Permit i CiTY Y OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00282
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/29/2007
PARCEL: 2S 102DC -00510
SITE ADDRESS: 09115 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG
PROJECT: LARSEN
Project Description: Connect existing house to sewer, approximately 60' and reverse plumbing. Septic tank is to be
pumped and filled. Reimbursement District #31 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: 60 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PAUL & LORI LARSEN
9115 SW EDGEWOOD ST Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 6/29/2007 $117.50
[TAX] 8% State Surchart 6/29/2007 $9.40
Phone : 503- 6639 -6325 Total $126.90
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 d' - ct questions
to OUNC by . .. 503 246.6699 or 1.800 332 2344
Issu:d By: ( i Ali 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.
Plumbing Permit Application
Building Fixtures -.r.-..' 7 ; ? FOR OFFICE 'USE ONLY "
City of Tigard Received �� �� i PeunitNo ' I7 � ag2.
Date/By /
II
- a 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review O ther Permit No OW CJ �/ /� /
Phone 503 639 4171 Fax 503 598 1960 7 `
Other
'TIGARD Inspection Line 503 639 4175 Date Ready /By
;fir"
u 65 See Page 2 for
Internet www tigard -or gov Notified/Method « Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description 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
❑ 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: //,T SCU D r'(, p 5 ` Catch basin or area drain 16 60
City /State /ZIP: / / l", 61 P-0 �� L ' °° Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: / A - 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 i Page 2 .-5-7426)
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
( rn(accir y cD .•, -Cc.� Backwater valve 16 60
l Clothes washer 16.60
Dishwasher 16 60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: p„ $ 0 � ` ,i , 4 P'5- ' Expansion tank 16 60
Address: Cl i/ `lr 1 L ) ' ( J G i< p o `p Fixture /sewer cap 16 60
City /State /ZIP• —r ,k-....6 d / , ' Floor drain /floor sink/hub 16 60
` ? -3 a5
Phone: (568) � / d„,, -3 ( ) 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
n Water closet 16 60
Business name: 0 / „ ,� J S% /% Water heater 16 60
Address: l.�J t � / (�/ �� Other /1 .de,2_ 1D P(.I'/. e .A..`5
City /State /ZIP: Subtotal
Minimum permit fee $72 50 // 7 S
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee $36 25
CCB Lic.: ' robing Lic. no.: ,�
Plan review (25% of permit fee)
c,�_ V
State surcharge (8% of permit fee) 9 •
Authorized signature _ /" /Is ' ` —.0! TOTAL PERMIT FEE
Print name: ( 19 4 ( a4( 5-1,1 Date: _ ,.,_09- This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tr- County Building Industry Service Board
i \Building \Permits \PLMF- PermnApp 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 - 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 $40,000 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
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
\Bmlding \Pern6ts \PLM- Perm5App doc 12/27/06
•
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: P13442007-00282
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2007
Phone: (503) 639-4171 /4,1111111111p
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/20/2008 TIME: 7:02AM • PAGE: 20
SITE ADDRESS: 091°15 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDG - EWOOD LOT #: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: Connect existing house to sewer, approximately 60 and reverse plumbing. Septic tank is to be
pumped and filled. Reimbursement District #31 fee paid this date.
OWNER: LARSEN, PAUL & LORI PHONE #: 503-639-6325
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/2012008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 071653-01 503-639-6325 Y
Corrections/Comments/Instructions:
Cze - 1 — eLL■V Pt .‘ 1 - 4 Se e, ity4 c ae . 1-..
./
Ccotr-e..CJI-
PASS I 1 PARTIAL APPROVAL fl CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
—
Inspector: Cf Ny■A--4._ Date: i4)s: Phone #: (503) 718-
i p
b •
V /1 bP
V 11055 S.W. Clay • Sherwood, OR 97140 -
0 � j Telephone: (503) 682 -0233
�� ; '1
Date(_42 ' "�- e .. ~
Service for ra.�- I k Cc_ VS -i
. .0
Address c E : / -! C.� ;; v c -, �,
r
07 k t Phon(a .), , �'
_. City f V � -
For Cleaning- Septic Tank 1
For Cleaning Drain Line
} For Cleaning Grease Trap
For Extra Labor
C V-4.\-\\4\1,\(}R ]
1) , ;
4 r...,,, ; TOTAL i
6
Amount Paid .,.,.1U I' Balance-Du
Due Date
1
f ,( I l
Signature �, �;, : ; ����!. -L- ,_�.--
----
Please make check out to present driver .-°f '`
Three percent per month interest charged on bills if not paid in 30 days. `-i
Not responsible for septic tank, drain field, curbing or driveway damage.
CITY OF TIGARD .-- ,...
BUILDING DIVISION PERMIT #: PI142007 -00202
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6129/2007
Phone: (503) 639 -4171 avuljp i i i
Inspection Requests (24 Hrs.): (503) 639 -4175 '_L.
INSPECTION WORKSHEET FOR DATE:.. 6/6(2000 TIME: 7 :01AM PAGE: 11
SITE ADDRESS: 09115 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: Connect existing house to sewer, approximately G0° and reverse plumbing. Septic tank is to be
pumped and filled. Reimbursement District #31 fee paid this date.
OWNER: LARSEN, PAUL & LORI PHONE #: 503"6639 -6326
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 616/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
310 c43 071028 -01 503 - 201 -2452 Y
S r 1'e.-�,e..,-„ 9)3--C, 3 9 (-0 7° ` Corrections /Comments /Instructions:
/DL t tkL C o f3 'o tn.‘,.. 1 pT S4.104-dc. T - AAA---p 4- P 1 L
6 i.. t\ co ✓ 1 , k W 1Tt- 3 D 0 in
•
I I PASS X PARTIAL APPROVAL lZI CANCEL ��� I ❑ NO ACCESS
I l FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: SI-A-✓A \ \h^^� Date: 6 ) ( 1 cent Phone #: (503) 718-
CITY OF TIGARD •
.
BUILDING DIVISION PERMIT #: PLM2007-00292
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2007
Phone: (503) 639-4171 04mspriov. it\
Inspection Requests (24 Hrs.): (503) 639-4175 AM.
INSPECTION WORKSHEET FOR DATE: 6/312008 TIME: 7:00AM PAGE: 7
SITE ADDRESS: 09115 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEVVOOD LOT #: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: Connect existing house to sewer, approximately 60* and reverse plumbing. Septic tank is to be
pumped and filled. Reimbursement District #31 fee paid this date.
OWNER: LARSEN, PAUL & LORI PHONE #: 503-66396326
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/3/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
60E, Sanitary sewer 0707311-01 603-312-1363
Corrections/Comments/Instructions:
JA
e
4" 30_39 pu4.1,
Z -410-e( 4
p 1 / 4 -4■~4 D ,c,40 170L-A4- r-, Co PtA.-- Re c-A
fl PASS PARTIAL APPROVAL LII CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: 013\1 Date: 6 31 o z Phone #: (503) 718-