Permit v.
CITY TIGARD PLUMBING PERMIT
iet\ DEVELOPMENT SERVICES PERMIT #: PLM2006 -00395
AA= 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/25/2006
PARCEL: 2S 103C B -02000
SITE ADDRESS: 12220 SW JAMES ST ZONING: R -4.5
SUBDIVISION: WILLAMETTE LOT: JURISDICTION: TIG
Project Description: 60' line work for sewer connection.
CLASS OF WORK: OTR 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: 60 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
LARRY IVERSON
12220 SW JAMES ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/25/2006 $72.50
[TAX] 8% State Surcha 8/25/2006 $5.80
Phone : 503- 709 -3214 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
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 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.
i � tiz
Issued By: / / �I /1, 1 Permittee Signature: / - - - --
7
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busine day.
This permit card shall be kept in a conspicuous place on the job site until c•mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Buildin .Flixtures .
rill, , cc E ti ‘ ii
Plumbing Permit Applica inn ) 0 , t / FOR OFFICE USE ONLY
City of Tigard D / By: 0 t� / B Q Permit No.: '? � 0 ; �t
'1 13125 SW Hall Blvd., Tigard, OR ' ' ui t.,
Date/By: e ( j U
Phon 503.639.4171 Fx: 503. 9:.1'60 " 2006 Plan Revie
i p a E ' Other Permit N , _ -
Inspection Line: 503.639.41.75. Date Ready/By: y ® S Page 2 for
See a
TIGAKD 4 yy g rp' � / g
Internet: www.tigard- or.go $ U - j. Itjh!' Notified/Method: Supplemental Information
TYPErOli '1 *. , v- . s ' w . .. , . ` FEE SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) '
,, CATEGORY .QE 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
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
e ' a °JOB SITE INFORMATION. AND - LOCATION • t Site utilities
Job site address: /,,e12■V --S -a g7i/nit S Catch basin or area drain 16.60
City /State /ZIP: /1_,, D/e Ci. G ,J 9 2ZZ.. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 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.:(4) Page 2
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
SEA 's 2 t A/,t/' C! - /o e/ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
, tit PROPERTY "OWNER . l° . ❑ TENANT
Ejectors/sump 16.60
Name: 441/j 7 ..... 3 z � Expansion tank 16.60
a� D s � /&1e n 5 -C £c r Fixture /sewer cap 16.60
City /State /ZIP: �(QI7/6O Q/L 972- Floor drain/floor sink/hub 16.60
Phone: (53) 5 i'7,, j 1 Fax: ( ) Garbage disposal 16.60
l { Hose bib 16.60
. -!' ' - :❑. APPLICANT - - 0 . °CONTACT ,?
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: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR„
, _ ,, , , _ - a ' � Water closet 16.60
Business name: / Water heater 16.60
Address: `, ► Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 / P. 5o
CCB Lic.: Plumbing Lic. no.: • Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5,102 A horized sip at
.I, ( TOTAL PERMIT FEE 7 Q 3a
_� t n. • e: Ii /L - Date: This permit application expires if a permit is not obtained within
- .VW 180 days after it has been accepted as complete.
* methodology set by Tri -County Building Industry Service Board.
1. \Building\Permits\PL ,' - PermitApp.doc 04/06/06 440 -4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard f` '!
Page 2 - Supplemental Information
•
Fee Scheduler Residential Fire Suppression Systems:
Site Utilities; , . `, ,_ . Qty. Fee (ea)` Total Square Footage: Permit-Fee: _ ,o;
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 Valuat Perniit 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
specially requested inspections - per hour 72.50 and including $50,000.00.
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 Structures ` -- ',:
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Qu antity by (Fixture) Work Performed
El Any new commercial •building.
;.Fixture Type: ' Replace ❑ Any new exterior plumbing site utilities.
. Previous' Capped Added Existing . ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator a
are being installed for the food service are_
Dishwasher - Commercial ' ❑ Any new residential building containing three (3) or more
- Domestic dwelling units. .
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system:`
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
4 „
Car Wash Drain - _ ' 'Isometi' c or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial -
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter -
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Permits\PLM - PermitApp.doc 07/06/05
JOB INVOICE
BYER'S SEPTOC TANK SERMICE,
P.O. (BOX 549
OREGON CITY, OREGON 97045 CUSTOMERS ORDER NO. DATE ORDERED
(503) Gse-san
ORDER
TAKEOY. - _ • • DATE � PROMISED ❑ A.M.
.{
- 69JL �Q.e F 1 0 - 24 ❑ P.M.
BILL TO P HONE ,d.. PHONE - •
Larry Iverson ` -: _ 9- 7219 -
ADDRESS • MECHANIC
•
12220 SW James St.
CITY HELPER
Ti
JOB NAME AND LOCA �d . 9722 ,
❑ DAY WORK
n A V I I P w i l l raa _L,av -Try not homgm
. -, ❑ CONTRACT -
DESCRIPTION OF WORK
❑ EXTRA
•
T
QUANT. ' DESCRIPTION OF MATERIAL USED PRICE AMOUNT
R (J Q Jf
Tank pumping 26 .
•
HOURS LABOR AMOUNT TOTAL
MECHANICS Q MATERIALS
HELPERS Q TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR .- TAX
completion of the above described work.
SIGNATURE DATE COMPLETED TOTAL
'
CITY OF — .
��un m ��x TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00395
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/25/2006
Phone: (503) 639-4171
|nmpooion Req�eo�o (24 Hrs.): (503) 639'4175 W�� - - - --- -
INSPECTION WORKSHEET FOR DATE: 12/4/2006 TIME: 7:03AK4 PAGE: 13
SITE ADDRESS: 12220 SW JAMES ST CLASS OF WORK:
SUBDIVISION: WILLAMETTE LOT #: TYPE OF USE:
PROJECT NAME: |YERSON
DESCRIPTION: 0% line work for n mmn rCnnnectnm.
OWNER: IVERSON, LARRY PHONE #: 503-709-3214
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/4/2OO6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 040603-01 503-521-8753 V
/
Corrections/Comments/Instructions:
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'''41 PARTIAL APPROVAL El CANCEL fl NO ACCESS
I FAIL I CALL FOR INSPECTION. I | ADDITIONAL FEES ASSESSED
Inspector: k Nri` � |nopeo�o �
Date: * � Phone #: (503) 718-
�- '^ .� � . . .. _
' CITY OF TIGARIY
BUILDING DIVISION e " - • . PERMIT #: PL.M200600396
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/2512006
Phone: (503) 639-4171 noudovilliii
Inspection Requests (24 Hrs.): (503) 639=4175 - ..AA '
_ INSPECTION WORKSHEET FOR DATE: 10/23/2006 TIME: 7:04AM PAGE: 22
SITE ADDRESS: 12220 SW JAMES ST CLASS OF WORK: •
SUBDIVISION: WILLAMETTE LOT #: TYPE OF USE:
PROJECT NAME: IVERSON
DESCRIPTION: 60 line work for sewer connection.
OWNER: IVERSON, LARRY PHONE #: 503409-3214
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/23/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 038655-01 503-21-5912 N
Corrections/Comments/Instructions:
pmisilwArtwilim"._Ar
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"Ass 'I PARTIAL APPROVAL n CANCEL H NO ACCESS .
El FAIL 0 ALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: 1 / k-'(_, Date: 5 i a t Phone #: (503) 718- _29,P_____