Permit m• i .A
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: P -00226
DATE ISSUED: 6/1/2005 1/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S103CD - 04600
SITE ADDRESS: 11635 SW TERRACE TRAILS DR ZONING: R - 4.5
SUBDIVISION: TERRACE TRAILS LOT: 014 JURISDICTION: TIG
Project Description: Repair sewer line in driveway & sidewalk area.
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: 5 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MURILLO, JOSEPH J AND
BARBARA L Description Date Amount
11635 SW TERRACE TRAILS [PLUMB] Permit Fee 6/1/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/1/2005 $5.80
Phone : 503- 748 -5422 Total $78.30
Contractor:
ROOT EXCAVATION
108245 E OAK ST
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Phone : 503- 638 -3447
Reg #: LIC 134498
PLM 3 -433PB
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: SR .e � \.(1
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.
May 31 05 01:41p• BRIDGET WILSON (503) 777 -6655 p.2
RECEIVED - '
PlumbingPermit Application Foii ol•FIC F, t:s1: ONLY
City of Tigard Dat
MAY 1 21 R ece i ve d eBy, { 1 ��> permit N.01\ � 0d2,2 6
13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TI A' • Plan Review • Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 �'*11,�ire: l '''' Date /By:
24- Hour Inspection Line: 503.639.4175 BUILDING 8 _�Jy '1 II Date Ready/By: Joss: B1 See Page 2 Br
Internet: www.ci.ligard.or.us • Notified/Method: j1 Supplemental Information
TYPE OF WORK FEES' SCHEDULE
For special information use checklist
■ New construction ■ Description I`. Qty. I Ea. I Total
; ■ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility_connection)
1 �� 249.20
SFR (1) bath
SFR (2) bath • 350.00
``= ■ Co 399.00
SFR (3) bath
• ccessory buikling ■ Each additional bath/kitchen 45.00
■ . ■ Fire sprinkler ( sq. R) _ Page 2 _
INFORMATION JOB SITE Site utilities '
- .' Job site address: 11635 SW TERRACE TRAIL Catch basin or area drain 1 6.60
City/State /ZIP: TIGARD, OREGON .. Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: • Manufactured home utilities 110.00
Cross street/directions to job site: Manholes • 16.60
Rain drain connector 16.60 •
• Sanitary sewer (no. linear ft.: ) i Page 2 •�
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2 •
Subdivision: I Lot no.: -
Fixture or item
Tax map /parcel no.: - . . .
. Absorption vave 16.60
DESCRIPTION OF WORK Backflow preventer - Page 2
REPAIR SEWER IN DRIVEWAY AND SIDEWALK AREA Backwater valve 16.60 '
Clothes washer 16.60 -
Dishwasher 16.60 .
Drinking fountain., 16.60
�: PROPERTY OWNER I 0 TENANT 16.60
Ejcctors/sump
Name: \'\?:\A`\ \\ a � ()_�Q, Expansion tank 16.60 a
Address: ' I ` Fixture /sewer cap 16.60
City/State/ZIP: : Floor drain /floor sink/hub 16.60
Garbage disposal 16.G0
Phone: �oj) 'f y�� Fax: ( ) . 16.60 .
L1 -s
d Hose bib
❑ APPLICANT ❑ CONTACT PERSON ice maker / 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
•
Primer 16.60
Address:
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
1 CONTRACTOR Water closet 16.60
Business name: 'tQ D' - 65cC,(j JS f \ bw,/ Water heater I 16.60
t ■
Other:
Address: 10824 SE OAK STREET # 322 •
Subtotal
City /State /ZIP: MILWAL'KIE, OREGON 9722 Minimum permit fee: $7 2.50
Phone: (503) 638 -3447 Fax: (503) 656 -6625 Residential backflow minimum permit fee: $36.25
CO
Plumbing Lic. no.: Plan review (25% of permit fee) CCB Lie'.: 134498 • - g State surcharge (8% of permit fee)
Authorized signaturd:, ' \k( r� �� ' V.,1)1.' � `i - TOTAL PERMIT FEE
� � L , 05 -31 -2005
Print name: PATRICI4 RAGLAND This permit application expires if a permit is not obtained within - 180 days after it has been accepted as complete.
. . ' 'Fee mcthodoloev set by Tri -County Building Industry Service Board.. '
i j , r - �� . r �"� � �� , "sue- �c- - 7C� \V NZTh \ 4.L3
May 31 05 01:40p BRIDGET WILSON (503) 777 -6655 p.1
Plum bill Per mit Applicat - City of Tigar
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
55.00 0 to 2,000 $115.00
Footing drain - 1 100' 2,001 to 3,600 $160.00
Footing drain - each additional 100' 46.40
g 3,601 to 7,200 $220.00
Sewer - 1st 100' ; 55.00 CAD 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 $1.00 to $5,000.00 Minimum fee $72.50
Storm tk Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 onal the first 00 or f $5,000.00
ction thereof, for
Fixture or Item Qty- Fee (ea) Total including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 each $148.50 for the first $10,000.00 and
n thereof, f for
Residential Prevention Device and including $25,000.00.
(minimum permit ermit fee $36.25) 27.55
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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain ,
Eye Wash
-
Floor Drain/sink - 2"
3 ,.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refrig. Drains fees assessed for the sewer increase must be paid before the
Oil Separator (Gas Station) plumbing permit can be issued.
Rec. Vehicle Dump Station
Shower -Gang
-Stall -
Sink -Bar/Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service _
Swimming Pool Filter ,
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
CITY OF TIGARD _
BUILDING DIVISION ERMIT #: p 0 -0022-‘,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 All
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6,— 3 - TIME: PAGE:
SITE ADDRESS: / / ( 3,s- i,..e ut.c1ex, D ' CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: LS 3 / 1 1 - 7
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Rquairias - j -A Tr
0; GA'
Code #3 Inspection Description Confirm # Contact # Message
X51. r6t).44-11-4-
Corrections /Comments /Instructions:
/(,) A"-k
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I L rg . ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 13 °
g Phone #: (503) 718-