Permit CITYOF TIGARD PLUMBING PERMIT
, Er COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00090
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/5/2008
PARCEL: 2S 103CA -00602
SITE ADDRESS: 13360 SW 121ST AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: FRANZ
Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #30.
Fees paid 3/5/08.
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: 75 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ROSEMARY FRANZ
13360 SW 121ST ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/5/2008 $72.50
[TAX] 12% State Surch 3/5/2008 $8.70
Phone : 503 698 - 3992 Total $81.20
Contractor:
PUREFLOW PLUMBING LLC
16869 SW 65TH AVE #351
LAKE OSWEGO, OR 97035 REQUIRED ITEMS AND REPORTS
Contact # : PRI 971 -219 -9313
FAX NA
Reg #: LIC 168699
SUP 3 -542PB
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: 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.
L.
Plumbing Permit Application
. , Building Fixtures �� - FOR i OFFICE USE ONLY
of Tigard � " �� DateBe� S -e /37-7- Permit No.: /2G!'N d d 8 --, J`�J
v 13125 SW Hall Blvd., Tigard, OR 9722 j f;\ V
Z. � .. 4J Plan Review f.V /
Phone: 503.639.4171 Fax. 503.59 /' D ateB Other Permit No.: ✓Vr •T�`y^'�
Inspection Line 503.639.4175 ` ` PCC y
�1 ate Ready/By: Sufis' See Page 2 for
�
TIGARD ��� Internet: www.tigard- or.gov .�eO s�`& jotifiedMethod: Supplemental Information
TYPE OF WORK C 4 <# ' FEE* SCHEDULE
❑ New construction ❑ Demo no--- 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
It 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: / 3.3 6,. 0 51 Ui . la i 5 Catch basin or area drain 16.60
City /State /ZIP: - co d o p G3 '7 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: fkitg 2___. 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.: X 76) / / 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 0 - i - jj Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER Drinking fountain 16.60
❑ TENANT
Ejectors /sump 16.60
Name: R e m A ' 'PR A a , Expansion tank 16.60
Address: I b-'1 1 4, S• G • FOR 6 s' 1 V ; ee.{.}3 f / ' d Fixture /sewer cap 16.60
City /State /ZIP: Uri. ( ( e j O g_ / 7 t p , 5? 6 Floor drain /floor sink/hub 16.60
Phone: (5.c:3 io 9 .3 9 g Z 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
Phone: Sink/basin/lavatory 16.60
( ) Fax: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: /4,/,./ phoyddit. Water heater 16.60
Address: l¢ $ 2.„,-- 6 5 t. Other:
�q Subtotal
City /State /ZIP: Lake 0 5 ire OR
�t-L , r^ , � , o 2 Minimum permit fee: $72.50
Phone: (56 3) pm -rlJl 0 9 Fax: ( ) Residential backflow minimum permit fee: $36.25 7aO
CCB Lie.: /6 90y 2' /,rll0 Plumbing Lic. no, , 4 3 _j 7,. q Plan review (25% of permit fee)
r____c State surcharge (12% of permit fee) 'g, 7f)
Authorized signature ...e.,....,..--- eV 7 ` ' � U TOTAL PERMIT FEE 0,
Print name: e ` n 0eVi Date: z - 2 J -- This permit application expires if a permit is not obtained within
�� 180 days after it has been accepted as complete.
41, hanft i V 1 7(" ► 9. - 4 3 f)� *Fee methodology set by Tri -County Building Indu try Service Board
I \Bmldingi . .. • . - • - .1 • .. • • 12 27/06 440- 4616T(10 /02 /COM/WEB) , F , (� /6 ` V V
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.
$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.
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 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
ORVALL T. CADE DATE
BYER'S SEPTIC TANK SERVICE, INC. 10-9-08
P.O. Box 549 NUMBER
OREGON CITY, OREGON 97045 Job; 1 0-7/
(503) 656 -3326
Daniel Bliss h �,�
13360 SW 121st. Avenue � ac's
Tigard, OR 97223 ilk
TERMS: NET 10 DAYS 1
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ I
Y.SCwg ..aN3'Y2-i� =N ^'1 F`.So- .. - °" �°di§Y` W^ e �nov . ` =Fa tt,- "a E.,rtx"�""z^a 'x''.« .;4r E¢: -'�. xz�
DATE 4 CHARGES AND<CREDI =T =S " 9 +BAIU4NGEa s ,,
" a`a ..>•,2'=., :. ��...4�. aci.L,k�,„i s '� .:..,, `. `- -§L1 ;�r r£ :wi:�`:°�
BALANCE FORWARD 0 $330.00
10 -7 Tank pumping 330.D0
�j Q
ORVALL T. CADE C /7i �
BYER'S SEPTIC TANK SERVICE, INC. p PAY LAST AMOUNT
IN THIS COLUMN
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM20003- 00090
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/5/2008
Phone: (503) 639 -4171 4,u'a 104'1Iit\
Inspection Requests (24 Hrs.): (503) 639 -4175 M
INSPECTION WORKSHEET FOR DATE: 6/5/2000 TIME: 7:00AM " PAGE: 60
SITE ADDRESS: 13360 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: FRANZ
DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and,filled. Reimbursement #30.
Fee paid 3/5/00.
OWNER: FRANZ, ROSEMARY PHONE #: 503698 -3992
CONTRACTOR: PUREFLOW PLUMBING LLC PHONE #: 971 - 213 -9313
Inspection Request Scheduled For: Date: 6/5/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc, inspection 070716 -01 503 -780 -7943 I�
Corrections /Comments /Instru
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❑ PASS I I PARTIAL APPROVAL n CANCEL I NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector tv l.-$ Date: 6 I C, Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -00090
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/5/2008
Phone: (503) 639 -4171 / vIM � u�b'il
Inspection Requests (24 Hrs.): (503) 639 -4175 4- , .
INSPECTION WORKSHEET FOR DATE: 9/3/2008 TIME: 7 :01AM PAGE: 31
SITE ADDRESS: 13360 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: FRANZ
DESCRIPTION: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #30.
Fees paid 3/5708.
OWNER: FRANZ, ROSEMARY PHONE #: )03-698-3992
CONTRACTOR: PUREFLOW PLUMBING LLC PHONE #: 971-219-9313
Inspection Request Scheduled For: Date: 9/3/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 95 Misc. inspection 074976-01 503 - 780.7943 N
Corrections /Comments /Instructions:
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n PASS n PARTIAL APPROVAL CANCEL I I NO ACCESS
54 FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CR A-1'►-A--)% Date: 9 le3 I Phone #: (503) 718-
CITY OF TIGARD - 1 - '•• . -
BUILDING DIVISION PERMIT #:
P I ..M2008.00090
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/b72008
Phone: (503) 639-4171 4,pai i ,
Inspection Requests (24 Hrs.): (503) 639-4175 A314-• -
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
1017/2008 7:00AM 22
SITE ADDRESS: CLASS OF WORK:
13360 SW 121ST AVE
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: FRANZ
DESCRIPTION: Connecting isting house to sewer. Septic tank to be pumped and filled. Reimbursement #30.
Fees paid 3/5108.
OWNER: FRANZ, ROSEMARY PHONE #: 603-698-3992
CONTRACTOR: PUREFLOW PLUMBING LLC PHONE #: 971
Inspection Request Scheduled For: Date: 10/7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1
399 Plumbing final 07637401 503-780-7943
N
Corrections/Comments/Instructions:
F‘ I c 170,,AZ
evt co ..c_ft,,
0 PASS 0 PARTIAL APPROVAL El CANCEL Li NO ACCESS
FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: (11A-y)..A... V il- Date: it, \-) Vil '1'1 Phone #: (503) 718-
•
CITY OF TIGARD 11111Pir
BUILDING DIVISION PERMIT #: PLM2008-00090
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 302008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
10/17/2008 7:02AM 29
SITE ADDRESS: CLASS OF WORK:
13360 SW 121ST AVE
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
FRANZ
DESCRIPTION:
Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #30.
Fees paid 3/&08.
OWNER:
FRANZ, ROSEMARY PHONE #: 503.698
CONTRACTOR:
PUREFLOW PLUMBING LLC PHONE #: 9 71_ 219 _ 9 3 1 3
Inspection Request Scheduled For: Date: Pour Time:
10/17/2008
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 076844-01 503-780-7913 N
Corrections /Comments/ Instructions:
outi- f--;
Cea. fit— c i ViJ ..e.....,k,
K PASS 1-7 PARTIAL APPROVAL El CANCEL El NO ACCESS
FAIL r-7 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: (7 Date: 10 ft) 1011 Phone #: (503) 718-
, , _