Permit 1
7 l CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2007 -00368
'` COMMUNITY DEVELOPMENT DATE ISSUED: 8/15/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102CC -01800
SITE ADDRESS: 10255 SW HILLVIEW ST ZONING: R -3.5
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT: 021 JURISDICTION: TIG
PROJECT: HART
Project Description: Connect existing house to sewer service, septic tank is to be pumped and filled. Reimbursement
District #39 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
VIRGINIA HART Description Date Amount
10255 SW HILLVIEW DRIVE
TIGARD, OR 97223 [PLUMB] Permit Fee 8/15/2007 $72,50
[TAX] 8% State Surcharl 8/15/2007 $5.80
Phone : 503- 620 -2964 Total $78.30
Contractor:
CANTRELL & SONS CONTRACTING
6860 SW NORSE HALL RD
TUA LATIN, OR 97062 REQUIRED ITEMS AND REPORTS
TUALATIN,
Contact # : PRI 503- 638 -0800
Reg #: LIC 97005
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 b 503.246.6699 or 1.800.332.2344.
Iss d By: / 0 /' i' / / P ermittee Signature: r9101,,,f,te,,:d g
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 Permi Ap plicatio n
EOR_OFFICE- USE_ONLY
City of Tigard Received �o O � Permit No.: LN 7.JySC.�� g
x(f
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review � �
Phone: 503.639.4171 Fax: 503.598.1960 Date/
- Other Permit No.:4i[ ;9/0'7.
Inspection Line: 503.639.4175 Date Read !B IA See Page 2 for
w
TIGARD Internet: www.tigard or.gov Notified/Method: / 1j. Supplemental Information •
• TYPE OF WORK FEE* SCHEDULE I
❑ New construction ID 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
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATIO Site utilities
Job site address: /c s co g L L b.() Catch basin or area drain 16.60
City /State /ZIP: 7(p /2-D r 02 9 -3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l Project name: I4 s-2-' 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.://121 Page 2 35.00
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
DESCRIPTION _ OF WORK Backflow preventer Page 2
�A -e T � i 5r, /6 A a his , 6 1-o g/e . Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
0. . I Drinking fountain 16.60
P OPERTY OWNER;
❑T ENANT
Ejectors /sump 16.60
Name: / 2 d t ii 1 yi- 21 Expansion tank 16.60
Address: ,Lb a 5r 141 LL I 1 ctw) - • Fixture /sewer cap 16.60
City /State /ZIP: - ,� - D 2 9 7 , j Floor drain/floor sink/hub 16.60
Phone: 1O '
( (._�._ (996 c ` 7 - 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 name: ,4 Aj 7121 L Q�l M� � 6 Water heater 16.60
Address: 6,8 40 6.1 9 L kb Other:
�� (>2. F7 p 6 ?i Subtotal
City /State /ZIP:
�`�' ' 7 Minimum permit fee: $72.50
Phone: ) to 3c -• d (640 Fax: ( ) Residential backflow minimum permit fee: $36.25 ,�
(..)
CCB Lic.: 9700,5 Plumbing Lic. no.: Plan review (25% of permit fee)
• State surcharge (8% of permit fee) 6j ,
Authorized signature / 10/4/ 10/ //' TOTAL PERMIT FEE - 7g t .50
Print name71 / 9 7 // ,./ L /9�e� i Da at te � :7/�j� /�� This permit application expires if a permit is not obtained within
f , 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits \PLM- PermitApp.doc 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
Storm & Rain Drain - 1st 100' 55.00 V a l uation:.- 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
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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations'
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check'all that apply.
.Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
' Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower III New exterior plumbing site utilities for any complex structure
Jacuzzi/Whirlpool as defined in OAR918- 780 - 0.040.
- Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Car Wash
Each t o l ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain
Eye wash Isometric or Riser Diagram.
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
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 • •
*Note: Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewerpermit will be issued and
f - 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:
i:' Building \Permits\PLM- PermitApp.doc 12/27/06
G giVbLL T CI JOB INVOICE
L Y 'S SEPTIC C MC SEPW CC, WC.
k����
P.O. Ira 5^49p1
OREGON CITY, , OREGON 970`4�q
5 CUSTOMERS ORDER NO. DATE ORDERED
(503) 65 8-1 8- 0'7
ORDER TAKEN BY DATE PROMISED Am
Grace 8 -20• P.M.
BILL TO PHONE
Gene Cantrel 692 -6308
ADDRESS MECHANIC
Scott 312 -1363
CITY t [p R
JOB NAME AND LOCATION
❑ DAY WORK
10255 SW Hill View Dr . .• .•
DESCRIPTION OF WORK
❑ EXTRA
1
QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
•
I i
Tank pumping 'i'
>
HOURS LABOR AMOUNT
TOTAL
MECHANICS MATERIALS
HELPERS QD TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATE COMPLETED TOTAL
Kr VT'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00368
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: B/15 /2007
Phone: (503) 639- 4171ii���l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/20/2007 TIME: 7:02AM PAGE: 15
SITE ADDRESS: 10255 SW HILLVIEW ST CLASS OF WORK:
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT #: 021 TYPE OF USE:
PROJECT NAME: HART
DESCRIPTION: Connect existing house to sewer service, septic tank is to be pumped and filled. Reimbursement
District #39 fee paid this date.
OWNER: HART, VIRGINIA _ PHONE #: 503-520-2964
CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503-638-0800
Inspection Request Scheduled For: Date: 8/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 054324 -01 503. 3121363 N
Corrections /Comments/ Instructions:
f 4Y Itt Pic- -v e-G$ f' s- C-‘.‘ V(IN7 V.
PASS PARTIAL APPROVAL ❑ CANCEL Li NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (.`-) Date: . 12(S 10 Phone #: (503) 718-
CITY OF
��w n n m�pn TIGARD
BUILDING DIVISION
~°~~"~~~~..~~� ~�.°.~~.~~.~ PERMIT #: PLk�20D�UO3G8
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/1EJ2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/21/2007 TIME: 7:00AM PAGE: 1�
SITE ADDRESS: 10255 SW HILLVIEW ST CLASS OF WORK:
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT #: 021 TYPE OF USE:
PROJECT NAME: HART
DESCRIPTION: Connect existing house to sewer mrn/icw, septic tnk is to be pumped and filled. Reimbursement
District #39 fee paid this date.
OWNER: HART, VIRGINIA PHONE #: 503-620-2964
CONTRACTOR: CANTRELL & S0NBC0NTRAGTNG PHONE #: 603-638-0800
Inspection Request Scheduled For: Date: 8/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer 054403`81 503-312-1363 N
I C; ' [
Corrections/Comments/Instructions: .
�
� '� ��
_»e x� A-4-1--" / w�r+� ���J �V~ '
/ ' - a'JC.Tr - A Li \ \
PASS | \ PARTIAL APPROVAL | | CANCEL NO ACCESS
El FAIL 0 CALL FOR INSPECTION { I ADDITIONAL FEES ASSESSED
Inspector: CID \~'�~^���~-°�- Date: g Phone #: (503) 718-
`