Permit WI CITY OF TIGARD PLUMBING PERMIT
•
• COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00405
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/5/2007
PARCEL: 2S 104BD - 01400
SITE ADDRESS: 13665 SW FERN ST ZONING: R -
SUBDIVISION: OBRS HEIGHTS LOT: 001 JURISDICTION: TIG
PROJECT: ROMAN CATHOLIC ARCHDIOSECE
Project Description: 89' of sewer line to connect, empty and fill in the septic tank.
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: 89 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ROMAN CATHOLIC ARCHBISHOP OF
PORTLAND IN OREGON Description Date Amount
2838 E BURNSIDE [PLUMB] Permit Fee 9/5/2007 $72.50
PORTLAND, OR 97214
[TAX] 8% State Surcha 9/5/2007 $5.80
Phone : Total $78.30
Contractor:
THE EXCAVATORS LLC
PO BOX 690
YAMHILL, OR 97148 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 649 -5354
Reg #: LIC 152333
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 ob -in opies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B • // // 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.
• P .amhing Permit Application
. S't }f U-f i L t �s ' fog '.OFFIC USE ONLY -
ReceBy: r p _6
City of Tigard Re
Date/By:
q � UL Permit No.: l
111
- ,0 1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review l � ^
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No xJ r6 (x(7 „ S
Inspection Line: 503.639 4175 D ate Read /B ® e 2 for
TIGAKD Ready
/B
www.tigard - ocgov Notified /Method: od: /� 17 Supplemental See Pa g Information
TYPE OF WORK FEE* SCHEDULE.
❑ N construction El Demolition For special information use checklist
Description Qty. Ea. Total
Addition/alterationlreplacement
El Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
nd 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: / 3a , S ('C(" ��1 .7 Catch basin or area drain t6.60
City /State /ZIP: TI j 4 Q l oie X7 , 3 Drywell, leach line, or trench drain 1 6.60
Suite/bldg. /apt. no.: Project name: t-b ,� T,' 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.:2 1 I Page 2 Sc .C(D
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 Backflow preventer Page 2
/ LF
.5 e: -4LE' /' ` C'L Backwater valve 16.60
7'Y T)" 77/6 C '7 7e Clothes washer 16.60
L6-- /1(1' Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name OA-1110U i-I l4 0 C R o_Ctf D , 0 Sie `� Expansion tank 16.60
Address: 0 3g ` emu a o `a- € Fixture /sewer cap 16.60
City /State /ZIP: 1,--c) / OtL 47/ a Floor drain /floor sink/hub 16.60
Phone: ( ) 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: e 44 `f 7 f ..C: Water heater 16.60
Address: P,. o , A' ' 94$ Other:
( Subtotal
City /State /ZIP: fi ivfitz. O T76
® V Minimum permit fee: $72.50 � e �
Phone: (.5P:, epto' 0 e7/0 Fax: ( ) Residential backflow minimum permit fee: $36.25 so
CCB Lie.: /5 333 PI Plan review (25% of permit fee)
Authorized signature: 4444 State surcharge (8% of permit fee) 5. 80
TOTAL PERMIT FEE 9-? 3D
Print name: i `' ' '/6 C cr Gee Date: 7.-r -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.
I.\Building\Permits \PLMF - PermitApp doc 12/27/06 440- 46I6T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard -
Page 2 - Supplemental Information
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Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square, Footage: Permit • -
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 66.0a 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
Storm &Ram Drain - 1st 100' 55.00 Valuation:. Permit Fee:
$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
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
Subtotal: 55 00 $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 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:
\Building \Permits\PLM - PermitApp doc 12/27/06
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ALOHA SANITARY SERVICE
INVOICE NO ,t
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 $ 1 2 5
503 -644 -2797 * 503 - 648 -6254 * 503 - 639 -5188
NAME: 6 09 v7 r 1
ADDRESS:
CITY: STATE: ZIP:
HOME: WORK: CELL: 7D P- ���
JOB SITE: I ���.7 .S•� ��' �'� f / * 7.7.9.40A? P.O. #:
PAID BY CHARGE ❑ CHE K ! CASH ❑ CREDIT CARD ❑
DATE f - /,1- c5 DRIVER /)/5 74 Toe! AMOUNT
®' PUMP SEPTIC TANK , '527 G�
❑ LINE OPENING
❑ INSPECTION FEE
❑ SERVICE CALL
❑ LABOR, LOCATING, DIGGING, BACKFILL
• - - - - -- ❑ - MATERIAL' - - -- - - - -- .
- THIS Is NOT A SEPTIC SYSTEM INSPECTION REPORT - -
TOTAL $ J "l
- — REMARKS - -
TYPE OF TANK: STEEL ❑ CONCRETE ❑ PLASTIC ❑ HOMEMADE ❑
HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ , ❑ - OOT.HER -
SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 1000 0 1.250`❑ 1500 ❑ 2000 ❑ 3000 ❑
LID LOCATION: INLET ❑ OUTLET ❑ /MIDDLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD ❑ FAIR -E POOR ❑
FITTINGS: BAFFLES ❑ CONCRETE ❑ CAST IRON ❑ PLASTIC ❑ j
NEEDS NEW LID? YES - SIZE 1 -,& / FR h./•"i 4 / e
GROUND COVER OVER TANK
COMMENTS ON CONDITION OF DRAINFIELD ETC.
SIGNED BY DATE 'F-- �f - 5,7
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2007- 00406
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2007
Phone: (503) 639 -4171 ��4��ii A
Inspection Requests (24 Hrs.): (503) 639 -4175 _ F
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7 :01AM PAGE: 31
SITE ADDRESS: 13665 SW FERN ST CLASS OF WORK:
SUBDIVISION: OBRS HEIGHTS LOT #: 001 TYPE OF USE:
PROJECT NAME: ROMAN CATHOLIC ARCHDIOSECE
DESCRIPTION: 89' of sewer line to connect, empty and fill in the septic tank.
OWNER: ROMAN CATHOLIC ARCHBISHOP OF, PHONE #:
CONTRACTOR: THE EXCAVATORS LLC PHONE #: 503.649 -6354
Inspection Request Scheduled For: Date: 9/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 055650 -01 503-708-2706 Y
Corrections /Comments/ Instructions:
•
PASS I 1 PARTIAL APPROVAL n CANCEL n NO ACCESS
I I FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: <JO X 4-4 i \ q---- -- Date: 4 71 2 ) 67 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00405
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 315/2007
Phone: (503) 639 -4171 �iIJ�I +I
Inspection Requests (24 Hrs.): (503) 639 -4175
' 'INSPECTION WORKSHEET FOR DATE: 8/130007 TIME: 7:01AM PAGE: 30
SITE ADDRESS: 13665 SW FERN ST CLASS OF WORK:
SUBDIVISION: OBRS HEIGHTS LOT #: 001 TYPE OF USE:
PROJECT NAME: ROMAN CATHOLIC ARCHDIOSECE
DESCRIPTION: 89' of sewer line to connect, empty and fill in the septic tank.
OWNER: ROMAN CATHOLIC ARCHBISHOP C)F, PHONE #:
CONTRACTOR: THE EXCAVATORS LLC PHONE #: 503'649 -5354
Inspection Request Scheduled For: Date: 9/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 055650 -02 503- 708 -2706 N
Corrections/Comments/Instructions:
�P Pf 16,44 „L -y'1 elate✓ ,
xf PASS I I PARTIAL APPROVAL I CANCEL NO ACCESS
I I FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: 6 � '�"`-' 1 � '`^�- Date: � JO'? Phone #: (503) 718-