Permit •
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00602
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/29/2006
PARCEL: 2S 103DA -00400
SITE ADDRESS: 13150 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: DERRY DELL LOT: 004 JURISDICTION: TIG
Project Description: Connect existing house to sewer service. Septic tank is to be pumped, filled and inspected.
Reimbursement District fee paid this date.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
DAWN O'LEARY
13150 SW WATKINS AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/29/200€ $72.50
[TAX] 8% State Surcha 12/29/200€ $5.80
Phone : 503- 984 -1841 Total $78.30
Contractor:
KEN RICHARDSON EXCAVATING
3675 SE MAPLE
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 640 -2168
Reg #: LIC 117817
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 to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: � f � , Permittee Signature: X
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. •
Plumbing Perinit Application
City of TigardY �,2 // 9i /� �' Permit No. L >�(p --6.-
.1 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review o 04. ..ee 3/
II II Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit No <
T I C A It p Ins Line: 503.639.4175 Date Ready/By: r�� ® See Page 2 for
Internet: www.tigard- or.gov Nonfied/Method. _ / Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information 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
❑ 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
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: j "5 i 50 5 \NI UJ 14--04..04 S Catch basin or area drain 16.60
City /State/ZIP: I IO,GI. rcti 0 Q 'j Z Z s ) Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: DOI.W 11 0 ` L.� 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 R:/ ) Page 2 5 .a
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
Back flow preventer Page 2
a (S001,1 v1 t° S h G, V) 0 0 k Li {p t"D Backwater Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I 0 TENANT
Drinking fountain 16.60
Ejectors sump 16.60
Name: - 0 0..1k) a 0 1L- i Expansion tank 16.60
Address: :it kee 1 S v..j 12_ eL(Lc.irl A --U.2. Fixture/sewer cap 16.60
City/State/ZIP: Gj ywert9 (i Floor drain/floor sink/hub 16.60
Phone ( )2 I+ • 14a) tk ( I 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: S ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name ti -PAI C, I,�14 �� 'mil E-x Water heater 16.60
Address: 36 45-- E I....1a C.i r1 other
City / State/ZIP: /4-i L - 'k./'& G�L 9 7/P,5 Sab l Minimum permit fee: g2.50 7a 5�
Phone: (i53 I Q /6 - 02 A Fax. ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: , 1 g j 7 fC 7 / 0 Plumbing Lic. no N Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5 l�U
Authorized signature: 1te? TOTAL PERMIT FEE 76'
Prmt name: iNa W 4 0 t-c Date 7 2_ , 2 9 a 4, 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.
I \&dldmg\Penn its \ PUN - Pam,Npp doc 0&2406 440-4616T(I0/02/COM/W®)
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 - I 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: 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 gamer except systems designed and stamped by licensed
Fixture Type: engineer.
Previous Capped Added Exlstiog ❑ 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 Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
-Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
-Commercial
-Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
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HI NEXT PUMPING N 77%
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JOB ADDRESS s DAT
Phone: (503) 648 -8246 VD, 1
} P.O. Box 793
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Mils/y% OR 97123
H
a SEPTIC PUMP:
DIG iirdil ,` . ...-_---.1. 2 TANK & DRAINFTPW INSTALLED:
ME
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TOTAL $
CHART PUMPING q
Household Size
(Number of People) 1
2 3 4 5 6 7 8 9 10
500 5.8 2.6 1.5' 1.0 0.7 0.4 0.3 0.2 • - b.1
750 9.1 4.2 2.6 1.8 ..
•
N 1000 12.4 5.9 3.7 2.6 1.3 1.0 0.7 0.6 0.4 0.3
m Tank 1250 15.6 7.5 2.0 i .5 i .2 1.0 0.8 0.7
.5 4.8 3.4 2.6 2.0 1.7 1.4 1.2 1.0
m Size 1500 18.9 9.1 5.9 4.2 3.3 2.6
1 750 22.1 10.7 6.9 5.0 3.9 2.6 2.2 1.9 ].6
.9 3.1 2.1 1.8 1.5 1.3
� 2000 25.4 12.4 8
2250 28.6 14.0 5.9 4.5 3 . 7 3.1 2.6 2.2 2.0
9.1 6.7 5.2 4.2 3.5 3.0 2.6 2.3
2500 31.9 15.6 10.2 7.5 5.9
co
4.8 4.0 4.0 3.0 2.6
in
ti Note: More frequent
r ' garbage needed N garbage disposal is used.
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DELIVERY TICKET NO: 1043829
PLANT NO.171
GLACIER
E R
�
2/ 15/2007 11:47:10 AM Cobb Rock Plant Q { Today: 7.57 Ton
lEkl cl 'L% 0 1 CUSTOMER: 07895
Loads: 1
pfikett ON ORDERT 0001ARDSON. KEN EXCAVATI
PQ�
LB TON mTON
V � \ PICKED UP/13150 SW WATKE GROSS 36180 18.09 16.41
8 T ARE 21040 10.52 9.54
P.O.: NET 15140 7.57 6.87
PRODUCT: 8510 3/4 "- 0 7.57 Ton
DEL. TO: WEIGHMASTER= Scale 1
MTL.
ZONE: FRT.
HAULER #: 999 ENVIRO.
TRUCK #: KW2 TAX
RECEIVED BY: TOTAL
GLACIER NORTHWEST, INC. 503- 649 -5661
NOT RESPONCBLE FOR MUM CAM BY MIRY INSIDE CURB LINE
COPY I
DELIVERY TICKET NO: 1043829
PLANT NO.171
2/15/2007 11 :47 :10 AM G L C I ER
Cobb Rock Plant Qty. Today : 7.57 Ton
CUSTOMER: 07895 Loads= 1
SOLD TO: RICHARDSON, KEN EXCAVATI
ORDER: 0001 LB TON mTON
PICKED UP/13150 SW WATKE GROSS 36180 18.09 16.41
TARE 21040 10.52 9.54
P.O.: NET 15140 7.57 6.87
PRODUCT: 8510 3/4 "- 0
DEL. TO: 7.57 Ton
WEIGHMASTER= Scale 1
ZONE: MTL.
HAULER #: 999 FRT.
TRUCK #: KW2 ENVIRO.
TAX
RECEIVED BY: TOTAL
GLACIER NORTHWEST, INC. 503 649 - 5661
NOT RESPONSIBLE FOR DAABGE CAUSED BY DBJFBIT MBE CURB LINE
ORIGINAL
CL Y -OF TIGARD
BUILDING DIVISION PERMIT #: PLM200&00602
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/29/2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 1—
INSPECTION WORKSHEET FOR DATE: '1/3012007 TIME: 7 :03AM • PAGE: 20
SITE ADDRESS: 13150 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 004 TYPE OF USE:
PROJECT NAME: O LEARY
DESCRIPTION: Connect existing house to sewer service. Septic tank is to be pumped, filled and inspected.
Reimbursement District fee paid this date.
OWNER: O'LEARY, DAWN PHONE #: 503 -984 -1641
CONTRACTOR: KEN RICHARDSON EXCAVATING PHONE #: 503 -640 -2
Inspection Request Scheduled For: Date: 1/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 042686 -01 - 503- 984 -1841 N
Corrections /Comments /Instructions:
CC5
LEA
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITL FEE ASSESSED
Inspector: • �, • Date: I #: (503) 718 - J
•