Permit l� e,pr n -�' ,perms ; 7 - 4r adckd u)GL Se i c.2
-.i" CITY OF TIGARD . rClG� P L3ERMIT
COMMUNITY DEVELOPMENT
PERMIT #: PLM2007 -00252
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/19/2007
PARCEL: 2S 103DA - 03290
SITE ADDRESS: 10655 SW PARK ST ZONING: R - 3.5
SUBDIVISION: DERRY DELL PLAT 2 LOT: 035 JURISDICTION: TIG
PROJECT: KRAGER
Project Description: Connect existing house to sewer, approximately 45', reversing plumbing under house. Septic tank
is to be pumped and filled. 7/25/07 ADD 40' of water service.
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: 45 ft
WATER CLOSETS: WATER LINE: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ROBERT W. KRAGER
10655 SW PARK STREET Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/19/2007 $117.50
[TAX] 8% State Surcha 6/19/2007 $9.40
[PLUMB] Permit Fee 7/25/2007 $55.00
Phone : 503- 684 -4902 [TAX] 8% State Surcha 7/25/2007 $4.40
Contractor: Total $186.30
WOLCOTT PLUMBING CONTRACTORS
PO BOX 20698
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 235 -8784
FAX 503- 491 -2932
Reg #: LIC 23847
PLM 26 -208PB
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 1.800.332.234.4.
Issued B • A /Xla / ti Permiftee Signature: rir?
ice
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.
I
CITY TIGARD SEWER CONNECTION PERMIT
° , COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00139
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/19/2007
PARCEL: 2S 103 DA - 03290
SITE ADDRESS: 10655 SW PARK ST ZONING: R -3.5
SUBDIVISION: DERRY DELL PLAT 2 LOT: 035 JURISDICTION: TIG
PROJECT: KRAGER
Project Description: Connect existing house to sewer service.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
ROBERT W. KRAGER
10655 SW PARK STREET Description Date Amount
TIGARD, OR 97223
[SWINSP] Sewer Inspection Fee 6/19/2007 $35.00
[SWUSA] Sewer Connection Fee 6/19/2007 $2,700.00
Phone: 503- 684 -4902 Total $2,735.00
• Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the
date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer
laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given.
If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon
law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through
OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss ed by: I Permittee Signature: y
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
Building`Fixtures FOR OFFICE USE ONLY
/•
City of Tigard Date/By: K 7 Permit No.: Gj--6,-M
I II • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ' C
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: )L . o 7-DO / 3 4
T I G A 12 D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ID New construction ❑ Demolition For spedal injornration 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
❑ 1- 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: /e2‘.5:5" 55 5 eAl. /s_,-/c: S .4. Catch basin or area drain 16.60
City /State /ZIP: "I ,f a rd O ,e 972 Z 3 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: /fir a 9 r
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: V6 Page 2 93
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
e r i o r r y r r a7‘ c e ( v - r u - s . . . , 1 4 0 1 , - . 0 > e . J Q r../ . - - • Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: /2 t L ry €.i„_. if r a 9 -e-v- Expansion tank 16.60
Address: /O 6 j S ..s GJ, yea v. (G - 5 ";7‘: Fixture /sewer cap 16.60
City /State /ZIP: T'1' y a o,e 9'77 7 3 Floor drain/floor sink/hub 16.60
Phone: (5 '3) G ra �1- Y 90 z_ 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
Sink/basin/lavatory 16.60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
1
Business Water he ter 16.60
Address: Other: kf i de,. �c�yi • 6,.,--t. 62. 5-0 Subtotal
City /State /ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 // /. -
CCB Lie.: Plumbing Lic. no.:
Plan review (25% of permit fee)
State surcharge (8% of permit fee) F. yo
Authorized signature: , ,.ey/ TOTAL PERMIT FEE M6 .90
Print name: /4 • 1,441` re rt 01 ay e rr- Date: 6 -/7..20,2 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.
IABuilding\Pe nits\PLMF- PennitApp.doc 12/27/06 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information y.
•
•
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 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
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 *. ❑ 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:\Building\Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
r, f
BUILDING DIVISION _ PERMIT #: PLM2007- 0O253.
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 61190007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: d17(2007 TIME: ?MIN PAGE: !)
SITE ADDRESS: Ma. SW PARK Si CLASS OF WORK:
SUBDIVISION: L)fRRY DEl.l. PLAT 7 LOT #: 035 TYPE OF USE:
PROJECT NAME: KRAt ER
DESCRIPTION: Connect ' housre4o.wwet,: proximately 45', reversing plumbing u house. Septic tank is
to b4 pumped and filled. 7125101 ADD 40' of water I:ervic :o
OWNER: KRAGER, ROBERT PHONE #: 503 604-1902
CONTRACTOR: WOLCO1T PLUMBING CONTRACTORS PHONE #: 603 13784
Inspection Request Scheduled For: Date: 9/7/2001 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 053661-01 503-235.87784 Y
Corrections /Comments/ Instructions:
Otte- 4 ■-,-‘4- 44"
M PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: d kM> >
Date: � � 7 � t�� Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION u PERMIT #: PLM2007- 00252
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/19/2007
Phone: (503) 639 -4171 440
Inspection Requests (24 Hrs.): (503) 639 -4175 IL
INSPECTION WORKSHEET FOR DATE: 8/2/2007 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 10655 SW PARK ST CLASS OF WORK:
SUBDIVISION: DERRY DELL PLAT 2 LOT #: 035 TYPE OF USE:
PROJECT NAME: KRAGER
DESCRIPTION: Connect existing house to sewer, approximately 45', reversing plumbing under house. Septic tank is
to be pumped and filled. 7/25/07 ADD 40' of water service.
OWNER: KRAGER, ROBERT PHONE #: 503 -6134 -4902
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503 - 235.8784
Inspection Request Scheduled For: Date: 8/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 053272 -01 503-235-8784 Y
Corrections /Comments /Instructions:
got‘, ��� cr �-[ `t P vG 303 y ,a— f ro
I Sx t ibvtac
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C13 � `" )4' Date: 31 Z 10/ Phone #: (503) 718-
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