Permit w b ;ti -
CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00327
�I�� DEVELOPMENT H BMENg Tigard, -639 -4171 DATE ISSUED: 7/25/2005
PARCEL: 2S111 BD -00412
SITE ADDRESS: 09700 SW MARILYN CT ZONING: R -3.5
SUBDIVISION: DARMEL NO. 3 LOT: 029 JURISDICTION: TIG
Project Description: Connect existing house to sewer service. Approximately 38' of sewer service. Septic tank is to be
pumped, filled and inspected. Reimb Dist #27 fee paid this date.
CLASS OF WORK: NEW 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: 38 ft
WATER CLOSETS: • WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
RICHARD LUNDSTROM Description Date Amount
9700 SW MARILYN CT
TIGARD, OR 97224 [PLUMB] Permit Fee 7/25/2005 $72.50
[TAX] 8% State Surchari 7/25/2005
Phone : 503 684 - 0472 Total $78.30
•
Contractor:
OWNER •
REQUIRED ITEMS AND REPORTS
Phone:
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 • _ s. This permit 'II expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 da s. • TTENTIO I Oregon law
requires : • low rules adopted by the Oregon Utility Notification Center. Those ule • are set fort in OAR
9524501-0010 throb •h OAR 952 -0001 -0100. You may obtain copies of these rules •r d ect questio - to OUNC by
calli g 503 - 246 -6699 • r -804' 2 -2344.
1
lss d By: Permittee Signature: , a , V I
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit cans 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.
Building Fixtures 0 E
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Plumbing Permifi Lcation FOR OFFICE 11SF ONLY
City of Tigard g L ` ) 5 005 Rece
Da. e ivved p 5 d
k & P ermit No.:3 5 2zt 0.y
. 13125 SW Hall Blvd., Tigard, OR 972'23 T1GAR Plan Review
Phone: 503.639.4171 Fax: 503.59�..( Of' , i/, ,.. I \ Date/By. Other Permit No.: ,e jj -'C .3
24- Hour Inspection Line: 503.639.4T[5� G J 1
Notified/Method: Internet: www.ci.tigard.or.us s p�� - Date Ready/By: r'j� S SeePage2� or
���, Supplemtal Iaformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
�} t ,, J 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 (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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
• Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ¶1 OD SCE) /tn O (f t ` h ( • Catch basin or area drain 16.60
�` 0°
City /State/ZIP: ` ' c3 ( t� ` q• 1 2. N l Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I 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 j gg
Storm sewer (no. linear ft.: J Page 2
Subdivision: I Lot no.: Water service (no. linear ft: ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
1 DESCRIPTION OF WORK Backflow preventer Page 2
AAA) .4l4,) L ✓ w t^ e1 di co At f i.,', P s, •-� Backwater valve 16.60
/
Soft/ c Clothes washer 16.60
.
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
r
Name: t IC.(/n d � r 44 5 1 fQ vi/- Expansion tank 16.60
Address: 4100 G ,) Marl'. C v i. C 1. Fixture/sewer cap 16.60
City/State/ZIP: 1 1 oL U oR l 7 2` L d Floor drain/floor sink/hub 16.60
Phone: (t);) 0({ -(, 3 2 -, Fax: (s-D3 ) & f -6 Garbage disposal 16.60
7 " ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Inteaceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
. Address: Primer 16.60
City / State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: ( ) Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
•
Business name: 0 {\ r 4 , Water heater 16.60
Address: 1 ` V Other:
City /State/ZIP: Subtotal
Minimum permit fee: $72.50 ^
Phone: ( ) : ( Residential backflow minimum permit fee: $36.25 tat '
CCB Lic.: 1 �' umbing Li�. no.: Plan review (25 %ofpermit fee)
State surcharge (8% of permit fee) 5. Y'
Authorized signature: ``= . 1'�, - T O TAL PERMIT FEE - 7 • 3 0
Print name: DateT 25 O 6 T permit application expires if a permit is not obtaine within
CJV l,Jl Lccva t 180 days after it has been accepted as complete.
* meth
IM methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pennits\PLMF- PennitApp.doc 06/OS 440-46161 10/02/COMM'EB)
Plumbine 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
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
Water Service - each additional 100' 46.40 Medical Gas Systems:
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
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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
•
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A `complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
-Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ • Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter -
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Pennits\PLM- PetmitApp.doc 07/06/05
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invoice
GRIlFF'S SEPTIC SERVICE
Name A / / A L /(,J 0 S �iG) !l1 - Date 7 "2- ' " C-5---
Address 9,66 s& /1
/U cY Phone (:. 7Q
City ! r Cg !P- -4 Initial
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State C T) l � Zip Code 5 2 /
Price' Amount
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NOT RESPONSIBLE FOR DAMAGES PAST CURB LINE OR LANDSCAPING
• A service charge of 1.5% will be levied on all past due accounts. f 7e;
• Returned check fee is $20.00. Total:`
• In case suit, action or arbitration is instituted by either party for breach or to enforce any
provisions herein, the court shall award reasonable attorney's fees and actual costs to the
prevailing party at trial or arbitration, or upon any appeal taken therefrom.
Approval
`
By: \ Cf ,.• ``-, i , . ,)•
Customer Signature
P.O. BOX 1136 • Canby, OR 97013 DEQ# 37464
�Fcanl� You
(503) 263 -2087 or (503) 632 -6138 CCB# 104320
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00327
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/25/2005
Phone: (503) 639 -4171 �U.m� ��
Inspection Requests (24 Hrs.): (503) 639 -4175 �!�+�- °':__.
INSPECTION WORKSHEET FOR DATE: 8/8/2005 TIME: 7:07AM PAGE: 63
SITE ADDRESS: 09700 SW MARILYN CT CLASS OF WORK:
SUBDIVISION: DARMEL NO. 3 LOT #: 029 TYPE OF USE:
PROJECT NAME: LUNDSTROM
DESCRIPTION: Connect existing house to sewer service. Approximately 38' of sewer service. Septic tank is to be
pumped, filled and inspected. Reimb Dist #27 fee paid this date.
OWNER: LUNDSTROM, RICHARD PHONE #: 503 -684 -0472
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 802005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013047 -02 503 - 849-6325 N
Corrections /Comments /Instructions: C
/
I �/ / .....A__. _
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fil dg(A) $r.'C lri4:47.\)'
CIIIIASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: irr f � Date: Phone #: (503) 718 -