Permit i. _ l
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00350
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/26/2008
PARCEL: 2S103BA - 01001
SITE ADDRESS: 11975 SW WALNUT ST ZONING: R-4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: ANDERSON
Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement district
#18. Fees paid 8/26/2008.
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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ED ANDERSON
11975 SW WALNUT ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/26/2008 $72.50
[TAX] 12% State Surch 8/26/2008 $8.70
Phone : 503- 984 -4882 Total $81.20
Contractor:
MICHAEL B MCBEE
11704 SE 63RD AVE
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 239 -2707
Reg #: LIC 55821
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 �O/ �i� 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
Building Fixtures O FOR OFFICE USE ONLY
lipg City of Tigard 0*° Date/B Received .2i /g Permit No / f7))r �`-� Y
a 1 3125 SW Hall Blvd ,Tigard, OR o� Plan Revte / ''u —` � j �
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C Phone 503 639 4171 Fax 5 i (.� iti �
4[ � Date/By Other Permit No Swi2ew� /4
TI G n R D Inspection Line 503 639 4175 \\\\� Y �O ate Ready /By rums ®See Page 2 for
Internet www Tigard or gov pv+ 1, �` ) otified/Method 7769 Supplemental Information
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TYPE OF WORK � _ ` � �V -a FEE* SCHEDULE
❑ New construction ❑ D 1 For special information use checklist.
�`` VV Description I Qty Ea Total
❑ Addition/alteration/replacement ❑ lJ New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249 20
❑ I- 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
0 Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / / 9 7 5' f rQ'r _
S t J �c* nJ Catch basin or area dram 16 60
City/State /ZIP: / r 00 CVC i O 0 n C / .4 223 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: • I Project nalfte: Footing drain (no linear ft.. ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site:
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft Fr&) 1 Page 2 c
Storm sewer (no linear ft _) Page 2
Subdivision: 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
Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
n
Ejectors/sump 16 60
Name: 4.:L Ar'1t YSo n Expansion tank 16.60
Address: /0 O 8 ox 22193 Fixture /sewer cap 16 60
City /State /ZIP: 7"rry„1 0.,..>rCC. O ye OZ'S 9 .a9/ Floor drain/floor sink/hub 16.60
Phone: (603) 9$ . yg 86 � ax: ( ) f Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Ice maker 16 60
Business name: /71.! QS 0 hril 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: i'i i k e _ M C> ee Water heater 16.60
Address: f/ 70 4 1 S t G3 ht ' Ave, Other
City /State /ZIP: CI , l L )C..0 (C,; Q, 0 re 0 r" 2 a s Subtotal
Minimum permit fee $72.50 _-
Phone: ( ) Fax: ) Residential backflow minimum permit fee $36.25 o<
/ -V.
CCB Lic.: SS g a I Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of permit fee) Y'_
TOTAL PERMIT FEE f ,
Print name: L V D A IV r2S6 A Date: g/ a /O 2 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
/ /1 ° *Fee methodology set by Trr -Co Buildi Industry Service Board
1 \Buildmg\Permits
V/ /1 pp.doc 12 /27/06 440- 4616T(10 /02/COM/WEB)
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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 - ls' 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 ss. ✓ 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 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
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
Subtotal: $50 00 and up $742 00 for the first $50,000.00 and $1 20 for
each additional $100 00 or fraction thereof
Commercial 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
\Bwldmg\Permits\PLM- PermiiApp doc 12/27/06
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008- 00350
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26/2008
Phone: (503) 639 -4171 rl
Inspection Requests (24 Hrs.): (503) 639 -4175 .J' 'L I..
INSPECTION WORKSHEET FOR DATE: 8/28/2008 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 11975 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ANDERSON
DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement district
#18. Fees paid 8/2612008.
OWNER: ANDERSON, ED PHONE #: 5039844802
CONTRACTOR: MICHAEL B MCBEE PHONE #: 503239 - 2707
Inspection Request Scheduled For: Date: 8/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 074803 -01 503 -481 -5348 Y
Corrections /Comments/ Instructions:
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t V PASS . ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr111 :\ M Date: 712T ‘O Phone #: (503) 718-