Permit i
w_` - . CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00117
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/23/2007
PARCEL: 2S 103 BC -02800
SITE ADDRESS: 12150 SW ALBERTA AVE ZONING: R -4.5
SUBDIVISION: CANOGA PARK LOT: 002 JURISDICTION: TIG
PROJECT: UHL
Project Description: Line work to connect sewer. Septic system to be pumped and filled or removed.
CLASS OF WORK: NEW 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CURTIS UHL
12150 SW ALBERTA ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/23/2007 $72.50
[TAX] 8% State Surcha 3/23/2007 $5.80
Phone : 503 -524 -8978 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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.
i elit4,4-1.4 .4 4.
Issued 2/4/A 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.
J
Plumbing Permit Applicat eF .\ /ED , FOR; HI(E ilst 0N1 ' - , d '
City Tigard Dee/By� 4,1,5A 4,1,5A Permit Nob iC lYl 7�OU it 7
SW
13125 SW Hall Blvd., Tigard, OR 97223 2007 pan Revie
o z Phone. 503.639.4171 Fax: 503.5 Other Permit .1960 y. t G 2044,)7 7
`r :. Inspection Line: 503.639.4175 U I Y �� I d(3ARD
T I G A �' BUILDING DIVISION Date ed/Me , S see Page for
Internet: www.tigard or.gov
NotiSedMtethod Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
: aka' 1ey�. �ib� ,��",5!,°�ti`i':� "{u�r_�.;3,�., . ,� ,... �xa;r,.;.,,. ." �-.,.�. ai�,n ;.� �+'.w ,
's .":;' c x ii' CAT, EGOIIII ,`.;;OF;.GUNSI7CUGTIOIV''x,` '` r/ ' ` Z' t " SFR ( r _ f.,:t., `T�,`4,`"�» - � - � .,. - �, _ � ,� .. t' � - 4�� `�' � ?�,.�; ()bath 249.20
❑ 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
❑ Other:
" " "_` .i fi *4 y . , a w. x'. • s... ti - Fire sprinkler ( sq. ft.) Page 2
AA: ' JOB SITF :14,TOR i = 0, ; ' t : .
,,, ,[.�t. - a , . �, _ .,. * . w ON�AND y L:OCATION ,� '�� Site utilities
` . .
?•'n =�.PV i :.'..'. , 'F£ _RT m27R, .. � - '.��i°:3FZ�'�'Y':_" � ,N'f1�,t F
Job site address: /2 1 5 - 6 SV.. A[ ge 4_ S'7-. Catch basin or area drain 16.60
City /State/ZIP: --T- /c, RK D ` 0 t_ 9 72 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Cross street /directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector s� 16.60
• Sanitary sewer (no. linear ft.:4(/) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
rri�y; " ;ti �:r: �.. .� ..�,�, _ .. �, _. .. - v._�: a, Absorption valve 16.60
r yr z a'v `` + r - * , ,. 3DES . CRIPTI N F ' WO RK y �r 1
._r• he ,.,_ .4 -411 -, . r�r U a�:O , tea ,q_ ,,,,,,- ..m1_: . j .f V, ,y am k
. ° #«,, ° Back flow preventer Paget
p i>
G4..._ A LA' Backwater valve 16.60
AS IA, , ) J a i Clothes washer 16.60
Dishwasher 16.60
(, . =: K.si'`,„ - dr ' ..'�,�, _ •�.•,.ru a• -,... xy : Y . g . ",,.... va. to-. -> -�r �-a Drinking f .
o
z"^ PROkiii 4. WNER-' ;- ' 'x`'' g� .14 . fountain 16.60
`vr <f� ,''•' ® TENAIVT
..- a:,t, Ejectors/sump 16.60 •
Name: ('' 1.02 T/, s / /SA e.ii!G
Expansion tank 16.60
Address: f 2 / 5 - 0 S IN f4 L e g7 A S Fixture /sewer cap 16.60
City / State/ZIP: G^t 9 OR q Z-2.3 Floor drain/ floor sink/hub 16.60
Phone: (So 3) 5-2 Y- 5.17 13 Fax: ( ) Garbage disposal 16.60
,. a v °h r tt # " ®. 2. ` ', o,4 'wv - ,..,dy ,,.. � . .. ..w.�c�.w, .., a ,- , ;> Hose bib .
x ;',?;l';. ,-*, -,`k". APPI:ICA` ,.'1 t i r,,iatg ,4,. <
`.t ,® CU'A RSO 16.60
°" N7 Cf "pE N: "'" 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: -
' ,} = X'" ;r $x, Urinal 16.60
";
z, a ,. " - '"�`. . s, m' . eF'v CONTRA p "' ":$ : r. ,7 t , . ",` . r .
:. k•; a a' 4 r' .L . ,. "- '.' '.. v," � t-,. • -- LT _.aR � ; m 5 A P I N, ; iS , . .
*_ s �sfr «. 4 Water closet 16.60
Business name: Q VlW jvG Water heater 16.60
Address: Other:
City / State/ZIP: Subtotal
Minimum permit fee: $72.50 �j
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 /p fit/
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) , 0
Authorized signature: 7. 56
TOTAL PERMIT FEE
Print name: euoz 77 5 t1H4_ Date: 3 2 2 -Q 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.
1: \Bui 'ding \Perm its \PLM- PermitApp.doc 06/26/06 440- 4616T( 10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
a2/ s ,, ;
SitaUtihtle5,' f _a Qty Ee (ea) Totat S,.(lllat'Q FOOraf;C � �� Perffi1t 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�,,�b�
0 IPerffiit3 ee : 4eai
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
`TofaI i additional $100.00 or fraction thereof, to and
,;r a °9 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 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
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or
and including 0.00.
specially requested inspections - per hour 72.50 the
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: ' a A �
��.�Plan R:eview`' for ;�Pluuibing��Installahonss�A
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
°: r,iiiiatiq by'(Fii ire) Wor`k'Performed'` greater, except systems designed and stamped by licensed
A 1 � _ f ��'Replaee engineer.
hl• fi,I,77 c�' a f.�,54 P,IevI0U3� x.- Ciip' �a.Addeda:.:;+tEiistluj„ -xY plumbing any complex .
�' �, �� �_ �� '� ~ � R- • ❑ New lumbin site utilities for an com lex 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 A .* I som ef' ric ` oirRiser _Dagraffi "' ,t,;
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 Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Penniu\PLM- PennitApp.doc 09/22/06
CITY OF TIGARD .. „
BUILDING DIVISION PERMIT #: PLMM32007 -00117
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/23/2007
Phone: (503) 639 -4171 , 4,1141,11# �
'Inspection Requests (24 Hrs.): (503) 639 -4175 : -
INSPECTION WORKSHEET FOR DATE: 5/9/2007 TIME: 7 :00AM PAGE: 63
SITE ADDRESS: 12150 SW ALBERTA AVE CLASS OF WORK:
SUBDIVISION: CANOGA PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: UHL
DESCRIPTION: Line work to connect sewer. Septic system to be pumped and filled or removed.
OWNER: UHL, CURTIS PHONE #: 503 - 5248978
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/9/2007 Pour Time:
II
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 047868 -01 503 -686 -4406 N
Corrections /Comments /Instructions:
ti_ ` -
F _
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jsEA SS *ARTIAL APPROVAL fl CANCEL I I NO ACCESS
I I FAIL H CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: i AA i A Date: /
V " Phone #: (503) 718-
248 -BARK 648-BARK I
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Check _ ._ ._ ...
12,,11S Price Per . , - -- Amount
Quantity `' nP10 $39 2 301_______$__________119.46
$1
3 Yar Rea Grave! � 99.00
2 _..- Yard MASON SAND 1 $39.801 $79.60
2
iIEDEMAN ..... THROUGH 4 WAY STOP -----------------
o RIGHT 1 WALNUT
R LEFT 121ST -_ ---
. RIGHT ALBERTA _ ---- -- ---
' Mill
. ; NOTES -DUMP PEA GRAVEL FIRST, THEN SAND. Wir HAS EXACT ..Dr-c. + S TO
DUMPT WHEN YOU ARRIVE CALL #, IF NO ANSWER KNOCK ON DOOR
Side olor
Check Dump apbook 655B4
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NOT RESPONSIBLE FOR DAMAGE -AGE 1 1 Q D ..— .
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