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Permit
CITY TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00247 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/15/2007 PARCEL: 2S 102CC -03700 SITE ADDRESS: 13990 SW 102ND AVE ZONING: R -3.5 SUBDIVISION: FRELEON HEIGHTS LOT: 005 JURISDICTION: TIG PROJECT: MERRICK Project Description: Line work for sewer connection. Septic system to be pumped and filled or removed. CLASS OF WORK: ALT 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 MERRICK, BRET 13990 SW 102ND Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 6/15/2007 $72.50 [TAX] 8% State Surcha 6/15/2007 $5.80 Phone : 503- 684 -9354 Total $78.30 Contractor: CANTRELL & SONS CONTRACTING 6860 SW NORSE HALL RD TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 638 -0800 Reg #: LIC 97005 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:C&I- �..c_ A.GI�— Permittee Signature: � t%� , 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. Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY • Received, i City of Tigard Date BYtO �J�(l/ c3 Permit NI/2M 2. v7 IN V 13125 SW Hall Blvd., Tigard, OR 97223.] 2007 Plan Revt _ Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit NCI r�aRb 1 _,,,,,„,,.., TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: .1- ® See Page 2 for Internet: www.tigard- or.gov BE DIVISION Notified /Method: Supplemental Information TYPE OF WORK i � FEE* SCHEDULE ❑ New construction El Demolition For special information use checklist Description I Qty. 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 (g 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 sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND .LOCATION Site utilities Job site address: 1' f2 c 3 ( j © of 1 v t_ Catch basin or area drain 16.60 City /State /ZIP: "\; �a r a `1 -7 a3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 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.: ) /OD Page 2 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 Backflow preventer Page 2 4 A--94Z11/41 Backwater valve 16.60 c 2 _ Q e- Clothes washer 16.60 �L �' 1 Dishwasher 16.60 ❑ PROPERTY OWNER I TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: t Ce7 L, 8 C aro v (1-( cr; ck Expansion tank 16.60 Address: 9 0 5 ( t 0 N ci Fixture /sewer cap 16.60 City /State /ZIP:' 7,. ra 0 R a 7 �.a,_ Floor drain /floor sink/hub 16.60 Phone: 53 5y Fax: ( ) Garbage disposal 16.60 1=1 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 Sink/basin/lavatory 16.60 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: - 11 EA S „, S Water heater 16.60 Address: Other City /State /ZIP: Subtotal Minimum permit fee: $72.50 -1,1 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 /o(- 5 CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) �/ State surcharge (8% of permit fee) 5 . D O Authorized signature O. e f/,�, �Ii )i� TOTAL PERMIT FEE 7 3C7 Print name: ravel /r /Q kern 6,6 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 Tri- County Building Industry Service Board. I:\ Building\Permits \PLMF- PermitApp doc 12/27/06 440- 4616T(10 /02 /COMM'EB) 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 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 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 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. orRiser 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 Garbage -Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. 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 EDUs, 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 - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: \Bwlding\Permiis \PLM- PermitApp doc 12/27/06 . . - S - Cy. e 1? -- Ne 0 vbqytil '•--‘?' '1 ,.? s z, , fo it 001- OC &ku.o-vio\ ' . _ _ L 1- . -----I-- ...-1-. J... ■ ORVALL T. CA JOB INVOICE BYER'S SE r AC TANK SERVICE, INC. P.O. BOX 549 OREGON CITY, OREGON 97045 (503) 656-3326 CUSTOMERS ORDER NO ekTEftERty ORDER TAKEN BY )AryR 0 A „, .. grace 6 0 P.M. BILL TO PHONE Gene Cantyell 3 1 24.3 6 3 ADDRESS MECHANIC CITY HER JOB NAME AND LOCATION 1 3 9 9 0 SW 1 0 2nd. 0 NAY WORK 0 CONTRACT DESCRIPTION OF WORK O EXTRA QUART. DESCRIPTION OF MATERIAL USED PRICE AMOUNT • Tank pumping > HOURS LABOR AMOUNT TOTAL MECHANICS MATERIALS TAL HELPERS M LABOR I hereby acknowledge the satisfactory TOTAL LABOR TAX completion of the above described work. SIGNATURE DATE COMPLETED TOTAL • CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007 -00247 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/152007 Phone: (503) 639 -4171 °aN�i;� P Inspection Requests (24 Hrs.): (503) 639 - 4175' I.. INSPECTION WORKSHEET FOR DATE: 6/18/2007 TIME: 7:04AM PAGE: 15 SITE ADDRESS: 13990 SW 102ND AVE CLASS OF WORK: SUBDIVISION: FRELEON HEIGHTS LOT #: 006 TYPE OF USE: PROJECT NAME: MERRICK DESCRIPTION: Line work for sewer connection. Septic system to be pumped and filled or removed. OWNER: MERRICK, BRET, PHONE #: 503 -684 -0354 CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503 -638 -0800 Inspection Request Scheduled For: Date: 6/18/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 050402 -01 503 - 638 -6428 N Corrections /Comments/ Instructions: r ai/ep . -s SS PARTIAL APPROVAL H CANCEL NO ACCESS FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: 11 /1/1--c (/ Date: / n Phone #: (503) 718-