Permit 1p; ' ' "" CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00261
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/20/2007
PARCEL: 2S 102CC -02700
SITE ADDRESS: 13965 SW 102ND AVE ZONING: R -3.5
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT: 011 JURISDICTION: TIG
PROJECT: TAYLOR
Project Description: Connect existing house to sewer service, approximately 100'. Septic tank is to be pumped and
filled. Reimbursement District #39 fee paid this date.
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
PETER TAYLOR Description Date Amount
13965 SW 102ND
TIGARD, OR 97223 [PLUMB] Permit Fee 6/20/2007 $117.50
[TAX] 8% State Surcha 6/20/2007 $9.40
• Phone : Total $126.90
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 ru =- • •i -, questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu •d By: la, I vl ids _ f Permittee Signature: . 71Z
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
Buil`ding'Fixtures / . • FOR OFFICE USE ONLY
City of Tigard Date/By: /• Di / Permit No.: /( T e0 ,4/
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
- Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit No.;�WO7 W1 ?�
Inspection Line: 503.639.4175 Date Read B lur ®See Pa e 2 for
TIGARD Internet: www.ti and -or. ov Ready /By: g
g g Notified /Method: ( Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
- CATEGORY OF C ONSTRUCTION SFR (1) bath 249.20
❑ 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 LOCATION , Site utilities
f
Job site address: l C jAv /' Catch basin or area drain 16.60
City /State /ZIP: / / 7 2 g_ g Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: •7� /pt^ 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. /e56 Page 2 j' S o)
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
"fax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
- i-41/ ,4,7; Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: f g �� 7 r Expansion tank 16.60
Address: Ay ?1 ,.... 6 �j A/, AO ---- Fixture /sewer cap 16.60
City /State /ZIP: d 9 ? 2.. gi Floor drain /floor sink /hub 16.60
Phone: ( )' O ,Z 1 3 9 . /� 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: $ ) 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: Gi /j-„/Ti ¢ G L 9,. i DN c�7 Water heater 16.60
Address: / ii, ° S l'It/ � �� ^ �. /. .,/ Other: � g J . 4 � d
Subtotal
City /State /ZIP: 3�� 77,b . Minimum permit fee: $72.50 /
Phone: (5,0 Z,) t ?(� - ;2-39 / � /Y �' Fax: ( ) Residential backflow minimum permit fee: $36.25 (�T 5-b CCB Lie.: 9 ! 9 Plumbing Lic. no.: g _ Plan review (25% of permit fee) _
iJ �� State surcharge (8% of permit fee) 7.1/0 Authorized signature: i / (9� TOTAL PERMIT FEE /W4.., 9e) Print name: �Pi to / ✓ Pt Date: /� f2/� /� 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.
]. Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 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 - 1s 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 7201 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 ValnatiOII' 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 *. El Y new commercial building with water service 2" and An
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 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
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:
i \ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION • - PERMIT #: PLM2007- 00261
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6120/2007
Phone: (503) 639 -4171 ""� 'p�°� ��I�
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 6125/2007 TIME: 7:01AM PAGE: 36
SITE ADDRESS: 13966 SW 102ND AVE CLASS OF WORK:
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT #: 011 TYPE OF USE:
PROJECT NAME: TAYLOR
DESCRIPTION: Connect existing house to sewer service, approximately 100'. Septic tank is to be pumped and filled.
Reimbursement District #39 fee paid this date.
OWNER: TAYLOR, PETER PHONE #:
CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503 - 638 -0800
Inspection Request Scheduled For: Date: 6/2512007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 050852 -01 503-638-0800 N
Corrections /Comments /Instructions:
5
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111Fr 11
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`i: SS RTIAL APPROVAL n CANCEL NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector: Ili `� )< '
� Date: � Phone #: (503) 718-
ORVALL T. CADE JOB INVOICE
\
BYER'S SEPTIC TANK SERVICE, INC..
P.O. BOX 549 `
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO D TEORDERED
(503) 656 -3326
ORDE NBY T PRO ED ❑ A
p / , ry�_ .M.
BILL TO ��: , ,/ ( ❑
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ADDRESS��_ C ��1�
MECHANIC
CITY
HELPER
JOB NAME A D OCA rION A /
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DL CRI ION OF WORK / / /,/ I/1S!//I CONTRACT
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OUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
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HOURS LABOR
AMOUNT
TOTAL .
MECHANICS @ MATERIALS
HELPERS @ TOTAL
LABOR •
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I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
i SIGNATURE DATE COMPLETED
L / / TOTAL
L l
•
ORVALL T. CADE
JOB INVOICE
BYER'S SEPTIC TANK SERVICE, INC.
P.O. BOX 549
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO 7ORDERED
ORDE N BY PROhgSED
_ � ❑ A.M.
J 4 / • P.M.
BILL TO 1 , PHONE 'f 4 '
ADDRESS MECHANIC , ($ g am ,
CITY HELPER L fi
JOB NAME D OCgTION ❑ Y WORK JUL Y1 %/� ���� , 0 GIP �,,, 1 ? 0 07
D C RI ION OF WORK �/ ' , / ) l /� j C
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QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
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HOURS LABOR AMOUNT
TOTAL
MECHANICS CO MATERIALS
HELPERS @ L B OL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATE COMPLETED TOTAL
1 3 9 (a C / 6 42-- /rid
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