Permit CITY TIGARD PLUMBING PERMIT
�� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00118
III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/22/04
SITE ADDRESS: 12915 SW WALNUT ST PARCEL: 2S104AD -02700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: REP 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: 60 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing house to sewer. Approximately 60' of sewer service and reversing plumbing under the
house. Septic tank is to be pumped, filled & inspected.
FEES
Owner:
Description Date Amount
MURPHY, RONALD V + CATHERINE L
12915 SW WALNUT [TAX] 8% State Surcharl 3/22/04 $9.40
TIGARD, OR 97223 [PLUMB] Permit Fee 3/22/04 $117.50
Total $126.90
Phone : 503 - 590 - 0970
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503 653 - 5301 Misc. Inspection
Reg #: LIC 138941 Final Inspection
PLM 3 -434PB
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
Issued By: ; Plir, Permittee Signature:
Call (503) 6 * 5 by 7:00 P.M. for an inspection needed t e next bus' ess day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Date /By I "' d Perrmt No . P /. --40/1g
13125 SW Hall Blvd., Tigard, OR 97223 y
g Plan Review
Phone 503.639.4171 Fax: 503 598.1960 //y IN ;',N �• Date/By Other Permit No
24- Hour Inspection Line: 503.639.4175 c'l I1 Date Ready/By Juns ® See Page 2 for
Internet: www.ci.tigard.or us Notified/Method Supplemental Information
,, . - '.TYPE OF WORK' ' _ „; ,' : - .- ” = FEE* SCHEDULE.. -. '
❑ New construction ❑ Demolition For special information use checklist
Descnption 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 -- . c: < _ - 7-- ': - ' 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 spnnkler ( sq ft.) Page 2
. SITE INFORMATION. AND LOCATION ' - ; `• Site utilities
J1ob sitt;address: /.) / ' �f�2 e P: 77 /, /_ i ce— h� I `!� 'Z r Catch basin or area drain 16 60
ty - I / /)"� f f�� Gj 7 �� 3 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: � /� r imituj - .me %, / v ( / �/,,� Footing drain (no linear ft : ) Page 2
(.1 Manufactured home utilities 110 00
Cross street/directions to job site.
Manholes 16 60
Rain drain connector -rra�yy 16.60
Sanitary sewer (no. linear ft.: l/) _ Page 2 56O 17
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
' - '-: Backflow preventer Page 2
�..eyl -) ...- -e.---/ ,4oe3 4 ` 72 Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
• Drinking fountain 16 60
.❑ TEN --
-- - Ejectors /sump 16 60
f /2 /VU' /i- v Expansion tank 16 60
/5--- � j c- /n f ///
,,..h_ . . icy
,-,e y/Statei ZlP: 7T ��L 9" 73 1 Fixture /sewer cap 16 60
Floor drain/floor sink/hub 16 60
111:°111141:5-63) ' - '9 r 09 76 Fax: ( ) Garbage disposal 16.60
a Hose bib 16 60
'': .❑' APPLICANT ' - • 0 CONTACT PERSON...„
Ice maker 16 60
Business name:
Interceptor /grease trap 16 60
Contact name: Medical gas (value $ ) Page 2
Address: Pnmer 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:
Unnal 16.60
, - , _ I(XDJN O R _ ,, Water closet 16 60
•QBusinesc name: 7i14. �Oneed j ak , e j Water heater 16 60
i d 3 3 '3 7 W Lev A /,„ 1y J�,, Other �g JF_2SEa del 1. (oa.so
iv, ubtotal
ftylStteF2'I)?: , /2a- a /e„. " ( 7 X Minimum permit fee $72 50 . 9'
one 3 /te /
) C� 5 3 - 5 / Fax: ( ) — Residential backflow minimum permit fee. $36 25 1 / 7
k c -- - -/3 cy/ Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) q,' f
./ktsfhoriww --st trite: , / �� •
TOTAL PERMIT FEE
P t ir ' n ' �� i-- 3 1---- ,$ -,--5-611-1 ,� This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
i \Building\Pemuts\PLMF- PermitApp doc 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. Fee (ea) Total Square Footage:.. ' Permit Fee:
Footing drain - i 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 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
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:
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
-Dnve Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
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:
r\Buildtng\Pernuts\PLM- PemutApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lin 9 -4175
INSPECTION DIVISION Business Line: 3 39 -4171 MST
BUP
Received Date Requested - £ 3 AM PM BUP
Location /2 gi,c C)dL 4e Suite MEC p�
Contact Person Ph ( ) g - / a 3/ PLM 4 0 0 /1 0
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing e z
• c -P -k A4‘.. ;-i 11 'Zee :€
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
•
Fin
PART FAIL
M HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3/23/0 Inspector Cit' AA. ,0. ; )1(101 ' 1s2 " - Ext
Other: -
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
r '
Sche uled' 03/23/04 Date 03/
we A l �.
o Ignel Work Order # W015997
River City Environmental, Inc. Complete Industrial
P.O. Box 30087 503 - 252 -6144 Waste Removal
Portland, Oregon Septic Tank Cleaning
97294 Sump
Line Cleaning
Mr. Rooter Site Information
15033 SE McLoughlin #344 PO#
Milwaukie, OR 97267 �`-
503 - 653 -5301 12915 SW Walnut St
Description Units ' Amount
Septic Service
.@ / 5Lo()
•
Instructions: Driver Notes
Ron Murphy
Tigard, OR 97223
503 - 590 -0970
Map Page 655 A4
River City Environmental, Inc. is in no way responsible for damage to the septic tank or lids on the system.
Terms: Net 10 days. 1.5% per month will be charged on past due accounts. (18% per annum).
Terms and Conditions The Right to Lien
The customer agrees to pay all invoices arising out of pumping services, and any other special services herein within X10 days.
The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered, over and above the
normal servicing schedule, on behalf of to customer.
The customer agrees to assume responsibility damage to customer's real or pq nal property arising from pumping services which take place
on customer's premises, where the drivers and vehicles of River City Environmental have been instructed to enter.
This includes, but is not limited to driveways, trees, power lines or poles and building structures.
- �T c
If River City Environmental, Inc. finds it necessary to add liquid to the tank on jobgite, customer will be charged for the additional gallonage resulting
from these condidtions.
Customer agrees to reimburse River City Environmental, Inc. for all reasonable attorney's fees court costs and other expense incurred by said
company to enforce collection or to serve their rights under this agreement. .
Customer agrees to the above conditions • Redeemable in Multnomah County
Work Authorized by _ Date / / ...,
Driver Signature � Date � 3 / L S/ ° Time
ed
rti Cr VIP
4 " 4