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Permit
• " CITY OF TIGARD PLUMBING PERMIT ,31011_111. DEVELOPMENT SERVICES PERMIT #: PLM2006 -00464 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/9/2006 PARCEL: 2S 103CB - 00500 SITE ADDRESS: 12185 SW JAMES ST ZONING: R -4.5 SUBDIVISION: WILLAMETTE LOT: 007 JURISDICTION: TIG Project Description: Line work for sewer connection. Reverse plumbing. Septic system to be pumped and filled for removed. 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: 65 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES GROSSE, E R E F 12185 SW JAMES ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 10/9/2006 $117.50 [TAX] 8% State Surcha 10/9/2006 $9.40 Phone : 503 -590 -7219 Total $126.90 Contractor: REQUIRED ITEMS AND REPORTS Contact # : Reg #: 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: 0 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 Building Fixtures` [ECE - FOR OFFICE USE ONLY City Tigard C T 2 006 R eDate ceived /B g. O 315 / /, � Permit No.: " , O dLgp� �� 13125 SW Hall Blvd., Tigard, OR 97223 Rev Phone: 503.639.4171 Fax: 503.598.19Y 60 TIGARD OF pate Date/By e W Other Permit45ta D6 _ Inspection Line: 503.639.4175 ' Ti G A Date ReReady/By: )uris: n See Page 2 for ti `D BUILDING DIVISION Internet: www.tigard- or.gov Notified/Method: L ® Supplemental Information TYPE OF WORK FEE* SCHEDULE .. ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I 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 and 2 -family dwelling 0 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: .) al X �C � a r�1 � S t Catch basin or area drain 16.60 City /State /ZIP: I j , (- z t, l ��t g 7 e ?, Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: v 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 4 / 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 l J l L .I..)trti, �Q.LiA)�/( -- - Backwater valve 16.60 " ii Clothes washer 16.60 • Dishwasher 16.60 Drinking fountain 16.60 O. PROPERTY OWNER ' 1, ' '. ❑ TENANT' - - / .. - Ejectors/sump 16.60 Name: e fie i (cis e. Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 • Phone: (..,3) 6-W) , 70/./ 9 Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 . ', ❑, APPLICANT ' . , I❑ CONTACT PERSON 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:( ) I Fax::( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR , Water closet 16.60 - Business name: ( n t !/G5.5 W. - • - . ter t 16.60 Address: Other: _ . ! � 1. tE" City /State /ZIP: Subtotal Minimum permit fee: $72.50 . �� Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 / . CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) Authorized si atur� State surcharge (8% of permit fee) 9. `. / o • / � Q�/LC - TOTAL PERMIT FEE /, ,,CO Print name: _ (ont, Gr C ,,ss Date: id IC��G+ 6, 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- PennitApp.doc 04/06/06 4404616T(l0 /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 - l 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 i 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 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 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 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 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) WorkPerformed greater, except systems designed and stamped by licensed engineer. Type: Replace neer. Previous Capped Added Existing ' ❑ Any new exterior plumbing site utilities. Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities. Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system. - Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040. Car Wash - Each Stall - Drive Thru Submit 2 sets of plans with any of the above. Cuspidor/Water Aspirator • Dishwasher - Commercial Domestic Isometric. or Riser•Diagram ., Drinking Fountain ❑ Isometric or riser diagram is required for new buildings Eye Wash that meet the qualifications above. Floor Drain /sink - 2" -3 Car Wash Drain Comments regarding fixture work: Garbage - Domestic Disposal - Commercial - Industrial Ice Mach./Refrig, Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory *Note: If the fixture work under this permit results in an - Bradley increase of sewer EDUs, a sewer permit will be issued and - Commercial fees assessed for the sewer increase must be paid before the - Service plumbing permit can be issued. • Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\ Building \Pennits\PLM- PermitApp.doc 09/22106 ©RMMLL To CAD2 JOB INVOICE MEWS `S SEPTIC TANN SERVICE, , INC. P.O. BOX 549 OREGON a f _ ®R 2 N 970 45 CUSTOMERS ORDER NO DATE ORD BED D Fr �� ORDER TAKEN BY D PROMISED Am Grace 11 -24 ❑ P.M. - BILL TO Gene PHONE ADDRESS MECHANIC 12185 SW James St., CITY HELPER Tigard , 97223 JOB NAME AND LOCATION ❑ DAY WORK ❑ CONTRACT • DESCRIPTION OF WORK • ❑ EXTRA QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT /1 n fj (A • • Tank pumping / C • HOURS LABOR • AMOUNT - TOTAL MECHANICS @ MATERIALS HELPERS @ TOTAL LABOR -' I hereby acknowledge the satisfactory TOTAL LABOR TAX completion of the above described work. SIGNATURE DATE COMPLETED TOTAL CITY OF TIGARD., BUILDING DIVISION ,3 , , PERMIT #: PLM2006-00464 13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 10/9/2006 Phone: (503) 639-4171 ViAt Inspection Requests (24 Hrs.): (503) 639-4175 j.. -- -... INSPECTION WORKSHEET FOR DATE: 12/4/2006 TIME: 7:03AM PAGE: 12 SITE ADDRESS: 12186 SW JAMES ST CLASS OF WORK: SUBDIVISION: WILLAMETTE LOT #: 007 TYPE OF USE: PROJECT NAME: GROSSEE DESCRIPTION: Line work for sewer connection. Reverse plumbing. Septic system to be pumped and filled for removed. OWNER: GROSSE, E R E F, PHONE #: 503-590-7219 CONTRACTOR: PHONE #: 1 Inspection Request Scheduled For: Date: •2/412006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 040603-02 603-621-8753 Y Corrections/Comments/Instructions: f 7 -PASS 0 PARTIAL APPROVAL I I CANCEL fl NO ACCESS I I FAIL 0 CALL FOR INSPECTION pi ADDITIONAL FEES ASSESSED Inspector: I 1 Date: / - 1 Y i-A Phone #: (503) 718-