Permit i`o CITY OF TIGARD
PLUMBING PERMIT
l COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00369
TIGARD ' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/16/2007
PARCEL: 2S 111 AB -02300
SITE ADDRESS: 09145 SW MOUNTAIN VIEW LN ZONING: R-4.5
SUBDIVISION: ELROSE TERRACE " LOT: 019 JURISDICTION: TIG
PROJECT: CAUFIELD •
Project Description: Line work for connection to lateral. Septic system to be pumped and filled or removed.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CAUFIELD, LARRY L + JUDITH M
9145 SW MTN VIEW LN Description Date Amount
TIGARD, OR 97224 • [PLUMB] Permit Fee 8/16/2007 $110.00
[TAX] 8% State Surcha 8/16/2007 $8.80
Phone : Total $118.80
Contractor:
CANTRELL & SONS CONTRACTING
6860 SW NORSE HALL RD
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
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 by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: a ■,,
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.
V
Plumbing Permit Application •
REcVED FOR OFFICE USE ONLY R eceived
City of Tigard Date/By: 60 u I to / t E 03 Permit No.. M 2Dca ,6 b?
IN n 13125 SW Hall Blvd., Tigard, OR.1 0221 6 2007 Plan Review , ` -�
C Phone: 503.639.4171 Fax: 0' 598.1960 Date/By: Other Permit N6'1412a001 - 00 2
T I G n R D Inspection Line: 503.639.41 VII Y OF riGARD Date-Ready/By: y: Julis B See Page 2 for
Internet: www.tigard- or.g.w tnu n '�S1V►V b�/�� Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
❑ New construction. ❑ Demolition
Description 'I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: . New 1- 2 -family dwellings (includes 100 ft: for each utility connection)
.. t
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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION utilities
Job site address: 9/4<4 jai n/�� 0 a , Catch basin or area drain 16.60
City /State /ZIP: 779/4 „Q g Q '7 Drywell, leach line; or trench drain 16.60
Suite/bldg. /apt. no.: / ` P roject 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.: Za / Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision: Lot no.: . Water service (no. linear ft.• / , Page 2 ' t
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
A lii.it - W A-R .c' , Backwater valve 16.60,
C r/' y 0 V ^ b
4, -,N..... 4,-,N..... Clothes washer 16.60
, Dishwasher 16.60
0 PROPERTY OWNER I
0 TENANT Drinking fountain 16.60
• Ejectors/sump 16.60
Name: ii iy ¢/ \ 84 , -/ ( 6/IA/a( Expansion tank 16.60
Address: . yS�i) seix ike)7 � C v.�,r) , „,,, Fixture /sewer cap 16.60
City /State /ZIP: T� G
QP d /1 9 c/ Floor drain/floor sink /hub • 16.60
Phone: ( /b',31f 4 JK 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: . /iP ( /� O S,.S Water heater 16.60
Address: Other:
City/State /ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: (' . ) Fax: ( ) Residential backflow minimum permit fee: $36.25 /_l p_ r 1'V
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) • ' ` .� `
�iJ State surcharge of permit fee) , 8()
Authorized signature: U - ✓ 6..e.igeigi TOTA L PERMIT FEE , g fig • �Q�
Print name: T h is 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 r Industry Service Board.
is\Building\Permits\PLM- PermitApp.doc 17/27/06 44O- 4616T(IO/07/CO "' Y 352�v at, 'g 153 ....t____ a 53.
•
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
Se: 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 4'6 aD 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
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 Backtlow 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for •
Subtotal: 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 El New exterior plumbing site utilities for any complex structure
• -Jacuzzi/Whirlpool Tub/S as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
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: If the fixture work under this permit results in an
- Bradley
- 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:
•
i:\ Building \Pennits\PLM- PennitApp.doc 12/27/06 •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00369
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/16/2007
Phone: (503) 639 -4171 �ru l l +l
Inspection Requests (24 Hrs.): (503) 639 -4175 F_
INSPECTION WORKSHEET FOR DATE: 9/17/2007 TIME: 7:00AM PAGE: 31
SITE ADDRESS: 09145 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: ELROSE TERRACE LOT #: 019 TYPE OF USE:
PROJECT NAME: CAUFIELD
DESCRIPTION: Line work for connection to lateral. Septic system to be pumped and filled or removed.
OWNER: CAUFIELD, LARRY L + JUDITH M, PHONE #:
CONTRACTOR: CANTRELL & SONS CONTRACTING PHONE #: 503 - 638.0800
Inspection Request Scheduled For: Date: 9/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 'Ft x ,, i I, 055803 -01 503- 639 -8841 Y
Corrections/Comments/Instructions:
CA r C
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r) k'1 \ \I t><- -. Date: 01\003 Phone #: (503) 718-
ORVALL T. LADE JOB INVOICE
BYER'S SEPTIC . ‘TANK SERVICE, iNC.
;.0. BOX 549
OREGON UPI, O GON 97045 CUSTOMERS ORDER NO. AIATE O DER
(503) ORDER TAKEN BY DATE PROMISED
❑
/' u ^ ^
G A.M.
(c..�_ LJ 0 ❑ P.M.
BILL TO 1 PHONE
G am. Ca n t
ADDRESS ` MECHANIC
CITY Y
JOB NAME AND LOCATION �'/•�// ^ ❑
7/ 5. M 4 • d L" _ ❑ CONTRAC WORK T
DESCRIPTION OF WORK
❑ EXTRA
s L =++ - 21 J SC3
QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
T
V`
HOURS LABOR • AMOUNT
TOTAL
MECHANICS MATERIALS
HELPERS TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATECOMPLETED
TOTAL
,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: P 1
8/16 /200 -00369
6/2007
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 _„' rilt _—
8/30/2007 7:00AM 8
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
09145 SW MOUNTAIN VIEW LN
SITE ADDRESS: ELROSE TERRACE 019 CLASS OF WORK:
SUBDIVISION: CAUFIELD LOT #: TYPE OF USE:
PROJECT NAME: Line work for connection to lateral. Septic system to be pumped and filled or removed.
DESCRIPTION:
CAUFIELD, LARRY L + JUDITH M,
OWNER: CANTRELL & SONS CONTRACTING PHONE #: 503. 638 -0800
CONTRACTOR: PHONE #:
8/30/2007
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 054913-01 503-312-1363 N
f i Jdd Is
Corrections/Comments/Instructions:
...te+1 c. 76,,,,k‹. eu 4 4 1 1,E -dl e c: r
Ca pc, 1 C b L 94,-)
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � 6 ' 4.A -1 1 ''.."�— Date: 7130107 Phone #: (503) 718-