Permit CITY OF TIGARD
PLUMBING PERMIT
�� DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00120
s =s' ..� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4(6(2006
PARCEL: 2S 102C D -04900
SITE ADDRESS: 09777 SW O'MARA ST ZONING: R -4.5
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SUBDIVISION: PP1992 - 012 LOT: 002 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
CLAYTON, MARLIN L
9777 SW O'MARA ST Description Date Amount
. TIGARD, OR 97223
Total
Phone : 503 639 - 8148
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: (4 , - /
I `
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.
FtECEIVED e., t, 0,
Plumbing Permit Aa
City of Tigard b 2006 A Received
DDate/By f Permit No�) _ t
13125 SW Hall Blvd., Tigard, OR 97223 b/ 0 G r Ug
Phone: 503.639.4171 Fax: 503.598.1 Place Rev1e `
TY OF TIGARD ,- ; ,�� Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.41'j5 DNISIO'__- I
Internet: www.tigard-or.gov Date Ready/By. r1° "' SI See Page 2 for
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 gs (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 budder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: i 717 5 , /2 � - Catch basin or area drain 16.60
City/State/ZIP: 1 C/ L K Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 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.g S ) _ Page 2
Stone 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 Back preventer Page 2
I t9 _
•_ - . : i •r `lli . -4 _ _ J Ai A. _ � e Backwater valve 16.60 •
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: � • �� -
Expansion tank 16.60
Address: 9 7 7 7 J! Fixture/sewer cap 16.60
City /State/ZIP: � d � IDI q 7�,,7 3 Floor drain/floor sink/hub 16.60
Phone: � ) / q /,!g Fax: ( ) Garbage disposal 16.60
13 ( APPLICANT ($ El CONTACT PERSON Hose bib 16.60
Business name:
Ice maker 16.60
Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) 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
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Oth
City /State/ZIP: Subtotal
Minimum permit fee: $72.50 n
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 "i�-ct)
CCB Lic.: Plumb' Lic. no.: Plan review (25% of permit fee)
Authorized signature:, �� State surcharge (8% of permit fee) 5U
TOTAL PERMIT FEE 7� 30
Print name: f jlhi to I Date: � b This permit application expires if a permit is not obtained wwithin
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Buildineamins \PLM- PamitApp.doc 12/30/0S 4404616T(IU'02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: • Residential Fire Suppression Systems:
Site Utilities Qty. Fee (es) 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 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 fix the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (a) 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 Back flow 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: $50,001.00 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 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 (Fhtare) Work Performed
❑ Any new commercial building.
Future Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Kristin ❑ 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 - D multipurpose fire sprinkler system.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
-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./Refiig. 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 *Note: If the fixture work under this permit results in an
Water Extractor i ncrease of sewer EDUs, permit Closet - Toilet s, a sewer rmit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: _ plumbing permit can be issued.
i1Building \Prnniu\PLM- PennitApp.doc 07/06/05
CITX OF TIGARD -19.1-1
BUILDING DIVISION � �� PERMIT #: - 06 i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 i l
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I � ��� 2S T
INSPECTION WORKSHEET FOR DATE: 1 / ta2./ £ CO TIME: PAGE:
SITE ADDRESS: D i Ot iv\ va-- 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
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Corrections/Comments/Instructions:
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v(94.6.6 ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
' 16 '
Inspector: Date: /as Phone #: (503) 718 ��
CITY OF TIGARD Air 1
BUILDING DIVISION PER MIT #: a 4 006_ bo / a
13125 SW Hall Blvd., Tigard, OR 97223 �- DATE IS SUED:
Phone: (503) 639 -4171 A 1a4P
Inspection Requests (24 Hrs.): (503) 639 -4175 ' �i
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: < 7 7 7 6 ' m Q/l,et__, CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
•
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: y- / 7 ` 0 Co Pour Time:
C e # Inspection Description Confirm # Contact # Message
397 6 3 9 — F/ (te
Corrections /Comments /Instructions:
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❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
J Y 1 ' 7'v Inspector: Date: �I 1 � l c� Phone #: 503 718- ��