Permit 1 / </e/ - o o-M "boo / tJ
C ITY OF TIGARD PLUMBING PERMIT
° ` COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00263
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/20/2007
PARCEL: 25111 BD -01802
SITE ADDRESS: 09980 SW MURDOCK ST ZONING: R -3.5
SUBDIVISION: ALDERBROOK FARM LOT: 005 JURISDICTION: TIG
PROJECT: WEBER
Project Description: Sanitary sewer line for sewer connection.
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
WEBER, WALTER N +
FLORENCE J TRUSTEES Description Date Amount
9980 SW MURDOCK [PLUMB] Permit Fee 6/20/2007 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/20/2007 $5.80
Phone : Total $78.30
Contractor:
GREG SCHROEDER
9812 SE WICHITA AVE.
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 654 -4734
FAX 503- 652 -2333
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 estions to OUN by alli g 503.246.6699 or 1.800.332.2344.
Issued By: I LI lid , Permittee Signature: J. ) eirjatf2.6 (a Ifry---
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 Application
• Buildfng *Fixtures FOR OFFICE USE ONLY
City of Tigard ived
g Date/By: 'LC3 Permit No.: p �MZt�?� 2�03
IN • 13125 SW Hall Blvd., Tigard, OR 97223 �� 1
C 2 0 2007 Date/By: an Review Phone: 503.639.4171 Fax: 503.598.196 Other Permit No.: Sta;0 _ O f
Inspection Line: 503.639.4175 Date Read /By: I ® See Page 2 for
7 I II D Internet: www.tigard- or.gov otified/Method: . 176)-1 Supplemental Information
TYPE QK I : FEE* SCHEDULE
El New construction i ibr Ei('iG DIVISION For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement VI Other: S .i Z% tr.OAR..ct New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
141- 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 ' f 47- /Gte/i e f7- Catch basin or area drain 16.60
City/State /ZIP: T ,(7-r7Z/ 0,1 t'7 zZ 5/ 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: 10 Tf!` ,,c1,9 fif/f,lr�iC /C_ Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: la) ( Page 2 95.00
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 Backflow preventer Page 2
Se - c_bnfl ec o - y , Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
jg PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ( -e,r- 1,3 el,o,cle Expansion tank 16.60
Address: f9.kp S'Al 1(//6,2dldCr S7 Fixture /sewer cap 16.60
City/State /ZIP: T,(5.7,l�. /2 q' - 7 , y _Floor drain/floor sink/hub 16.60
Phone:v40') 6 .; .1 g I k 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: . 7" - A1) Water heater 16.60
Address:
Other:
City /StatelZlP: Subtotal 55 .00
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 �2 . 50
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
�� L,, p State surcharge (8% of permit fee) S �D
. 1�-
Authorized signatur -2--
TOTAL PERMIT FEE %'g. 30
Print name /T/- /._- ( r / /L, 1 Date: 6720/7 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\Pennits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02/COM/WEB)
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 - 1 100' 55.00 0 to 2,000 $ 1 15.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' I 55.00 3,601 to 7,200 $220.00
56 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
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
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 futures? If "yes", Plan review is required for any of the following.
please indicate work performed by future. Failure to Please check all that apply.
accurately report futures 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 future 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\Pennits\PLM- PennitApp.doc 12/27/06
ORVALL T. CADE
JOB INVOICE
BYER'S SEPTIC TANK SERVICE, INC.
P.O. BOX 549
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO. RATE ORDERED
(503) 656 -3326 7 - 7
O 6� BY TE PROMISED ❑ Am
.urJ , g 17 ❑ P.M.
BILL TO PHONE
G," 5cL,.,,tott,
ADDRESS MECHANIC
CITY HELPER
JOB NAME AND LOCATION 9 [� C II .y. -,.`
S. NI. �ff eics L. ❑ DAY WORK
K. ❑ CONTRACT
DESCRIPTION OF WORK
❑ EXTRA
OUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
>
T„ K _ - --
HOURS LABOR AMOUNT
TOTAL
MECHANICS ® MATERIALS
HELPERS ® TOTAL
LABOR
A
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATE COMPLETED ' +
TOTAL 4
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20 /2007
Phone: (503) 639 -4171 A i ii .
Inspection Requests (24 Hrs.): (503) 639 -4175 ''I � ..
INSPECTION WORKSHEET FOR DATE: 8/21/2007 TIME: 7:OOAM PAGE: 56
SITE ADDRESS: 09980 SW MURDOCK ST CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 005 TYPE OF USE:
PROJECT NAME: WEBER
DESCRIPTION: Sanitary sewer line for sewer connection.
OWNER: WEBER, WALTER N +, PHONE #:
CONTRACTOR: GREG SCHROEDER PHONE #: 503 - 654 - 4734
Inspection Request Scheduled For: Date: 8/21 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 054358-02 503 - 780 -4734 N
Corrections /Comments /Instructions:
Ca arc ci 1 / - <i
yt PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ( J,.-)i 11 t 44-4. Date: g (2 (1 0 7 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2012007
Phone: (503) 639- 4171i�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ,„_.,
INSPECTION WORKSHEET FOR DATE: 8/21/2007 TIME: 7:OOAM PAGE: 57
SITE ADDRESS: 09980 SW MURDOCK ST CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 005 TYPE OF USE:
PROJECT NAME: WEBER
DESCRIPTION: Sanitary sewer line for sewer connection.
OWNER: WEBER, WALTER N +, PHONE #:
CONTRACTOR: GREG SCHROEDER PHONE #: 503 - 654 -41734
Inspection Request Scheduled For: Date: 8/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
350 Septic tank 054358 -01 503-780-4734 N
Corrections /Comments /Instructions:
CK PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \ l 1 i\-4. Date: $121 1 0 ? Phone #: (503) 718-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2007- 00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6120/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7:01AM PAGE: 55
SITE ADDRESS: 09980 SW MURDOCK ST CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 005 TYPE OF USE:
PROJECT NAME: WEBER
DESCRIPTION: Sanitary sewer line for sewer connection.
OWNER: WEBER, WALTER N +, • PHONE #:
CONTRACTOR: GREG SCHROEDER PHONE #: 503- 654 -4734
Inspection Request Scheduled For: Date: 8/17 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 054196.03 503-780-4734 Y
Corrections/Comments/Instructions: , za v7 / /� 1 p
gt10 -TG T ✓< e .. A, 1
�. V �-e.c_tc\c d-- C c
Foy - r — Lr
❑ PASS [Y:1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CI 1' 1 It -- Date: e// ?/a ? Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/17 /2007 TIME: 7:01AM PAGE: 56
SITE ADDRESS: 09980 SW MURDOCK ST CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 005 TYPE OF USE:
PROJECT NAME: WEBER
DESCRIPTION: Sanitary sewer line for sewer connection.
OWNER: WEBER, WALTER N + PHONE #:
CONTRACTOR: GREG SCHROEDER PHONE #: 503.654 -4734
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
350 Septic tank 054196 -02 503. 780.4734 N
Corrections /Comments /Instructions:
1 1 5.. f',t 1� �--� w C �� � $ . caivt
F✓ 'v-L3 v- fit✓ fi
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: d LA-A. Date: ZI 1 -7 /07 Phone #: (503) 718-
CITY OF TIGARD
1 .
BUILDING DIVISION PERMIT #: PLM2007 -00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20 /2007
Phone: (503) 639 -4171 /�he11:414,-1i11\
Inspection Requests (24 Hrs.): (503) 639 -4175 . '
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7:01AM PAGE: 57
SITE ADDRESS: 09980 SW MURDOCK ST CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 005 TYPE OF USE:
PROJECT NAME: WEBER
DESCRIPTION: Sanitary sewer line for sewer connection.
OWNER: WEBER, WALTER N +, PHONE #:
CONTRACTOR: GREG SCHROEDER PHONE #: 503 - 654 - 4734
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 054196 -01 503 - 78114734 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Yd (,►- 1 1 t n-'+ -- Date: 71/ 7 / 7 Phone #: (503) 718-