Permit -r. "CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00401 •
TIGARD ' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/4/2007
PARCEL: 2S 111 AB -02200
SITE ADDRESS: 09185 SW MOUNTAIN VIEW LN ZONING: R-4.5
SUBDIVISION: ELROSE TERRACE LOT: 018 JURISDICTION: TIG
PROJECT: LINDSAY
Project Description: Line work for sewer connection. NO reversal. Septic 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
LINDSAY, ROY L + CHARMAINE C TR
9185 SW MTN VIEW LN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 9/4/2007 $72.50
[TAX] 8% State Surcha 9/4/2007 $5.80
Phone : • 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: Permittee Signature: X 41 Y9VA/1/41
Call 503.639.4175 by 7:00 a.m. for an inspection that busin s 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 . ,
Buildin Fixtures ' S.,.-7? 0 4 2007 FOR OFFICE USE ONLY
R eceiv
.� City of Tigard / Permit N
� 13125 5W Hall Blv �^+ -_ d, 9 3 . / '�� a Plan Re ew
DateBy 11/12 '. 2 O� YLJ'� � i �-, � '^ �w y� ��
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C Phone: 503.639. 7 9 y . Other Permit
Ins ection Line: 6 ' W /..1`,44a3` ' N, r . s ION D ate B
T I G n R D p > � �' A x Date Ready/By: tu El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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
❑ I - 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: % ' J GJ . ki r (� � IA ) LA A14 Catch basin or area drain 16.60
City /State /ZIP: /0440 Q� , la 1 7, 9, !) Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project Proj � t 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 I 16.60
DEON OF WORK Backflow preventer Page 2
(( Backwater valve 16.60
7 L`∎ e�f Clothes washer 16.60
✓"� - � `+- Dishwasher 16.60
igi PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
, ^rl Ejectors/sump 16.60
Name: / , L 1 N () ki Expansion tank 16.60
Address: § I 5 J 4 1 . f 4 i', I / r m j A, Fixture /sewer cap 16.60
City /State /ZIP: --r• 1 6 2 n DR 91 y .. . Floor drain/floor sink/hub 16.60
Phone: (j 03 ) 6, ` 3 q - 51 6,, / Fax: ( ) Garbage disposal 16.60
/ Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
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: Water heater 16.60
Address: Other: )1/4)0
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
7� `n
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 .�/
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
/ , State surcharge (8% of permit fee) .j .&)
X
Authorized signature: / A TOTAL PERMIT FEE 7
Print name: 0 . Z /A) O f'/S Date: d T his permit application expires if a permit is not obtained within
7 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building\Permits\PLMF- PermitApp.doc 12/27/06 440-46I6T(10/02/COM/WEB) .... R . �3 5. ea
as i 3.30
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: ' ' e 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 - I st 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
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
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 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
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:\ BuildinOermits \PLM- PermitApp:doc 12/27/06
ORVALL T. CARE
.� 4fO INVOICE
BYER'S SEPTIC SERVICE, INC.
P.O. BOX 549 _ _ .
OREGON CITY, OREGON 97045 I
(503) 656 -3326 CUSTOMERS ORDER NO DATE TE O1DE - O 7
ORDER TAKEN BY DATE PROMISED ❑ A M
Grace 9` -1 1 ❑ P.M.
BILL TO PHONE
Gen' Can}r °1 31221363
ADDRESS ME AN
CITY
JOB NAME AND LOCATION
9185 SW Mtn. View Ln. ❑ DAY WORK
1:1 CONTRACT
DESCRIPTION OF WORK
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Ord: Scott
OUAN I . DESCRIPTION OF MATERIA USED PRICE AMOUNT
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HOURS LABOR AMOUNT
MECHANICS ® I TOTAL MATERIALS j /
HELPERS (0 TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATE COMPLETED
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- -00401
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/4/2007
Phone: (503) 639 -4171 � 4 ilj
Inspection Requests (24 Hrs.): (503) 639 -4175 "__..
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7:01AM PAGE: 2
SITE ADDRESS: 09185 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: ELROSE TERRACE LOT #: 018 TYPE OF USE:
PROJECT NAME: LINDSAY
DESCRIPTION: Line work for sewer connection. NO NO reversal. Septic to be pumped and filled or removed.
OWNER: LINDSAY, ROY L + CHARMAINE C TR, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/13/2007 S Pour T
Code # Inspection Description Confirm # Contact # M age
505 Sanitary sewer 055662 -01 503- 312 -1363 Y
Corrections /Comments /Instructi rls:
4 ( ire T?W V 5c., 4 D
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(..; vi --i "2,___,,,_,
36i \ S
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
p c i')1 \� o ( Z�I 7:1, Ins ector: v " Date: Phone #: 503) 718-
CITY OF TIGARD 4 & -06 4 #/
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Aik
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: L9// 3/0 7 TIME: PAGE:
SITE ADDRESS: q/ ( CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instr ctions:
(390 5c_pf?
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ��/ �" C) 4/ 4/ 13 / 6 Phone #: (503) 718 -