Permit ., y "., CITY OF 11GARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00435
1 - 1 - G -'
IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/24/2007
PARCEL: 1 S 125CD -07600
SITE ADDRESS: 07647 SW LANDAU ST 'ZONING: R -4.5
SUBDIVISION: TIGARD WOODS LOT: 002 JURISDICTION: TIG
PROJECT: LEWIS
Project Description: Sanitary sewer repair.
' 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: ft
WATER CLOSETS: WATER LINE: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
DON /ANITA LEWIS
7647 SW LANDAU ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 9/24/2007 $72.50
[TAX] 8% State Surcha 9/24/2007 $5.80
Phone : Total $78.30
Contractor:
PIPE REPAIR SERVICES
PO BOX 5603
PORTLAND, OR 97228 -5603 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 723 -3110
Reg #: LIC 168991
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'`. ` , _`� / ir A. Permittee Signature: 'A '
Call 503.639.4175 by 7:00 a.m. for an inspection that bus' - - .ay.
This permit card shall be kept in a conspicuous place on the job site up completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applica `it"
Building Fixtures FOR OFFICE USE ONLY
City of Tigard SEA 2 Received q
200 Date/B ,..v4/ /7 Q 6 Permit N y" � - Db y.5
14 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review j ,1
Phone: 503.639.4171 Fax: 5(�3.5�1 g p gl , g � ' ateBy Other Permit No.:
Inspection Line: 503.639.4175 fl T 1 DING lJ3 1 �. �3� aRead /B itn 0 See Page 2 for
Ti GARD Internet: www.tigard -or go BT Y t
ate ead ethod: J Supplemental Information
TYPE OF 'WORK FEE* SCHEDULE .
❑ N construction
El
Demolition _ For special information use checklist
Description Qty. [ Ea I 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: - 71 4 ,t' / S Lj/ �A - PA yt Catch basin or area drain 16.60
City /State /ZIP: '77 6_71 IL 0 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. )----"' Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Subdivision: 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
S , £ l t / /i (94 . // Backwater valve . 16.60
/� / Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ Drinking fountain 16.60
Ejectors /sump 16.60
Name: \ , . iC S-,.-/ pay( l ii17.t�tL ion tank 16 60
Address: 7' • 4� . IA 14 � - 7 - q S w # ture /sewer cap 16.60
City /State /ZIP: _Lo W IF I J (/' l p' Floor drain /floor sink/hub 16.60
y
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ��CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: !' O iL '� /) j L 2 Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( 503) 707 9 � Z 3 Fax:: ( ) Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR . . • Water closet 16.60
Business name: /7 p R/1 i_74. //L SAW (/ /64 S Water heater 16.60
Address: / /// Aux r1 03 Other:
Q 2 1l ,� Subtotal
City /State /ZIP: / 0 ` J Minimum permit fee: $72.50
Phone: (spa ) 72 3 - Z
CCB Lie.: / p ff 9y/ _ __Plum ing Lic. n' Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) jlJ
% TOTAL PERMIT FEE 'l8 , 3d
Print name: /2 A - Date: <7/ 5 r - o ,T s 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\PLMF - PermitApp.doc 12/27/06 440- 4616T(I0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential`Fire Suppression Systems:
Site Utilities- Fee (ea) Total S quare 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 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 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) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR9 1 8-780-0040.
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 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 - Toilet
Urinal
Other Fixtures:
is \Building \Permits \PLM- PermitApp doc 12/27/06
+E_ �_ 6 a •o •
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM2007 -00436
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/24/2007 'i
Phone: (503) 639 -4171 �� 8jl 1il
Inspection Requests (24 Hrs.): (503) 639-4175 - !� - 'I
INSPECTION WORKSHEET FOR 'DATE: 9/27/2007 TIME: 7 : 00AM ' PAGE: 36
SITE ADDRESS: 07647 SW LANDAU S T CLASS OF WORK:
SUBDIVISION: TIGARD WOOD LOT #: 002 TYPE OF USE:
PROJECT NAME: LEWI
DESCRIPTION: Sanitary sewer repair.
OWNER: LEWIS, SON /ANITA PHONE #:
CONTRACTOR: PIPE REPAIR SERVICES PHONE #: F, 03.723,.3110
•
Inspection Request Scheduled For: Date: 9/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 056476 -02 503-701-9625 N
Corrections /Comments /Instructions:
•,- i•-•4) .fr
_ .
,-.
x PASS ❑ PARTIAL APPROVAL I I CANCEL I I NO ACCESS
I I FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \r1id W I\ \•ta '� Date: 9 12`) j &-) Phone #: (503) 718-
e
CITY OF TIGARD
BUILDING DIVISION : , '` - PERMIT #: PLM2007 -00435
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: .'24/2007
Phone: (503) 639-4171 40111,
Arelop
Inspection Requests (24 Hrs.): (503) 639 -4175 Alri 41!
INSPECTION WORKSHEET FOR DATE: 9/27/2007 TIME: 7:00AM PAGE: 37
SITE ADDRESS: 07617 SW LANDAU ST CLASS OF WORK:
SUBDIVISION: TIGARD WOODS LOT #: 002 TYPE OF USE:
PROJECT NAME: LFW1S
DESCRIPTION: sanitary sewer repair.
OWNER: LEWIS, DON /ANITA . PHONE #:
CONTRACTOR: PIPE REPAIR SERVICES PHONE #: 503-723-3110
Inspection Request Scheduled For: Date: 9/27/3007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 0%476-01 76.01 503- 701 -9625 Y
Corrections/Comments/Instructions:
'14 PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ��� � ""' Date: 9 127/0 T' Phone #: (503) 718-