Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE
COMMUNITY PLM2009 - 00018
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/2/2009
PARCEL' 2S103DC - 00815
SITE ADDRESS: 11305 SW FAIRHAVEN ST ZONING: R -3 5
SUBDIVISION: VIRGINIA ACRES NO 2 LOT. 017 JURISDICTION. TIG
PROJECT: ADKINS
Project Description: (100) ft connect to sewer
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES.
TYPE OF USE. SF WASHING MACH BACKFLOW PREVNTRS:
OCCUPANCY GRP• 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
ADKINS, KATHRYN J TR
11305 SW FAIRHAVEN ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/2/2009 $81 20
[TAX] 12% State Surch 2/2/2009 $8.70
Phone : Total $89.90
Contractor:
LOVETT EXCAVATING INC
PO BOX 86280
REQUIRED ITEMS AND REPORTS
PORTLAND, D, O R 97286
OR
Contact # : PRI 503 -504 -2847
FAX S03 -288 -1630
Reg #. LIC 125507
PLM 26 -773PB
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 By • ' m ) _5\0 s A ■ 3 Permittee Signature. Q Q 399 l A C QtV rn
Call 503.639 4175 by 7.00 a.m. for an inspection that business day. App
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.
_ Pluthbing Permit Application RECEIVE f
Building Fixtures FOR OFFICE USE ONL
City of Tigard FEB 2 2009 Received en .-s
a
Date/By (y.• ot •� Permit No PL m2co; oe)0( 8
N 13125 SW Hall Blvd Tigard OR 97223
CITY OF TIGARD D an Review
Phone 503 639 4171 Fax 503 598 J 9 Pla Re Oilier Permit No .:O1A)Q- 2o0Q.0o0OS
TIGARD Inspection Line 503 639 4175 BUILDING DIVISION Date Ready /Bs r PI See Page 2 for
Internet Www tigard -or gov Notified/Method ( C7 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description I Qtv I Ea I Total
❑ Addition/alteration /t enlacement ❑ Other New 1 -2 -family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 24920
❑ I- and 2- family dwelling ❑ Commercial /mdustnal SFR (2) bath 350 00
❑ Accessory building ❑ Multi -family SFR (3) bath 399 00
❑Master builder ❑Other Each additional bath/kitchen 45 00
Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address / / 9, 5 .5 C / 7�iguA-VeN ST- Catch basin or area drain 16 60
City /State /ZIP r -- I 1L i Drywell, leach line, or trench drain 16 60
Smte/bld /apt no Pro Footing drain (no linear ft ) Page 2
g Project name P J 5.4tV/ ty' S4 iveit Manufactured home utilities 11000
Cross street/directions to Job site Re ce/`/r,vr n,srxx'rA /a3 '
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft (to) 1 Page 2 SS CC)
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 Backttow preventer Page 2
C O n(N PP T I- e9E-/f. re . 5rfl, P r .SC id, R Backwater salve 16 60
Clothes washer 16 60
Dishwasher 16 60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16 60
Ejectors /sump 16 60
Name
1 -J. 4.D K/ N Expansion tank 16 60
Addr i/ ge S . S (iJ P4/,Ql-li4U[�st _S•r— Fixture /sewer cap 16 60
Cit /Sta /ZI 2 azt /� / !`th G 1aa 3 Floor drain /floor sink/hub 16 60
Phone (57 ) 4 97 514 9`L Fax ( ) Garbage disposal 16 60
❑ APPLICANT. CI CONTACT PERSON' lose bib 6 60
Ice maker 16 60
Business name Interceptor /grease trap 16 60
Contact name Medical gas (value $ ) Paget
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 Lo vF TT Water heater 16 60
Address Other
City /State /ZIP Subtotal
Minimum permit fee $72 i0 72 50
Phone ( ) Fax ( ) Residential backflow minimum permit fee $36 25
CCB Lie Plumbing Lie no Plan review (25% of permit fee)
State surcharge (12% of permit fee) 4 S ) •7°
Authorized signature
TOTAL PERMIT FEE 8 t • 2 0
Print name Date This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by In-Count) Building Industry Service Board
i\ Building \ Permits \PLMF- PermitApp doc 12/27/06 440 - 46161(10 /02/COWWFB)
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 [0 3 600 $160 00
3601to7200 $22000
Sewer - 1st 100' 55 00 7 201 and greater $309 00
Sew er- 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 8, Rain Dram = 1st 100' 55 00 $1 00 to $5,000 00 Minimum fee $72 50
Stonn & Rain Dram - 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 $50 001 00 and up $742 00 for the first $50.000 00 and $1 20 for
Subtotal: 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 OAR91 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 1 hru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eve Wash ❑ Isometric or riser diagram is required for new buildings
door Drain /sink - 2 that meet the qualifications above
- 3'
-4 "
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach /Refng 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 EllUs, 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 - Cloches
Water Extractor
Water Closet - Ioilet
Urinal
Other Fixtures
I mwIdingtPenmts'PLx1- PermiiApp doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION I� �v PERMIT #: PLI ?00r�i1018
13125 SW Hall Blvd., Tigard, OR 97223 ' v DATE ISSUED: J ?J200 3
Phone: (503) 639 -4171
A
Inspection Requests (24 Hrs.): (503) 639 -4175 1 � .. I i / d C.
INSPECTION WORKSHEET FOR DATE: 2j6/2O09 TIME: 7:00A@, PA : PAI 30
SITE ADDRESS: 11306 SW FAIRHAVEN ST CLASS OF WORK:
SUBDIVISION: VIRGINIA ACRES NO. 2 LOT #: 017 TYPE OF USE:
PROJECT NAME: ADKINS
DESCRIPTION: (100) ft. connect to sewer. Sewer Reimbursement District #38 fee paid 2/2109
OWNER: ADKINS, KATHRYN J TR, PHONE #:
CONTRACTOR: LOVE1T EXCAVATING INC PHONE #: 503 - 504 -2847
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Inspection Request Scheduled For: Date: 2/812009 Pour Time: , :`
Code # Inspection Description Confirm # Contact # Mesta;
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399 Plumbing final (-/C1 ) ...../
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❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: Date: Phone #: (50 )