Permit �'' a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00254
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/19/2007
PARCEL: 2S 102C D - 02608
SITE ADDRESS: 09800 SW O'MARA ST ZONING: R-4.5
SUBDIVISION: TWALITY HILL LOT: 008 JURISDICTION: TIG
PROJECT: KIMBLE
Project Description: Connect existing house to sewer service, approximately 45'. Septic tank is to be pumped and
filled.
CLASS OF WORK: ALT 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
HENRY KIMBLE
9800 SW O'MARA Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/19/2007 $72.50
[TAX] 8% State Surcha 6/19/2007 $5.80
Phone : Total $78.30
Contractor:
NW SUNDANCE SERVICES
10117 SE SUNNYSIDE RD STE F120
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 888 -2672
Reg #: LIC 163547
PLM PB264
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 •' -ct questions o OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu >d By: /1 j7/f Permittee Signature:
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
City of Tigard Received y i f 0 7 Permit NO.: i � • _ 5�
1 0 a 13125 SW Hall Blvd., Tigard, OR 97223 plan Review i �O �l n
Phone: 503.639.4171 Fax 503.598.1960 DatdBy. Other Permit No.'. l() `7 9(9
Inspection Line: 503.639.4175
T I G A r
D Date Ready 113y. .1� ®See Page 2 for
Internet: www.tigard - or.gov NotifieNMethod / t(� Supple m ental info
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
o g Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 it for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
0 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:C go.) Catch basin or area drain 16.60
City /State/ZIP: -V. t �1zt� C aa3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt no.: � t Project name: Footing drain (no. linear R: ) Page 2
Manufactured home ut 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. litlear ft:(1 Page 2 6
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
(,D lJ to �G EExi r / ' rI f-OUf i- /D .eiwea- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
41 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name:
N��y booryi,A, I H 6L4., Expansion tank 16.60
Address: (,k7 , J Q 1 /Yl i4/Z $7 Fixture/sewer cap 16.60
City/State/ZIP: 7 c 'i1 �o Qe 4 702 0 1 3 Floor drain/floor sink/hub 16.60
Phone: (.03) 6 39 5-7 / Fax: (9)3) 6s' /. 5793 age disposal 16.60
41 APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: x)w .5unciety`C2. ices Interceptor /grease trap 16.60
Contact name: ux�S Medical gas (value: $ ) Page 2
Address: 1011-, c cS n�l� off& TA .5‘e_? t ��w Primer 16.60
City/State/ZIP: C \nc�u�nrnck`l car x(315 G � Roof drain (commercial) 16.60
Phone: ( )b - 7. Fax:: ( ) Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
>rma ft:
Urinal 16.60
CONTRACTOR n Water closet 16.60
Business name: \i r N ) 5 cinrc,e JPC V iCe_, Water heater 16.60
Address: Oil `7P ,'( )Y r j (Vie `Q 6► NE F 120\ Other:
Subtotal
City /State/ZIP: C1(rbncS 0A Q 1015
Minimum permit fee: $72.50 7r), 5-0
Phone:
(=03 ) - r `o7 f Fax: ( ) i Reside backflow minimum permit fee: $36.25
I C _3541 3 / / q 1 : foq Plan review CCB Lic.: ll! ! 7 r p Plumbin Lic. no.: �1.� 7lll ( (25% of permit fee)
Authorized signature: ' ^ State surcharge (8% of permit fee) 5 .8U
V ��� _ TOTAL PERMIT FEE 7g.3
I Print name: k.A. )P c, c 1 I Date: S' b/c7 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.
I :\&did ngNPennita\PLM.PumitApp.doc 06/26/06 410.4616T(IWO2ICOM/WkB)
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 a 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
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 Badcfiow 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 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 *. ❑ My new commercial building with water service 2" and
QuaodtY by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: R1 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 ❑ My multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ My 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"
_
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
-Industrial
Ice Mach./Refrig. 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
-Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes •
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures:
•
i :\&dwmgWermitstPLM- PermitApp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00254
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/19/2007
Phone: (503) 639 -4171 A I
Inspection Requests (24 Hrs.): (503) 639 -4175 "I
INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7:03AM PAGE: 36
SITE ADDRESS: 09800 SW O'MARA ST CLASS OF WORK:
SUBDIVISION: TWALITY HILL LOT #: 008 TYPE OF USE:
PROJECT NAME: KIMF3LE
DESCRIPTION: Connect existing house to sewer service, approximately 45'. Septic tank is to be pumped and filled.
OWNER: KIMBLE, HENRY PHONE #:
CONTRACTOR: NW SUNDANCE SERVICES PHONE #: 503-888-2672
Inspection Request Scheduled For: Date: 6/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 050657 -02 503-888-2672 ' Y
Corrections/Comments/Instructions:
e f ql — C S C, /
V
/
-- . 2 .-- \ .._,
I 4
1 Y ' /
E RASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: fl4 Date: Sif_ Phone #: (503) 718- 243/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00254
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/19/2007
Phone: (503) 639 -4171 0
Inspection Requests (24 Hrs.): (503) 639 -4175 '-- L
INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7:03AM PAGE: 37
SITE ADDRESS: 09800 SW O'MARA ST CLASS OF WORK:
SUBDIVISION: TWAI.ITY HILL LOT #: 008 TYPE OF USE:
PROJECT NAME: KIMBLE
DESCRIPTION: Connect existing house to sewer service, approximately 45'. Septic tank is to be pumped and filled.
OWNER: KIMBLE, HENRY PHONE #:
CONTRACTOR: NW SUNDANCE SERVICES PHONE #: 503-888-2672
Inspection Request Scheduled For: Date: 6121/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 050657 -01 503- 888 -2672 N
Corrections/Comments/Instructions:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-