Payment, Thank You 1017 1.000 - 285.00 - 0.00
0.00
5 90_ --0F50--5
•
ifeAsol 4411111
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CITY OF TIGARD • -
BUILDING DIVISION
A4 (As PERMIT #: PLiV12007-00362
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9113/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 ■
INSPECTION WORKSHEET FOR DATE: 8/213/2007 TIME: 7:00AM PAGE:
SITE ADDRESS: 10090 SW INEZ. ST CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 020 TYPE OF USE:
PROJECT NAME: LI1TLETON
DESCRIPTION: Connect to sewer and decommission septic.
OWNER: LI1TLETON, DAVID A AND WANDA J, PHONE #:
CONTRACTOR: JOLE GALANZA CONSTRUCTION PHONE #: 503-969-7319
Inspection Request Scheduled For: Date: 8128/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 054723-01 503-969-7319 N
Corrections/Comments/Instructions:
4 1"A
F. I I S. ( Re-
1/4- ev A ("o
re, ' FV -
I I PASS [yl PARTIAL APPROVAL fl CANCEL n NO ACCESS
I FAIL H CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: T3 \ Date: ?la' I -0- Phone #: (503) 718-