Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT . PERMIT #: PLM2007 - 00287
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/5/2007
PARCEL: 2S 111 AB -02100
SITE ADDRESS: 09235 SW MOUNTAIN VIEW LN ZONING: R -4.5
SUBDIVISION: ELROSE TERRACE LOT: 017 JURISDICTION: TIG
PROJECT: FINCK
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: 110 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
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Owner: FEES
FINCK, WILLIAM R MARILYN
9235 SW MTN VIEW LN Description Date Amount
TIGARD, OR 97223 • [PLUMB] Permit Fee 7/5/2007 $101.40
[TAX] 8% State Surcha 7/5/2007 $8.11
Phone : 503- 693 -2867 • Total $109.51
Contractor:
CANTRELL & SONS CONTRACTING
6860 SW NORSE HALL RD
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
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Contact # : PRI 503- 638 -0800
Reg #: LIC 97005
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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: / ! 4
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 ApplicatioftECEivr _at:
Butilding Fixtures FOR OFFICE USE ONLY
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City of Tigard JUL 0 5 2001 Date/BReceived y : 1 S /o 7 46 6 Permit N -011A g/
Iii 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - �yy l
0 Phone: 503.639.4171 Fax: 503.598. �96q�� j (� 1 y '�/ : /� ," . D , : Other Permi [Ut: 0 7 -00i b "
Inspection Line: 503.639.4175 vl Y VS 1 ill`► a s a ' ead /B Juris/ ® See Page 2 for
T I G A It D Internet: www.tigard - or.gov BT I DI T 1 I I G . 4thod: �f Supplemental Information
TYPE OF WORK ` DIVING' A 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
xi_ 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: ?s' .RW Mni- n `i a l, v , -e L Catch basin or area drain 16.60
City /State /ZIP: ` fitSo of ( 0 g ci 7 a- a C. 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 /0/40
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
4,1;1g . DESC ON OF WORK Backflow preventer Page 2
u ./ 141.4.,11.1.4._ J V JJ:� �' Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER
I 0 TENANT Drinking fountain 16.60
r � Ejectors /sump 16.60
Name: W i I l 1i011- c M' ) y y. (P Expansion tank 16.60
Address: 9 3 S s (h) In(\ 0 ,, u N '--e, 4 „ 1/4 3 l ey` Fixture /sewer cap 16.60
City /State /ZIP: _"r', ,1 ( o g '] D - (f Floor drain/floor sink/hub 16.60
( 5D- 63 g-4
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: 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: Ca. h'tr.e I / g-Sbrd Water heater 16.60
Address: Other:
City/State/ZIP:
Subtotal Jo /, ./0
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: / - rte 6" Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) . i (
Authorized signature: t E P �=' TOTAL PERMIT FEE
109 5 f
Print name: ' , Ill ) : LC A yl'i R , �' N e Date: 7 -. D'7 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:\ Building \Permits\PLMF- PermitAppdoe 12/27/06 440-4616T(10 /02/COM/WEB) i� • J 3e
VI . _J
Plumbing Permit Application - City of Tigard r , -
Page 2 - Supplemental Information
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Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square 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
5 7,201 and greater $309.00
Sewer - each additional 100' 46.40 4v % fv
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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: �n w $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
I YO 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 *. El 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 El 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 El Any multipurpose fire sprinkler system.
Car Wash -Each Stall El 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.
- 4 e,
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:
i:Building\Permits\PLM- PermitApp.doc 12/27/06
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ORVALL T. CADE JOB INVOICE
- . . v BYER'S SE PICO BOX 54ERVICE, INC. •
. \le , OREGON CITY, OREGON 97045
(503) 656 3 GUSroMERS NO. ORDERED
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ORDER TAKEN BY � PROMISED ❑ A.M.
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� � V Y \ �� JOB NAME AND L �A 10 w. 7 ` ``� ❑ DAY WORK
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v DESCRIPTION O WORK ❑ A
• 1 Iiii 2 AMOUNT ..
OUANT. D ESCRIPTION OF MAT' ' AL USEi�
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LABOR AMOUNT TOTAL
HOURS LABOR MATERIALS
M ECHANICS CO
i TOTAL 11111 '
HELPERS ® LABOR
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I hereby acknowledge the satisfactory TOTAL LABOR - TAX
completion of the above described work DATE COMPLETED
SIGNATURE TOTAL 111111 .
. : C ./e/7.14_,.. .
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CITY OF TIGARD .
BUILDING DIVISION r PERMIT #: PLM2007 -00207
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/5/2007
Phone: (503) 639- 4171 tk
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/9/2007 TIME: 7:02AM PAGE: 30
SITE ADDRESS: 09235 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: ELROSE TERRACE LOT #: 017 TYPE OF USE:
PROJECT NAME: FINCK
DESCRIPTION: Line work to connect sewer. Septic system to be pumped and filled or removed
OWNER: FINCK, WILLIAM R MARILYN, PHONE #: 503 -693 -2867
CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503 - 63110600
Inspection Request Scheduled For: Date: 7/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 051631 -01 503-638-0800 N
Corrections /Comments/ Instructions:
/ 7°16/ .--12 ,
/
/
7
PASS 10 • . RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
f fri Inspector: Q Date: Phone #: (503) 718 -