Permit " : CITY OE-TIGARD PLUMBING PERMIT
�, A*
A. DEVELOPMENT SERVICES
PERMIT #: PLM2006 -10038
�1I DATE ISSUED: 3/21/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103CB - 04200
SITE ADDRESS: 12270 SW MARION ST ZONING: R-4.5
SUBDIVISION: WILLAMETTE NO.2 LOT: 021 JURISDICTION: TIG
Project Description: LINE WORK FOR SEWER CONNECTION. SEPTIC SYSTEM TO BE PUMPED AND FILLED OR
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: 100 ft • '
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JOHN PIERCE
12270 SW MARION ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/5/2006 $72.50
[TAX] 8% State Surcha 4/5/2006 $5.80
Phone : 503 -579 -5553 Total $78.30
Contractor:
OWNER
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: AA 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. .
Plumb] is Permit Au c R% 71 'i,.,. ,IN ED
City of Tigard Renewed 3 aI y& 6 6 Permit Na?,A � _iOQ
13125 SW Hall Blvd., Tigard, OR 97223 MAR 2 1 200' %�
Phone: 503.639.4171 Fax 503.598.1960 u,.�, ,; .�l' Date/By Pest Nog 011640045
24 -Hour Inspection Line: 503.639.4175 � ; ` �.
Internet: www.tigard - or.gov CI TY OF T 1 - Date Ready/By. 3 iou' See Page 2 for
7 T TTirT _ Notified/Mcthod 4 Supplemental information
, llklif Nai ? y� ! F 11 FEE* SCHEDULE
❑ New construction • J{ q �wv D emolition For special information use checklist.
Description I Qty. I Ea. I Total
. 53% ' cldition/alterationireplacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
4and 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: j aa-7 5 t o yin ARA trh S t Catch basin or area drain 16.60
City/State/ZIP: TI 6 fi-G-0 a & q 7 (22 5 Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: / ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft: ) Page 2
Tax map/parcel no.:
Future or item
Absorption valve 16.60
DESCRIPTION OF WORK Badkflow preventer Page 2
o 1�..1.■ l c)Q .- 415) 'f -b Backwater valve 16.60
.VJ Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Name: ve) hi ' 7i' I C-r EExx a ors/sump 16.60
� 'e pannsion sion tank 16.60
Address: . l -).:Z...7 O c / it NA/ j' Fixture/sewer cap 16.60
(
City /State/ZIP: ( G 4(L p 9701)-"‹ Floor drain/floor sink/hub 16.60
Phone: ( 5 & 7 q - S S'S I 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: 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
CONTRACTOR Water closet
16.60
Business name: D W A Water heater 16.60
Address: Other:
City /State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential back flow minimum permit fee: $36.25 Z _ 1
CCB Lic.: Plu Plan review g Lic. no.: (25% of permit fee)
1 ,,, / /,J State surcharge (8% of permit fee) �J - t)
Authorized signatur ,11/
TOTAL PERMIT FEE
Print name: N 7 R r C f2, Date: 3. g. ( - oh, 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:\ Dui ldingTennib\PLM -0amitApp.doc 12/30/05 440- 4616T(I0102/COM/WFB) caf..,,3S.
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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 - I ° 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 $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 - multipurpose fire sprinkler system.
Eye Wash
Floor Drain sink -2"
- 3" Submit 2 sets of plans with any of the above.
-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
Water Extractor *Note: If the fixture work under this permit results in an
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 \Pertniu\PLM- PcnnilApp.doc 07/06/05
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Environmental Service ►
azI
COMPLETE SEPTIC SERVICE / DATE •
19631 S. Kolar Dr. ,/
u / /Z O /
Oregon City, OR 97045 qI C� t0
NUMBER
Molalla: (503) 829-8458 • Oregon City: (503) 658 -0518
Fax: (503) 722-7186
RECEIVED
. p�►L
2006
2770 Su-) ta iZ► J
� CITY OF TIGARD
fl CAS / DR 97173 BUILDING DIVISION
TERMS: Net 10 Days. A service charge o11 1/2% (18% per annum), $2.00 minimum will be applied to past due accounts.
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE
DATE CHARGES AND CREDITS BALANCE
BALANCE FORWARD 1
5W GAu o J ESf_pT(c, `TI!ln1K
tigil > MC6UY
•
Th ank You ou P INTHISCOLUMN T
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM 006. I003t3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/21/2006
Phone: (503) 639- 4171a�'p+�rll�I�
Inspection Requests (24 Hrs.): (503) 639 -4175 .- _
INSPECTION WORKSHEET FOR DATE: 4/14/2006 TIME: 7:07AM PAGE: 76
SITE ADDRESS: 12270 SW MARION ST CLASS OF WORK: •
SUBDIVISION: WILLAMETI - E 140.2 LOT #: 021 TYPE OF USE:
PROJECT NAME: PIERCE
DESCRIPTION: LINE WORK FOR SEWER CONNECTION. SEPTIC SYSTEM TO BE PUMPED AND FILLED OR
REMOVED.
OWNER: PIERCE, JOHN PHONE #: 5C)3-679.65's3
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 028030.01 503- 579.5553 N
Corrections /Comments/ Instructions:
N.),- cotue0--
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❑ PASS ❑[ ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL E L FO INSPECTION ❑ ADDITIONAL FE S ASSESSED
• ,r
Inspector: Date: ' a Phone #: (503) 718- 2+2-3