Permit v I
IN n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE
COMMUNITY PLM2008 -00197
TIGARD '13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/8/2008
PARCEL: 25101 DB -00609
SITE ADDRESS: 07665 SW FIR ST ZONING: R -3.5
SUBDIVISION: ROLLING HILLS LOT: 017 JURISDICTION: TIG
.
PROJECT: GUTHRIE
Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Sewer
Reimbursement District #44 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GEORGE & D GUTHRIE
7665 SW FIR ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/8/2008 $72.50
[TAX] 12% State Surch 5/8/2008 $8.70
Phone : 503- 639 -5421 Total $81.20
Contractor:
BRIAN CLOPTON EXCAVATING INC
PO BOX 509
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
•
Contact # : PRI 503- 682 -0420
Reg #: LIC 50337
PLM 3 -517PB
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 /4 Lei. s4 1, Permittee Signature. + F -..Le_,
Now
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.
Pk;lir 'Il Permit Application
Building Fixtures FOR' ,OFFICE:
USE ONLY
II City Of Tigard Received j O p' I Permit No ' L- (, IV. -- a) / ? 7
V 13125 SW Hall Blvd , Tigard, OR 97223 Date/By �/ j�
. Phone 503 639 4171 Fax. 503 598 1960 Plan Review �. ` v /� /f„
Date/By Other Permit No . pt 'r� J i 6004
TIGARD Inspection Line 503 639.4175 Date Ready /By Juris 65 See Page 2 for
Internet www tigard -or gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El New construction El Demolition For special information use checklist.
Description I Qty I Ea [ Total
El Addition /alteration/replacement El Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
El 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
El 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: ��Q 4 5 (sL..) }} 6 r Catch basin or area drain 16 60
City /State /ZIP: II a , O (2L g 72,'L 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: ( ^�� 4 Footing dram (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 (00 Page 2 4S' 0
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
C } no0 e_i v &w2 ei2('((a)f.._ Backwater valve 1660
Clothes washer 16 60
Dishwasher 16 60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16 60
� n � r.,Q,, � - Ejectors /sump 16 60
Name: lQ pi) e.10 � 1�� Lbt2 ,5 1-i-/ Expansion tank 16.60
Address: 7( ` F ter- Fixture /sewer cap 16 60
City /State /ZiP: --nCp 12:7 / OR Q 7 a-a- 3 Floor drain/floor sink/hub 16 60
Phone: (v )3) 5 _ " q/ 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
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16 60
Tub /shower /shower pan 16.60
E -mail: Urinal 16 60
CONTRACTOR Water closet 16 60
Business name76k1 A. IV iP 7 7i% E 7(�.4 J�-- IJ( Water heater 16 60
Address: p. O . � 5 ct — l "' Other
City /State /ZIP: W I L-6613 J . �� O2 9 707 Subtotal
Minimum permit fee $72 50
Phone: ($ ) j S a — Fax: ( ) Residential backflow minimum permit fee $36.25 ��'
CCB Lie.: 5 7 Plumbing Lic. no.:3 -5/ 7 Pb Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of permit fee) S 7D
TOTAL PERMIT FEE 1 % 1J
Print name: Date: This permit application expires if a permit is not obtain within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
i \Building\Permits \PLMF- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard r" '
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1U 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
Q ty. Fee (ea) Total additional $100 00 or fraction thereof, to and
Fixture or Item 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: $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 ❑ 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"
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
\Budding \Permis\PLM- PermitApp doc 12/27/06
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SOLD BY CASH C.O.D. CHARGE 1 ON ACCT. MDSE. RET'D. PAID OUT .
Wigc. DEGORIPTION PRICE AMOUNT
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All claims and returned goods MUST he accompanied by ibis bill i
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EGO-22.:, (.3a0 or r 2b3.:CM
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: PLM2008-00197
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5020013
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/15/2008 TIME: 7:00AM PAGE: 22
SITE ADDRESS: 07665 SW FIR ST CLASS OF WORK:
SUBDIVISION: • ROLLING HILLS LOT #: 017 TYPE OF USE:
PROJECT NAME: GUTHRIE
DESCRIPTION: Connect, existing house to sewer service: Septic tank is to be pumped and filled. Sewer
Reimbursement District #44 fee paid this date.
OWNER: GUTHRIE, GEORGE & DOLORES PHONE #: 503-639-5421
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503-682-0420
Inspection Request Scheduled For: Date: 511512008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 069958-01 503-849-7607
Corrections/Comments/Instructions:
P tA^^-i0 l
e tt o'T:
CA re F Le-1p
,PASS PARTIAL APPROVAL 0 CANCEL I NO ACCESS
I FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: rio 44-A- -A \11-1^.--12- Date: S140 Phone #: (503) 718-
. .,