Permit ,r ' c. CITY OF TIGARD PLUMBING PERMIT
° f^ DEVELOPMENT SERVICES PERMIT #: PLM2004 -00424
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/14/2004
SITE ADDRESS: 13175 SW WATKINS AVE PARCEL: 2S103DA -00800
SUBDIVISION: DERRY DELL ZONING: R -3.5
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: NEW 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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing house to new sewer lateral. Septic tank is to be pumped, filled and inspected.
FEES
Owner:
Description Date Amount
BRADEN, ROBERT W + KATHLEEN J [PLUMB] Permit Fee 9/14/2004 $72.50
13175 TIGARD, OR R 9 9722 3 SW S [TAX] 8% State Surcharl 9/14/2004 $5.80
GA722
Total $78.30
Phone:
Contractor:
THEODORE D. MCBEE
13691 SE WILLINGHAM CT
CLACKAMAS, OR 97015 -7253 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503 - 239 - 2707
Insp existing /capped fixtures
Reg #: LIC 75513 Final Inspection
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.
Issued By :2 Permittee Signature: S_c-e_ a„
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY : -
City of Tigard
Date/By Received 9 / o I Permit No 1 L�2v, _� ay
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503 639.4171 Fax: 503.598.1960 a oGC/
Od D an Review Q , / �a
b DateBy. Other Permit N r, Y
24- Hour Inspection Line: 503.639 4175 11 Date ReadyBy /y El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /ifj. Supplemental Information
- TYPE OF WORK - - : _. - . _ ' . ' ' FEE* SCHEDULE f , -
❑ w construction ❑Demolition For special information use checklist
Description Qt I Ea Total
Addition/alteration/replacement ❑Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
' , CATEGORY, OF CONSTRUCTION 4: SFR (1) bath 249 20
l 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 S ITE INFORMATION LOCATION. - Site utilities
Job site address: f 3175- 5W W at k( 0 S' Catch basin or area drain 16.60
City/State/ZIP: - rg es - c -t t 0 p • Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft. ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site: pa rk Manholes 16.60 .—
Rain drain connector - 16.60
ft
Sanitary sewer (no. linear ft.. t✓ Page 2 55"; ej3
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
L Seci) o1` - arV IrP CC9 yin 0t Backwater valve 1660
Clothes washer 16 60
Dishwasher 16 60
- . , ❑ .PROPERTY OWN . I 0• TENANT Drinking fountain 16 60
Ejectors /sump 16 60
Name: if3d 6 13 rad Ca f Expansion tank 16 60
Address: /3/7; Oc 1, J rQ)- k f v) $ Fixture /sewer cap 16.60
City/State/ZIP: 7; 4 a � 1 0 R Floor drain/floor sink/hub 16.60
Phone: ll � 2 if � Fax: ( )
, �,� 3) 6, 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
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: EX
3 j MC (.J C Water heater 16 60
Address: ' 3b l � li , LC tih. j hq Other
Cit ,iS oJ` 7 7Ol� Subtotal
Minimum permit fee $72.50 5a
Phone: Z ?G_ , 7 Fax: (e�3 - j0 77 Residential backflow minimum permit fee $36 25 7
cat Lie 755- / y / t Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: ,7 :f/L� ` /,A -7/2 State surcharge (8% of permit fee) 5. t0
TOTAL PERMIT FEE 7�
Print name: pd 0 ' (r�l J y1 5,0 ,1 Date. 9 --q-
/ , - This permit application expires if a permit is not obtaihed within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
I \Budding\Permiis\PLMF- PernuiApp dot 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 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
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 Dram, 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
and including $50,000 00.
specially requested inspections - per hour 72.50
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
-Drive 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 increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
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
- Bradley Quantity Total
Comme ia► 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 -
s \Bmlding\Pemuts\PLM- PcmdtApp doc 3/03
( ` }, 904-00 C1 i. INVOICE
P.O. Box 2349 '
Oregon City; OR
97045 ,, x ' 5 •
, �` ^' 4 : \ , , : \ ` ! �_ Complete
New Installations - Industrial
Repair Existing Systems n •. `' • • ` ..' -. ..c' •":: ' • ' Waste ■
Sewer Connections • • • • ..r.. r_ • • • • • • . ` • • Removal •
Drainfields • • • • • • • • . • • • Se ti Cleaning
�.,�, . . ■ ■ •• ,_i . ■ • . P g
Cesspools p
•
Excavating Al ` Cleaning .
Richmond Construction Ent., Inc. �� i • ooy
(503) 253 -7587 1
0 F.0G oN
cp O O N
`NG „
Customer P.O. # Date w9 / 1 6./.0.4
Billing Name McBee Excavating
Address
Job Site #
City State Zip Code •
Ordered By Mike Phone# 481 -5348 Date 9/15/04 _
Job Location 1 31 75 SW WAtkins /Tigard
i
Service Call $
Labor, $
d 0
Pumping septic gallons 1000 $ 280. 00 n 3,5 1 0,
Misc $ '
03k51' 00
Conditions of tank/Distribution Box(R) Cat if \ G %v
`TQ9c k t S P-Pca /,rto vn , 5 /o TOTAL CHARGES o
•
Enviroclear is in no way responsible for damage to the septic tank or lids on the system.
TERMS: Net 10 days. 1 -1/2% per month will be charged on past due accounts. (18% per a
P 95v2 - 69,98' - I/o7Y- /3 EV, 6 -A�
) 15/.0.
". 3 ,., ...1
Customer's Signature: /17� :.�=
Service Driver's Signatur- /Y Time /a i Date9 -7'6 l
TERMS AND CONDITIONS ON REVERSE SIDE REDEEMABLE IN ALL COUNTIES
61 0 1 00 1 61;;;i2-t ectic;;2,‘ Eci.13.6 Elicit ,
TERMS AND CONDITIONS
THE CUSTOMER AGREES TO PAY ALL INVOICES ARISING OUT OF PUMP-
ING SERVICES, AND ANY OTHER SPECIAL SERVICES HEREIN WITHIN 10
DAYS FROM THE DATE OF INVOICE.
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 THE CUSTOMER.
THE CUSTOMER AGREES TO ASSUME RESPONSIBILITY FOR ANY DAM-
AGE TO CUSTOMERS OWN REAL OR PERSONAL PROPERTY ARISING
FROM PUMPING SERVICES WHICH TAKE PLACE ON CUSTOMERS PREM-
ISES, WHERE THE DRIVERS AND VEHICLES OF ENVIROCLEAR HAVE
BEEN INSTRUCTED TO ENTER. THIS INCLUDES, BUT IS NOT LIMITED TO
DRIVEWAYS, TREES, POWER LINES OR POLES, AND BUILDING STRUC-
TURES.
IF ENVIROCLEAR FINDS IT NECESSARY TO ADD LIQUID TO THE TANK ON
JOBSITE, CUSTOMER WILL BE CHARGED FOR THE ADDITIONAL GAL-
LONAGE RESULTING FROM THESE CONDITIONS.
CUSTOMER AGREES TO REIMBURSE ENVIROCLEAR SERVICE 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 ALL COUNTIES.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested ` - AM PM BUP
Location ' Suite MEC
Contact Person Ph ( ) 6 PLM c2 66 q
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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �t � / 2! ,,
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
WI
P rains
Catch Basin / Manhole
Storm Drain
Shower Pan
S PART FAIL
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 �J
Approach/Sidewalk Date / 6 // Inspector Ext
Other:
Final DO NOT REMOVE inspection record from the Job site.
PASS PART FAIL