Permit (w
4 C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00282
., DATE ISSUED: 2510 005 --- 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 PARCEL: 2S 103DA -00600
SITE ADDRESS: 13210 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: DERRY DELL LOT: 006 JURISDICTION: TIG
Project Description: Line work to connect residence to lateral. Systic system to be pumped and filled or removed.
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: 55 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MEYER, DUANE FRANCIS Description Date Amount
ANNIE ELIZABETH
13210 SW WATKINS AVE [PLUMB] Permit Fee 6/23/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 6/23/2005 $5.80
Phone : 503 244 - 0614 Total $78.30
Contractor:
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A- AFFORDABLE SEPTIC SERVICE
PO BOX 1130 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
Phone : 503- 969 -9548
Reg #: LIC 158246
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 - 24699 or 1- 800 - 332 -2344. A
Issued By: ,6 ,, ,i Z 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.
, Building Fixtures
_ ,.
Plumbing Permit Ap tibf J 'JE® I OR OI.FICE USE ONLY
City of Tigard Received Date/By..L' g 5 /05 ?1,5 Permit No . n �Q
13125 SW Hall Blvd., Tigard, OR 97223 JUN J 2005 � j ...
' � JUN Plan Renew Other Permit No
Phone: 503.639.4171 Fax: 503.598.1960 All, t . \ Date/By 5wZ]zt) _CQ/
24- Hour Inspection Line: 503.639.4175 . Ll ~^•i i I Date Ready/13y. l° s -) El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR, - --- - Notified/Method. T Supplemental Information
TYP 4ik b1°14 FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
10, 1- 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: (3 2-(O 5u5 (.si lfi Ns it-cJ Catch basin or area drain 16.60
City /State /ZIP: '-t J f , pr/Z,p OV__ 1 7 3 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: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
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
Sir 12��tU , \ A )CA riJlevW2.r Backwater valve 16.60
/ ` n n ^ 40 Q Clothes washer 16.60
1 v"v l u. �� p �� Dishwasher 16.60 fie .a.rves•
❑ PROPERTY OWNER [ I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: V IA tat -l■t. M ft.ye'I--
Expansion tank 16.60
Address: [ 3 P IO 5t_ W ietr i b.! f it-4-- Fixture /sewer cap 16.60
City /State /ZIP: TTa AtR-p mf? c -r7-2. 3 Floor drain/floor sink/hub 16.60
Phone: (b)) 2414 -D(o('- Fax: (17( ) -o0 7S Garbage disposal 16.60
. , - ❑ APPLICANT ® CONTACT PERSON Hose bib.) 16.60
M r�r M e-)/ 54---- Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: 97 I- P- - ce7a Medical gas (value: $ ) Page 2
Address: Pnmer 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: A _ ,ep2fl Le- 5. fy( . 5 .„ , Water heater 16.60
Address: c-- 0 -"-(5x l \ 0- 4-, Other:
City /State/ZIP: ` o ,� Q p , ' O f� Ci -i (..) 1, - 0 -
Subtotal
/ �`^^ Minimum permit fee: $72.50
Phone: ( )3 L9 a C) _ o , - k tt a9 Fax: ( ) _ Residential backflow minimum permit fee: $36.25 2a.. so
CCB Lic.: ` $ a t4 ( Plumbing Lic. no.: Plan review (25% of permit fee)
�l^ , State surcharge (8% of permit fee) s _ Authorized signature: f/V( TOTAL PERMIT FEE �s,3
Print name: /Vl - t M FR___
I Date: ( Z 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 \ Building \Permits\PLMF- PennitApp doc 06/05 440-46I6Tt10/02/COM/WEB)
Plumbing Permit Application - City of Tigard, - 4 ,
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
Commercial Back Flow Prevention Device 46.40 including $10,000 00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow 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 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 Complex Structures
Are you capping, moving or replacing existing fixtures? If A "complex structure" is defined as an installation of a plumbing
"yes", please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
New Moved Existing Capped ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain - ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3 „
-4
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
-Commercial
- Service
Swimming Pool Filter
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Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for'the sewer increase must'be paid before the
Other Fixtures: plumbing permit can be issued.
i1Building\ Permits \PLMF- PermuApp doc 06/05
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Alp,$ . '.A� TI FORDASL
SEPTIC SERV OE
W { P.O.BOX1130
WILSONVILLE, OR 97070
(503) 682-1929 FAX (503) 570.0779
CUSTOMERS ORDER NO PHONE / DATE
76//S < 7 7 / /E -
NAME p / /
7 �
ADDRESS r
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SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
_ QTY. _ _ _DESCRIPTION • PRICE- AMOUNT
(7
TAX
RECEIVED BY TOTAL C All claims and re�tur ed qoods MUST be accompanied by this bill
/Arm/ ToRooder. THANK YOU
800- 225-6380 or nebs.corn
CITY OF TIGARD,
BUILDING DIVISION PERMIT #: PLM2005- 00282
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/23/2006
Phone: (503) 639 -4171 eolp yg ll1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/7/2005 TIME: 7:10AM PAGE: BO
SITE ADDRESS: 13210 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: DERRY DELL LOT #: 006 TYPE OF USE:
PROJECT NAME: MEYER
DESCRIPTION:. Line work to connect residence to lateral. Systic system to be pumped and filled or removed.
OWNER: MEYER, DUANE FRANCIS, PHONE #: - 503 - 2440614
CONTRACTOR: A AFFORDABI..E SEPTIC SERVICE PHONE #: 503-969-9548
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Inspection Request Scheduled For: Date: 7/7/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer 010889-01 603- 969.9546 Y
Corrections /Comments / Instructions:
/.41\
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[PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 7 , Phone #: (503) 718-