Permit c'1 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00147
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/17/2007
PARCEL: 25111 BA - 00804
SITE ADDRESS: 09940 SW MCDONALD ST ZONING: R - 3.5
SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 025 JURISDICTION: TIG
PROJECT: MILLER
Project Description: Line work to connect sewer. 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: 107 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PHILLIP MILLER
9940 SW MCDONALD Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/17/2007 $101.40
[TAX] 8% State Surcha 4/17/2007 $8.00
•
Phone : 03- 684 -2866 Total $109.40
Contractor:
CANTRELL & SONS CONTRACTING •
6860 SW NORSE HALL RD •
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 638 -0800
Reg #: LIC 97005
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 Signatur• •
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 h , ;� � -` aim -
Plumbing Permit Applicat' 1 i Virg. foil OFFICE USE ON1.1
City of Tigard pp r� y Received , / A . Permit N p
74 a 13125 SW Hall Blvd., APR , Tigard, OR 97223 1 f 2007 Date/By. / # / ,, ' L a ,...4e/ - Oa /ii
• Phone: 503.639.4171 Fax: 503.5981960 T • DDate/B eW
: Other Pemu5WQd001.. 00O I
(Ai Line: 503.639.4175 i Y or Il _
r I c. n r D Internet: www.tigard- or.gov S la See Page 2 for
So emmtal laformation
7
TYPE OF • • • 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(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: el ei ki, 4, '70...) 1 ud io o y l,„ j „ Catch basin or area drain 16.60
City / State/ZIP: 't'1 0 C (1- 2. 9- 4 . 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
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 Badtflow prevents Page 2
. (1,0d7 I- I.
Backwater valve 16.60
C' ��- n I ,.l 4- g, . Clothes washer 16.60
• `'�T Dishwasher 16.60
❑ PROPERTY OWNER I '❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ei•t►vvI r VU.t ,,--'
Expansion tank 16.60
Address: q C ( Ikt, /7w i17Gp.-P/-2 t.-. Fixture/sewer cap 16.60
City/State/ZIP: fit ii-fi 7 to 91. 7_24' Floor drain/floor sink/hub I 16.60
Phone: (Sol) L 4 . -2..< Le. 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: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
E -mail: Tub/shower/shower pan 16.60
Urinal 16.60
CONTRA OR Water closet 16.60
Business n.� 1 % , _ I __ �.A.- • Water heater 16.60
Address: Other:
City /State/ZIP:
Subtotal
- Minimum permit fee: $72.50
Phone: ( ) Fax: /l
( ) Residential backflow minimum permit fee: $36.25 �Q /
CCB Lic.: 97O Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signs State surcharge (8% of permit fee) ! '
L..- A . 1! TOTAL PERMIT FEE 1 10
I Print name: 7 V .0Jk1J ph 7L Date: �'1 t-1.l , •' This permit application expires if a permit is not obtaine within
i 1 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I: \BuiIding\Pamin\PLM.PamitApp.doc 06/26/06 U�
. e - 440.4616T(IO2/COM/WEB) Qg • �0
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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 g5 - Medical Gas Systems:
Water Service - each additional 100' 46.40 4, j
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 Backfow 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
specially requested inspections - per hour 72.50 and including $50,000.00.
h ,y $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: P WC 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 OAR918- 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 in 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.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage -Domestic
Disposal - Commercial • •
-Industrial
Ice Mach./Refig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
-Commercial
lumbin permit can be issued.
-Service vice P g Pe
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i i &dldingiPamits\PLM- PmnitApp.doc 09/22/06
ORVALL T. CADS JOB INVOICE
BYER`S SEPTIC TANK SERVICE, INC.
P.O. BOX 549
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO. DATE ORDERED
(503) 656 -3326 ' / - /q. 3()
ORDER TAKEN BY DATE 7 PROMISED ❑ A.M.
A / C O ❑ P.M.
BILL TO PHONE
cC A. I V< ,3 -ogDO
ADDRESS MECHANIC
CITY HELPER
JOB NAME AND LOCATION /wy ^/ l a 1 ¢ I t
5 SID S. w. ' / ❑ DAY WORK
❑ CONTRACT
DESCRIPTION OF WORK
❑ EXTRA
OUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
P
ary
TA/7h
•
HOURS LABOR AMOUNT
TOTAL
MECHANICS Co? 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
BILDING DIVISION PERMIT #: PLM2007 -00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/17/2007
Phone: (503) 639 -4171 At
f
l
Inspection Requests (24 Hrs.): (503) 639 -4175 F
INSPECTION WORKSHEET FOR DATE: 4/20/2007 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 09940 SW MCDONALD ST CLASS OF WORK:
SUBDIVISION: TIGARDVILL.E HEIGHTS LOT #: 025 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Line work to connect sewer. Septic system to be pumped and filled or removed.
OWNER: MILLER, PHILLIP PHONE #: 03-684-2866
CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503 - 638 -0800
Inspection Request Scheduled For: Date: 4/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitaiy sewer 046893 -01 503-638-0800 N
Corrections /Comments /Instructions:
" S o Pvc. She
3.19
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v oivx.t,.A -•— Date: Li 12 -D/0") Phone #: (503) 718-