Permit CITY TIGARD PLUMBING PERMIT
Ik DEVELOPMENT SERVICES PERMIT #: PLM2005 -00232
�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2005
PARCEL: 2S 103CA -00800
SITE ADDRESS: 13285 SW HOWARD DR ZONING: R -4.5
SUBDIVISION: WOODCREST LOT: 013 JURISDICTION: TIG
Project Description: Installation of approximately 50' of sewer service to connect existing house to sewer service.
Septic tank is to be pumped, filled & inspected. Reimb Dist. #22 paid this date.
CLASS OF WORK: NEW 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: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SPANGLER, JAMES P+ KAREN L Description Date Amount
13285 SW HOWARD DR
TIGARD, OR 97223 [PLUMB] Permit Fee 6/2/2005 $72.50
[TAX] 8% State Surchart 6/2/2005 $5.80
Phone : 503 - 590 - 7197 Total $78.30
Contractor:
A- AFFORDABLE SEPTIC SERVICE
PO BOX 1130 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
Phone : 503 969 - 9548
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- ough OAR 952 - 0001 -0100. You may obtain copies of these rules or, direct questions to OUNC by
calli 03- 246 -669 or - P i >332 -2344.
Is ued 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.
Building Fixtures
P1t robing Permit Application � FOR OFFICE USE ONLY
City Of Tigard DateB / Permit No.: + i� t�
13125 SW Hall Blvd., Tigard, OR 97223 / � ; Y �S 1 ((�a't/�
Phone: 503.639.4171 Fax: 503.598.1960 1� Date/By: ... Plan Review
. Other Permit No.. � 1 r/
/�
,��,,�
24 Hour Inspection Line: 503.639.4175 " I ��� Date Ready/By: � z
p /Met , Supplemental See Page for
Internet: www.ci.tigard.or.us Notified/Method: /� r Supplementt al l Innformation
*Ill' a; ° ' '' H1„.' 4 °s °:r' ' y i-0. 7° :1'7:-:
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�.: ..ate - s �..ae x� �. s`a, .x �. .�," -. ��.b.,�. . . ..
❑ 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)
mar r `, .a,,li ..< CATE ®RR Of COi� ,, TmN ? 7- , . 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
Each additional bath/kitchen 45.00 -
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
' fi : s
11
' JOBt SITE INk'® tIVI�iibI�J , fi 4
. . �.� .r, e :v:.., .ey fs. �x� ,,: & ,t,. n .� 4 i Site utilities
Job site address: /3 ag 5 4 4 . -- D , 2 , Catch basin or area drain 16.60
City/State /ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: p L� 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.:'' ) Page 2 Ov
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
w:?.: " .
z `u. : "�s ?y , s,,, a %:;4- .4- ^ag`.; »s'; ,. . ���:�..�x. �,�.... -. .. «;, Absorption valve 16.60
� .M ,1 fit.. DE Mill- 12N o� >:
Y,,M , ; lay ; - �
;,,,� .,,, . _ s r ,,: Backflow prey enter Page 2
'- 7 2 . Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
# .P ':.s,. Ma::.,,4aR >tk ,; ., a.s:;s ;a> Drinking fountain 16.60
, rte l i P iLiiiTY w, rfi a� tai r 1 ; < I EN '�C� ; 'r
, i_._;sa..,., t „. ,r.',,, .w.,..,,, r, i:,. ,,, ,.r,: ' : ,, „, ;,rt.':?.", ,,, ..... „. Ejectors /Sump 16.60
Name:PA bl' � Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain /floor sink/hub 16.60
Phone: (" b - -7/ 97 Fax: ( ) Garbage disposal 16.60
m ; A pt :rsw 3 , ; -. :,,,,:x.-. ,, . ,. ^ _° " fir.ftg a� 'ti Hose bib 16.60
*" aT t� l A P PU ICANT ' a :: A , i s CON A ST 4 P I2SOlY ,Mi .<
..Y. - k �. ��;,a B j ": 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
y N ova. s" ..� :s ev 4: - a _;,£ .. -. & z?:; «. ='rss" gs �,° _ °'. ,r�'r; ° '. sa; -n; •' ;t: �:. «�..
-; W', 41,-MiG a ` �7 g s a g IT N A ..
1, ` t ,', *r- -s : ` ::v .. ..,., tr.I,.� r .4 „te . 4 .4 Water closet 16.60
Business name: A- - A ; Fp , � r1 . g c_ p(!C p,., 0 Water heater 16.60
Address: - R \I Other:
City/State /ZIP: Wl 1.___3, 1 3 0 I LLB d - q(-70 -7O Subtotal
Minimum permit fee: $72.50
Phone: (J) 96,q -q Fax: ( ) Residential backflow minimum permit fee: $36.25 7a
CCB Lie.: `5 . Plumbing Lic. no.: Plan review (25% of permit fee)
L State surcharge (8% of permit fee)
Authorized signature: 5 TOTAL PERMIT FEE
Print name: Date: (e `�/G c 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:\ Bui lding\Permits\PLMF- PemutApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
`�.*a` •��" .. ^,... ; � "` ^�";�,' >` • ^'x��n^y ". �a'` =�;4 rnF`:,s'
S1tC 111t1eS t x Qty ^ $eel ea)c 'Total ' tttVaiva = ; 5 care F oot a ge P
ryry
Footing drain - 1s` 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:,•" .,,°.z € >'•:;:; :: ;�° ; -
Storm & Rain Drain - 1st 100' 55.00 �VilluatlOTl ; a� Perllllt ee„ F
$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
t
°a t Qee °ea' Tdfal additional $100.00 or fraction thereof, to and
'tFixture or"4IMIVS Ry F
a . - . ..a, �r ,:,�: „ � . . ^ 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:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
r7 uiitt ` b Fixture yAk 'erformed ,
Fix ure T e � ` ' 's . a
s t eplac
� r M0 Extshn Ga e
�x �� - �, �New � g piz � Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
•
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Building \Pemvts\PLM- PermiiApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200 -00232
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/2/2005
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ��i
INSPECTION WORKSHEET FOR DATE: 6/7/2005 TIME: 7:17AM PAGE: 8
•
SITE ADDRESS: 13285 SW HOWARD DR CLASS OF WORK:
SUBDIVISION: WOODCREST LOT #: 013 TYPE OF USE:
PROJECT NAME: SPANGLER
DESCRIPTION: Installation of approximately 50' of sewer service to connect existing house to sewer service, Septic
tank is to be pumped, filled & inspected. Reimb Dist. #22 paid this date.
OWNER: SPANGLER, JAMES P + KAREN L, PHONE #: 503.590-7197
CONTRACTOR: A- AFFORDABLE SEPTIC SERVICE PHONE #: 503 - 969 -9548
Inspection Request Scheduled For: Date: 6/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 San Italy sewer 008647 -01 503-969.9548 N
Corrections /Comments /Instructions:
dire
►1 PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑
n F. IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: A' Phone #: (503) 718-