Permit T CITY O'F TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00499
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/8/2007
PARCEL: 2 S 103 CA - 00302
SITE ADDRESS: 12020 SW FONNER ST ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: NOLL
Project Description: Connect existing house to sewer service Plumbing is to be reversed. Septic tank is to be pumped
and filled. Reimbursement District #30 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: 1
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JOHN NOLL
12020 SW FONNER ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/8/2007 $117.50
[TAX] 8% State Surcha 11/8/2007 $9.40
Phone : 503- 332 -0765 Total $126.90
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 318 - 4593 (work)
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 No a ion Center Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these r es or direct question : OUNC by calling 503 246 6699 or 1.800 332 2344.
Issu By: / 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.
Plumbigg Permit Application
Building Fixtures . FOR.,OFFICE USE ONLY
City of Tigard Date/By. Received �� /57 1 Permit No i aVel5)7 -a) ?7
it V 1 3125 SW Hall Blvd , Tigard, OR 97223
Plan Review
Phone 503 639 4171 Fax 503 598 1960 Date/By Other Permit No • (540407-0026.#2—
T 1 G A R D Inspection Line 503.639 4175 Date Ready /By I ® See Page 2 for
Internet www tigard -or gov Notified/Method / /Lip Supplemental Information
TYPE, OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description I Qty Ea 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
NI- 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: 062 ‘ go) r O4N er , c f Catch basin or area drain 16 60
City /State /ZIP: TG c cc/ OR 972:)3 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: // Project name: NO d Footing drain (no linear ft ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site: l'-/ s r • Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft. Page 2 h n d 0
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
L DESCRIPTION OF WORK Backflow preventer Page 2
eoon eel t cttr 5a-Pr — pect`, „..15 ti s7fj {e Backwater valve 16 60
t/ Clothes washer 16 60
Dishwasher fountain 16 60 16 60
PROPERTY OWNER ❑ TENANT Drinking
Ejectors/sump 16.60
Name: Jak.a A jo 1/ Expansion tank 16 60 ,
Address: j SO /-75-A rl Cr E - C. Fixture /sewer cap 16 60
City /State /ZIP: 7 G r_zi 4 f7,3 Floor drain /floor sink/hub 16 60
Phone: (C�' Z
3) _ 076 s- 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: ( ) I Fax:: ( )
Tub /shower /shower pan 16 60
E -mail: Urinal 16 60
CONTRACTOR Water closet 16 60
Business name: �t�rl Water he A 16 60
Address: Other. , W� £4C° (Q a.50
City /State /ZIP: L Subtotal
� btotal
Minim permit fee. $72 50 /pi
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee $36 25
Plan review (25% of permit fee)
CCB Lic.: Plumb).1 Lic. no.:
f State surcharge (8% of permit fee) y y e
Authorized signature: i //�
` � TOTAL PERMIT FEE 6,96
0
Print name: ✓k 4 n fi AA /7 Date: / f � �/ 7 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 doe 12/27/06 440- 46t6T(t0 /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
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 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 *. CI 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
\Budding'Pennns\PLM- PermuApp doc 12/27/06
SAND & GRAVEL, LLC. i
TONQUIN AND STAFFORD QUARRIES
P.O. BOX 4810 • TUALATIN, OREGON 97062
I •
• PHONE (503) 692 -1800
P F • ! f : q.t. TICKET NO.: 1 513 C
SOLD TO: ) `i 1 C r••0I.) DATE: .l c'i �. 2 +;i;'1 7
TIME: u?':7.% =: 2:x
JOB NO.:
JOB: TRUCK NO.: PI 1. kSGG,V; 7 1, 17i", 4
DELIVER TO:
NQl I . -IN 5 '` F. : -Q'.1 7 `.,f :-' ORDER NO.: •.1 `•_`1\iE Df.: : =. ,
1 •�,t i�, V.1 5,J .0 ! C : r_ f:: 4 _ P -. a ' ;1S:T
5 � � w
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Y;_..I' MNt - »fR $ T S. .d ._t -. »i I....
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'r`5,:;,; `C,",:,'�ra < k . wa`a^;� ,.� ' �, 3x: �`a. s �",� , . , ;Y, a �sc`'�,�.;�...s2.�•.krt ,� q ..� ;'.�. ''•f ;4 . ?`;- , ,'�".
I . ;af :'4a;€` i > j : , I Q'' & Vµ` > R :R EE� . ( TCi1 L ,
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1 s 7.r 0 F '0 ;' f'1 i' `,J�". ' -- i t ' - 1 h $ - 0 t ici,1 �{° t( v
{%{ 1 _. { . i I- C Y. ) , f :, , r = f ' 'lr {e. s "u i. _., i. u t, n 4't -L
)3 »_ N2'.: ',N1 et r';c T tof9:: .)%a i t <.9 , $•t 0,1,.`{., 1,71175
RECEIVED BY: l ` r' I 3 ( , f<> f /.. r .
WE MAKE DELIVERIES INSIDE THE CURB LINE AND ON THE LOT AT THE CUSTOMER'S RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR DAMAGE
RESULTING FROM SUCH DELIVERIES. ALL CLAIMS FOR SHORTAGES MUST BE MADE IN WRITING WITHIN 5 DAYS FROM DATE OF DELIVERY. FREE UNLOADING TIME
OF 10 MINUTES FOR A SINGLE TRUCK AND 20 MINUTES FOR A TRUCK AND TRAILER IS ALLOWED. EXCESS TIME WILL BE CHARGED AT EXISTING RATES.
CUSTOMER COPY -
NAME - `J ypj��j� DATE ? ,' 0, 7 f./ '
MAILING ADDRESS ss��w
t
1 NEXT PUMPING
�� ���`(� CITY
IT) .,, ` 1 F DATE
3 ..:. . ' JOB ADDRESS ; "1*' 4,) '::"a. .�` .p.` v O . j S ; E , 1'd .. �."-
Phone ( 503) 648 -8246 a?._ Ca ) §/' (:A tAT7c)
P O Box 793
Hillsboro, OR 97123
SEPTIC PUMP o ^ =, t , ,F T , \ °,
I DIG & LOCATE: I _ ' :)
( 3. k- k- ` F} / ‘,./ N I / : \ ' m
.,�
TANK & DRAINFIELD INSTALLED: C, y, , ar k' ,
1 MI SC- - -- ,: .. ? Lo \ \,4, , ', ..� ..-m ' -- ...".1 )
1 ' 4 T ; * ‘,., TOTAL $ UV j' "
PUMPING CHART 1 `" %-j
Household Size 1 2 3 4 5 6 7 8 9 10
(Number of People)
500 5 8 2.6 1.5' 1.0 0.7 0.4 0.3 0.2 0.1 --
750 9.1 4.2 2.6 1.8 1.3 1.0 0.7 0.6 0.4 0.3
1000 12.4 5.9 3.7 2.6 2.0 1.5 1.2 1.0 0.8 0.7
Tank 1250 15.6 7 5 4.8 3.4 2.6 2.0 1.7 1.4 1.2 1.0
Size 1500 18.9 9.1 5.9 4.2 3.3 2.6 2.1 1.8 1.5 1.3
(gal) 1750 22 1 10.7 6 9 5.0 3.9 3.1 2.6 2.2 1.9 1.6
2000 25.4 12.4 8.0 5.9 4.5 3 7 3.1 2.6 2.2 2.0
.
CITY �~�����N��������
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BUILDING DIVISION ` PERMIT #: PLM200700490
13125GVV Hall Bkd.. Tigard, DR07223 DATE ISSUED: 11/812007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 , 112.
INSPECTION WORKSHEET FOR DATE: 12/6/2007 TIME: 7:06AM PAGE: �2
SITE ADDRESS: 12M0 SW FUMMERST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: NOLL
DESCRIPTION: Connect existing house to sewer sorvice. Plumbing is to be reversed. Septic tank is to be pumped
and filled. Reimbursement District #30 fee paid this date.
OWNER: NDLL.JDHN PHONE #: 503'332
CONTRACTOR: OWNER PHONE #: 503-518'4593&morl.
Inspection Request Scheduled For: Date: 12/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 060933-01 8].3�332-0/G6 M
Corrections/Comments/Instructions:
Se is us T:
x� \. J� ' 6
�~=~ v'«� �-"^-~~`~`�v 94"3
e PASS PARTIAL APPROVAL 0 CANCEL NO ACCESS
0 FAIL I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: PL.M2007 -00499
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/8/2007
Phone: (503) 639 -4171 a°11 111111Iii
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/16/2007 TIME: 7 :01AMdi PAGE: 19
SITE ADDRESS: 12020 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: NOLL
DESCRIPTION: Connect existing house to sewer service. Plumbing is to be reversed. Septic tank is to be pumped
and filled. Reimbursement District #30 fee paid this date.
OWNER: NOLL, JOHN PHONE #: 503 - 332 - 0765
CONTRACTOR: OWNER PHONE #: 503 - 318 -4593 (wort-
Inspection Request Scheduled For: Date: 11/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 058830 -02 603- 332 -0765 N
Corrections /Comment /Instructiio 1� evlyv-z e x
A T 3 o 0 d,, C AN‘ y
S P e A- Artt -t LcA e1/4.4.1... tie-cc-6 e •
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (11 vr..- J1 V.►�► - Date: I I i it W7 Phone #: (503) 718-
.,1
CITY OF TIGARD ,
BUILDING DIVISION , PERMIT #: PLM I2007 -00*199
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 110.2007 g p4i�r�p►
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175'+ -
INSPECTION WORKSHEET FOR DATE: 1•Itlf12007 TIME: 7 :01AM PAGE: 20
SITE ADDRESS: 12020 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: NOLL
DESCRIPTION: Connect existing house to sewer seiyice. Plumbing is to be reversed. Septic tan, is to be pumped
and filled. Reimbursement District #30 fee paid this date.
OWNER: NOLL, JOHN PHONE #: 503 - 332 -0765
CONTRACTOR: O / ER PHONE #: 503-318-4593 (wort
Inspection Request Scheduled For: Date: 11/1612007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 059830 -01 503 --332 -0765 N
Corrections /Comments /Instructions:
g4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 66 i t \ V3-r^t- Date: ) 1 ) I L 1 1 Phone #: (503) 718-