Permit C ITY OF TIGARD PLUMBING PERMIT
T .1.1 DEVELOPMENT SERVICES PERMIT #: PLM2006 -00517
`�--� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/26/2006
PARCEL: 2S 102DC -00400
SITE ADDRESS: 09265 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 016 JURISDICTION: TIG
Project Description: Line work for sewer connection. Septic to be pumped and filled or removed.
CLASS OF WORK: OTR 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: 120 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ANNE /ROBER BOTHELL -MABE
9265 SW EDGEWOOD ST. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 10/26/200€ $101.40
[TAX] 8% State Surcha 10/26/200€ $8.11
Phone : 503 -598 -9885 Total $109.51
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.
Issued B Q 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 Applica ,.; ; CEIVED
Building Fixtures (�+h CEIVED OPT Icl . USE QN� Y • .
,t; a'', Cl of Tigard t 1, '1 2 O 20116 Received Permit N
�� City g Date/BY I D /A1106 313 t , - n 0577
13125 SW Hall Blvd., Tigard, OR 9
® R t ' anus= Plan Review Other Permit l io
Phone: 503.639.4171 Fax: 503 I Date/By Oth P it �06..e xlg
T I G A R I7 Inspection Line: 503.639.4175 4 ' .1/ i `" ® Date Ready/By. J�1�p��f fa See Pag e 2 for
Internet: www.tigard -or gov Notified/Method l Supplemental Information
' TYPE OF WORK FEE* SCHEDULE '
❑ 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)
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: .,92..6..5 S LJ Goa (,vt7G( �
o / - Catch basin or area drain 16.60
City /State /ZIP: (, Nc/ Oi C9 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: ' I 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 f t J 9 & Page 2 101. Lip
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16 60
,- DESCRIPTION OF WORK" Back flow preventer Page 2
11111a. �� , oti X4 Backwater valve 16.60
0 Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ' ❑ TENANT Drinking fountain 16.60
'Z'..1 ` ' .,1 �f . Ejectors/sump 16.60
p Name: i s l= 2 4 L._ ub /e.h e ` ert " t O Expansion tank 16.60
Ct Address • 9 c s'W C G._7 cc( Fixture /sewer cap 16.60
City /State /ZIP:` / u c ! 7�j 2 Floor drain/floor sink/hub 16.60
to Phone: 6 ) � 5:-,es- Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ' . ❑ CONTACT PERSON 7 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 ( ) Fax . ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16 60
. CONTRACTOR Water closet 16.60
- Business name: e- Water heater 16.60
• Address: Other:
City /State /ZIP • Subtotal
Minimum permit fee $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 /0 t. 1 0
CCB Lic.: Plumbs. Plan review (25% of permit fee)
� I ��� State surcharge (8% of permit fee) p c�
-
Authorized si TOTAL PERMIT FEE i c q. 51
int name. 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 \Permns\PLMF - PermitApp doc 04 /06/06 440-4616T( I 0/02/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 s ` 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
and including $50,000.00.
specially requested inspections - per hour 72.50
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 P " Ins t a ll ations
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 ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash -Each Stall
-Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher - Commercial
Domestic M Isometric or Riser Diagram
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink - 2"
-3"
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
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
a \Budding\Penmts\PLM- PermrtApp doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: M12006,00517
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/26/2006
Phone: (503) 639-4171
i.8.0214,17,vi,41, .
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/16/2007 TIME: 7:01AM PAGE: 18
SITE ADDRESS: 09266 SW EDGEWOOD SI - CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 016 TYPE OF USE:
PROJECT NAME: BOTHELL
DESCRIPTION: Line work for sewer connection. Septic: to be pumped and filled or removed.
OWNER: BOTHELLNABE, ANNE/ROBERT PHONE #: 503_598,.9685
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/16/2007 . Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 05769G-01 603-598-9886 Y
Corrections/Comments/Instructions:
Se k
g e cli_vo Se e t; c_ To
X PASS I I PARTIAL APPROVAL fl CANCEL I I NO ACCESS
I FAIL I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
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Inspector: CrtAivNA---/ \ % ‘ Date: Jo I IL I D Phone #: (503) 718-
, , , , • , , ,
CIT,Y.OF TIGARD ,
BUILDING DIVISION PERMIT #: PLM2006.00517
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10126/2006
Phone: (503) 639- 4171 fj�l�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7 :01Am PAGE: 17
SITE ADDRESS: 09265 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 016 TYPE OF USE:
PROJECT NAME: BOTHELL
DESCRIPTION: Line work for sewer connection. Septic to be pumped and filled or removed.
OWNER: BOTHELL- ivMABE, ANNE/ROBERT PHONE #: 503- 590 -m8B5
CONTRACTOR: OWNER PHONE #:
("'"
Inspection Request Scheduled For: Date: 11/1712006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
350 Septic tank 039978 -01 503 - 590.9885 ¥ R
Corrections /Comments /Instructions:
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II P S I J PARTIAL APPROVAL n CANCEL I I NO ACCESS
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OOO-223 -6. G or`fibtsar
CITY, OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00517
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/26/2006
Phone: (503) 639-4171
• oguliff
Inspection Requests (24 Hrs.): (503) 639-4175 l
INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7;01AIVI PAGE: 18
SITE ADDRESS: 09265 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 016 TYPE OF USE:
PROJECT NAME: BOTHELL-MABE
DESCRIPTION: Line work for sewer connection. Septic to be pumped and filled or removed.
OWNER: BOTHELL-MABE, ANNE/ROBERT PHONE #: 503-598-9885
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer 039977-01 503-598-9885 N
Corrections/Comments/Instructions:
SrgLEET
Ams
PASS PARTIAL APPROVAL pi CANCEL H NO ACCESS
FAIL pi CALL FOR INSPECTION ADDITIO AL FE' S ASSESSED
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