Permit .
Iii CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE
COMMUNITY PLM2008 -00438
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503 639.4171 DATE ISSUED' 11/25/2008
PARCEL: 2S1 030C-00806
SITE ADDRESS: 11385 SW FAIRHAVEN ST ZONING: R -3 5
SUBDIVISION: VIRGINIA ACRES LOT. 004 JURISDICTION TIG
PROJECT: TOPF
Project Description: Connect existing house to sewer service Reimbursement District #38 fee paid
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. 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PAUL & CHR TOPF
11385 SW FAIRHAVEN ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/25/200£ $72 50
[TAX] 12% State Surch 11/25/200£ $8 70
Phone . Total $81.20
Contractor
A AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # • PRI 503- 969 -9548
FAX 503 -570 -0779
Reg #. LIC 158246
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 dir t questions to OUNC by calling 503 246 6699 or 1 800 332 2344
,%�
Issu d By. -'- x t .k Permittee SignatureK, _ - jar
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 FOR OFFICE. EIRE, ONLY ° -
-
City of Tigard Date By
Date /By / Ai: Permit No I p/� 49
4 3 r
e 13125 SW Hall Blvd, I Igard OR 97223 Plan Renew
C - Phone 503 639 4171 Fax 503 598 1960 DateBy Other Permit No b cr 157
TIGARD Inspection Line 503 639 4175 Date Ready /fay r ® See Page 2 for
Internet www t)gard -or gov Notified /Method
r/ /`f Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty 1 Ea Total
Addnion/alteration /replacement ❑ Other New 1- 2 -family dwellings (Includes 100 ft for each utility connection)
/ CATEGORY OF CONSTRUCTION SFR (I) bath 249 20
04 and 2-Famili dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building 111 Multi-family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other
Fire sprinkler ( sy ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address / /335 $, 4). ra S52, Catch basin or area dram 16 60
City /State/ZIP 72 e p 9 7 Z e- Dry well, leach line, or trench drain 16 60
Suite /bldg /apt no 7 Project name Footing drain (no linear ft _) Page 2
Cross street/directions to job site J /5 -f7 L ,...„14,,,s44.>„, Manufactured home utilities 110 00
NV z '^ / Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft /O5 Page 2
Storm sewer (no linear ft _) Page 2
Subdivision Lot no Water service (no linear ft ) Page 2
Fixture or item
fax map /parcel no
Absorption valve 16 60
DESCRIPTION OF WORK
� // / Backflow preventer Page 2
�e'C1Jar�r r/YS Ors ,C7 r�/'.,i � u/ Backwater valve 1660
l •544/23Pi' / A S N 2'f J!/ Xu.rLL Clothes washer 1660
1 / / Dishwasher 16 60
f� O. P OWNER ❑ TENANT Drinking fountain 16 60
Ejectors /sump 16 60
Name -: id l0P F ' ) ` Expansion tank 16 60
Address / /38S /" sex) / trier j _ J./ Fixture /sewer cap 16 60
City/State/ZIP 7� ,,,,,_ /9, 972 2 Floor drain /floor sink/hub 1660
Phone (5—e) " 0 4 2 — / n Fax ( ) Garbage disposal 16 60
0 ❑ CONTACT PERSON hose bib 16 60
Ice maker 16 60
Business name
Interceptor /grease trap 16 60
Contact name 16 60
Medical gas (value $ ) Page 2
Address / Primer
Qty/ State/ZIP /V/ Roof drain (commercial) 16 60
Phone ( ) Fax ( ) Sink/basin /lavatory 1660
Tub /shower /shower pan 16 60
E -mail
Urinal 16 60
CONTRACTOR Water closet 16 60
Business name ,f4 --r4 p,4 2- 7 *' S '�� L Li Water heater 16 60
Address Y OX //SC Other
City /State /ZIP ,,Son& /L 5,,e p G 7 707 Subtotal
O Minimum permit fee $72 50
Phone (5-D3) oD 2 _ /C..1 ci Fax (563) 9 - 0777 Residential backflow minimum permit fee $3625
CCB Tic / S �. %!o I Plumbing Lic no Plan review (25% of permit fee)
Authorized signature
State surcharge (12% of permit fee)
�� S
t TOTAL PERMIT FEE
Pint name /" . c ' Date / /__25 ,Cfq This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by In-County Building Industry Service Board
I \BmldingWermns)PLMF- PermnApp doe 12/27/06 440- 46167710/02 /QOM/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' 5500 0to 2.000 $11500
Footing drain - each additional 100' 46 40 2 001 to 3,600 $160 00
Sewer 3 -601 to 7,200 $220 00
ewer - 1st 100 55 00
7201 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 [00 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 Backllow 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
Commercial 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 -7 ub /Shower ❑ Medical gas and vacuum systems for health care facilities
-Jacmn /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 /Refrie 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
VnimldmglermasAPLv- PermiIApp doe 12/27/06
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• AAAFFORDABLE
SEPTICSERVICE
-,� RQBOX;1130
W ILSONVILLE; OR 97070
(503) 682 =1929 'FAX•(503) 570 -0779
CUST 'S ORDF� R NO PHONE DATE
NAME' - b re
AD R SS 1 VI 1
-5W Pary L)eo 51-
McrA d'
SOLD B CASH COD CHARGE ON ACCT MOSE RET'D PAID OUT
., ��' 'a f5W ION in ialiRI AMOUNT
E AD a ra.
0 Se S
r Se,W Cam,
TAX
RECEIVED D \ tc TOTAL
All claims and retur ed goods MUST be accompanied by this bill
•
/ -/ To Reorder THANK Y
800-225-6380 or nabs corn
CITY OF TIGARD
BUILDING DIVISION � PERMIT # PLM200R- 004313
13125 SW Hall Blvd , Tigard, OR 97223 / - ` t t 7 DA ISSUED 11/26/2008
Phone (503) 639 - 4171 ;VW L I /
Inspection Requests (24 Hrs) (503) 639 -4175
INSPECTION WORKSHEET FOR DATE. 11/26/2000 TIME 7:00AIvi PAGE 16
SITE ADDRESS 11305 SW FAIRHAVEN ST CLASS OF WORK.
SUBDIVISION VIRGINIA ACRES LOT # 004 TYPE OF USE
PROJECT NAME TOPF
DESCRIPTION. Conned existing house to sewer service. Reimbursement District 00 foe paid.
OWNER. TOPF, PAUL & CHRISTA PHONE #
CONTRACTOR A AFFORDABLE SEPTIC SERVICE PHONE #: 503.969-9648
Inspection Request Scheduled For: Date 1it0E42000 Pour Time: A 4A, 4.r"
Code # Inspection Description Confirm # Contact # Mes 9-e J
399 Plumbing final 07056(301 503 - 9699548 Y :it:*
Corrections /Comments /Instructions:
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[PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL CALL F
I " v NSPECTION El ADDITIONAL FEES AASSSEE SED
1 C \ " Date: \ t / O - nspector Da te: Phone #: (503) 718-