Permit l a a CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00101
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/9/2007
PARCEL: 2S 102C D - 02702
SITE ADDRESS: 09735 SW O'MARA ST ZONING: R - 4.5
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 028 JURISDICTION: TIG
PROJECT: ANDERSON
Project Description: 120' line work to connect sewer. Septic to be pumped and filled or removed.
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: 120 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ANDERSON, CLARENCE N + ANN K
• 9735 SW OMARA STREET Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/9/2007 $101.40
[TAX] 8% State Surcha 3/9/2007 $8.11
Phone : 503- 620 -9735 Total $109.51
Contractor:
A- AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -9548
FAX 503 -570 -0779
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 -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.
_ /it ‘ iel.a. L eiter:fiterm _Ca te _
Issued By: Permiftee 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.
4 -
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Plumbing Permit App L . 'A �,r"
City of Tigard r 4/Ct/t2 � 46 Permit re ,02 _aD /b : • 13125 SW Hall Blvd, Tigard, Obi, 9723 ,, 2 Ran Revi
Phone: 503.639.4171 Fax: 561 9 .15 2007 Date/By. Other Permit No.:
�` 17 Inspection Line: 503.639.4 Date ReadYBy. ®See Page 2 for
Internet: www.tigard- or.t4 j ' j ' Norife&Method Supplemental Information
T om, TV FEE* SCHEDULE •
prNew construction T� � �
❑Demolition For spedal lajorne�lon rise eheckQst
Description I Qty. I En. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath _ 24920
Z 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 Site utilities
Job site address: 173 s $ C' ,e,,/.!P r S T / . Catch basin or area drain 16.60
City/State/ZIP: 7" A/ ep� f 7223 Drywell, leach line, or trench drain 16.60 -
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _
: ) Page 2
Cross street/directions to job site:
�� / 12,,,y1edd Manufactured home utilities 110.00
Manholes 16.60 •
(9/14ua- - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) /.77 r Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map/parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
r_ ' A)Ylh2/ .15 /eh-%-- 4 ..a.r pk - Backwater valve 16.60
o /i),7 e'/46l._ .i Clothes washer j 16.60
Dishwasher 16.60
In PROPERTY OWNER I in TENANT Drinking fountain 16.60
� /t Ejectors/sump 16.60
/ �
Name: � /hm_ i?r.//.
/� � Expansion tank 16.60
Address: / 73s j /4. Di)2 et_ , c Fixture/sewer cap 16.60
City/State/ZIP: 7 jze ®a 97223 Floor drain/floor sink/hub 16.60
Phone: ✓ �s��
( ) Fax: ( ) Garbage disposal 16.60
• 5APPLICANT ❑ CONTACT PERSON Hose
Ice maker er 16.60
Business name:
Interceptor /grease e: trap 16.60
Contact name: Medical gas (valu $ ) Page 2
if Address Primer 16.60
City /State/ZIP: Roof drain (commercial) I 16.60
Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 4 4F �� , p/D // b- $fr 7/L 5 ,y, /// Water heater 16.60 .
Address: / , i - • Other:
City/State2IP: / :140Y? a/ 4 /0/2 97070 Subtotal /2/.0 / Minimum permit fee: $72.50
Phone: (5') g-2 _ /7_24r Fax: (5e..?) 5 7
) ) - 07 7'7 Residential backflow minimum permit fee: $36.25
CCB Lic.: /5 - 1 „. 2 / Plumbing Lic. no.: Plan review (25% of permit fee)
-
State surcharge (8% of permit fee) O
Authorized signature:
TOTAL PERMIT FEE O 67
Print name: , Ono S Date: 3 - 9 _ 0 7 I This permit applieadon expires if a permit b not obtained within
180 days after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
MadwingTermia\PLM.pvmitApp.doc 06126/06 4404616T(10'02/COMnvES)
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 - I a 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 �( alp
Storrs &Rain Drain - 1st 100• 55.00 Valuation: 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 Bath 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 Backfow 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: 40 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
I I. _ 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 *. ❑ ` Any new commercial building with water service 2" and
Quandty by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Future Type: Replace engineer.
Previous Capped Added Ong ❑ 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
- 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"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refiig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures:
is \&dtdmg\Pcmia\PtdNt- PermitApp.doc 09r22106
A.AFFORDABLE
SEPTIC SERVICE
P.O.BOX 1130
WILSONVILLE, OR 97070
A (503) 682-1929 FAX (503) 570-0779
CUSTOMERS ORDER NO. PHONE DATE
NAME
ADDRESS
Ti4 - 2 t / l , 97223"
SOLD BY / CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT
1 v c
f � . P / f /?7/5 J t
?th -2O07- / o /
TAX
RECEIVED BY
TOTAL
All claims and retuned goads gap by this bill.
/ ^ / »0o- rzsMeo THANK YOU
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00101
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2007
Phone: (503) 639 -4171 "uG f 1
Inspection Requests (24 Hrs.): (503) 639 - 4175 "' L.
INSPECTION WORKSHEET FOR DATE: 3/14/2007 TIME: 7:00AM PAGE: 18
SITE ADDRESS: 09735 SW O'MARA ST CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 028 TYPE OF USE:
PROJECT NAME: ANDERSON
DESCRIPTION: 120' line work to connect sewer. Septic to be pumped and filled or removed.
OWNER: ANDERSON, CLARENCE N + ANN K, PHONE #: 503 - 620.9736
CONTRACTOR: A- AFFORDABLE SEPTIC SERVICE PHONE #: 503- 969 -9548
Inspection Request Scheduled For: Date: 3/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 044810 -02 503 - 969 -9548 Y
Corrections/Comments/Instructions:
*PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t V Date: J Phone #: (503) 718-