Permit CI TY OF TIGARD PLUMBING PERMIT
Alp DEVELOPMENT SERVICES PERMIT #: PLM2005 -00252
DATE ISSUED: 6/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103CA -00203
SITE ADDRESS: 11820 SW JAMES CT ZONING: R -4.5
SUBDIVISION: LOT: 017 JURISDICTION: TIG
Project Description: 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 60 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MODE, DEBRA KAY
FIELDS, TERRY LEE Description Date Amount
11820 SW JAMES COURT [PLUMB] Permit Fee 6/8/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/8/2005 $5.80
Phone : Total $78.30
Contractor:
A- AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Phone : 503- 969 -9548
Reg #: L1C 158246
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. `■0/11/1111A -
Issued By: 7--aj_c.e5r4 Permittee Signature:
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.
P i.
Building Fixtures
Plumbing Permit Application FOR OFFICE USE' ONLY Date/By: . . • ' '--
City of Tigard
Receiv DateB Y : ed ` tf�J _ 79 � / � Permit No'�31` , , 7
��\ 06 0074
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r
Phone: 503.639.4171 Fax: 503.598.1960 /� rrl , y Other Permit No.:
`�
24- Hour Inspection Line: 503.639.4175 (� . i
• Internet: www,ci.ti g ard.or.us 1 `. --• Date Ready/By: Juris./ Supplemental See Page 2 for
Notified/Method: I l (r Information
xn ; E, �- r; �,�.o .r�z- +."`�.+re� �=t`c „ �: ...r �.' < - s -e3-. � =z,,� „,�-; �z.:ss .,:.:r, .a t,�
{ I� l ,x i`� ,,`_. : ar N ` . i ," ; , t p ' `,`,_ irg tom " a
4i ` "s:PYe OE W® ' Y . . t�• s ' i �1 . :, 14- , C � '
❑ New construction ❑ Demolition - For special information use checklist.
Description Qty. I Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
N ,�<", #. • .. ,,A; p EGQRY'SOF COI STIiTICTroN a t ' ; 1 ': SFR(1)bath 249.20
11 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building CI Multi-family SFR (3) bath 399.00
Each additional bath/kitchen -45.00
El Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
�' J inffi Ii�IisparIOIY,, ftdoic N y i r -, Site utilities
Job site address: 1 g j 3 _yid .3/)t .io .0 r I Catch basin or area drain 16.60
City/State /ZIP:T/67/114 0� 9`7zz. 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: YY l Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
....z.,, f / u 5Q4-/ jcM - ., J /,/G(X2-ec o /..),, 1- Rain drain connector 16.60
i G� Sanitary sewer (no. linear ft.: 0) _ Page 2
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
' `� DESCRIPTIO 6R4i3RK �' �` 4
...;::%:,, .., d a.^ =m .0 . :,,. _ "e...,,. i x ".�. ". '._J ` Backflow preventer Page 2
_4i i . id l �/ u i Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
t o- r k �. 1 Drinking fountain 16.60
�. ,a ` PROPERTY (?,WN R fi � �� ` A ®tTEN
_. ��. _ .rte � . - fix.. _ Ejectors /sump 16.60
�.
Name: L. L . 1_,, �& is /'hrGk k' IY Expansion tank 16.60
Address: 8 0 S - Fixture /sewer cap 16.60
City/State /ZIP' Z iogy P (r)k '722_3 Floor drain /floor sink/hub 16.60
Phone: ( ) 5 1033 q_ I Fax: ( ) Garbage disposal 16.60
f r . . -: Hose bib 16.60
k f:* t" a °CAPPLIC ° ,: 1 ' k ' i 7 , CO r CT n 9,IN ?
_aS„ � a - `,�a ,' �� :�.�,rn.,. �,.:� x _� � , ..� �s 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: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
.'..". :';a',r>;; #: rK• .. =ssa.;.« ;;:;,'s:„*:^'?*?c:: "flan €.i _..: „ � °•^- '*x= �;.,. v�. . .,:b.::i
��'-' , 4:. i• I , .t -d :+z r =t.lva ..9 <;.±.
A. 1 � i ^ N; : re.CONTItACTQR,V,t , ,- Va- Water closet 16.60
Business name: A I _ 1 _ t Water heater 16.60
Address: 2,7 ,9,, , `/ - Other:
City/State /ZIP: Z.), /z / 9 70 Subtotal
Minimum permit fee: $72.50
Phone: (9D3) / Co 9 .. .75 Fax: (5 ) 5 _0779, Residential backflow minimum permit fee: $36.25
CCB Lie.: X53 ,2 e,/ 6, Plumbing Lie. no.: Plan review (25% of permit fee)
Authorized-signature: I State surcharge (8% of permit fee)
_ / TOTAL PERMIT FEE � , 3
Print name: _ , = Date: G � Q j 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\PLMF- PertnitApp. 12/03 440-4616T( I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
. es iri :Ttee((ea � n
S' teWtilities ..� � _ ,...:. ,% .. f �w , :SFqua>Se F;ootage•. Per rut 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
"1st 100' 55.00 3,601 to 7,200 $220.00
Sewer
�j��j 7,201 and greater $309.00
Sewer - each additional 100' 46.40 4
Water Service - 1st 100' 55.00
Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm & Rain Drain - 1st 100' 55.00 Valuation . ; ._..:, P e lTllt
$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
Pa i t "'`' reee eax 'WTbtal`°.' additional $100.00 or fraction thereof, to and
ixtureorItem� „y.t Q 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
/0/ /i ) each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees
FW: . Quanfit� by' F4►xture) Wo11 Perf6 ell i ='
xtureType s � � , ,W F t g ,N Replac r a 1
a } a1 1 1, ew ". MOW o a Ex,s �c e` Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain /sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter •
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal •
Other Fixtures:
i: \BuildingtPemvts\PLM- PermitApp doc 3/03
, ii.,---,.-.„ PeAFFOPL' '''
PTIC SE MC
. RO.80X 1130
Y, W'ILSONVtLLE, OR 97070
'"!', (503) 682.1929 FAX 003) 570.0779
CUSTOMERS ORDER NO. PHONE DATE
...•••••- 5V7- %.S`5A e,8/(,
NAME
ADDRESS
//g..20 5, (.,. ). ci L/e-5 e .--7/ '
Ss6 BY GASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
S
,
QTY. DESCRIPTION PRICE . AMOUNT
6
■ / i
a", __>,--r%d:7 e" i , 414
G - TAX
RECEIVED BY
TOTAL ,
All claims and returnetigoods MUST be accompanied by this bill.
// To Reorder THANK YOU
800 - 225.6380 or nebs.corn
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM 005 00252
1 13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 6/8/2005
Phone: ti503) 639 -4171 i ,�r 1 4lu ��mp G '� � �t
Inspection Requests (24 Hrs.): (503) 639 -4175 . .Jai- ''f I..
INSPECTION WORKSHEET FOR DATE: 6/9/2005 TIME: 7:09AM PAGE: 47
SITE ADDRESS: 11820 SW JAMES CT CLASS OF WORK:
SUBDIVISION: LOT #: 017 TYPE OF USE:
PROJECT NAME: MODE
DESCRIPTION: Sewer connection.
OWNER: MODE, DEBRA KAY, PHONE #:
CONTRACTOR: A- AFFORDABLE SEPTIC SERVICE PHONE #: 503 - 969-9548
Inspection Request Scheduled For: Date: 6/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 008849 -01 603.969 -9548 V
Corrections /Comments/ Instructions:
NN
.1 ._., .�6 �_
r ..._____9____ "t 4"
I N '_SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ) 771-1 Date: i' Phone #: (503) 718-