Permit u CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE COMMUNITY PLM2007 -00180
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/3/2007
PARCEL: 2S 102BC -03500
SITE ADDRESS: 13000 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: ROSE TERRACE LOT: 002 JURISDICTION: TIG
PROJECT: JENSEN
Project Description: Line work for sewer connection. Septic system to be pumped and filled or removed. D? 1 1-f_
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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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
•
RON & ERI JENSEN
13000 SW WATKINS AVENUE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/3/2007 $117.50
[TAX] 8% State Surcha 5/3/2007 $9.40
Phone : Total $126.90
Contractor:
PACIFIC GENERAL
PO BOX 220179
MILWAUKIE, OR 97267 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 653 -7473
FAX 503- 723 -5346
Reg #: PLM 171429
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: 614/A4( Permittee Signat . .drA�`��
■
Call 503.639.4175 by 7:00 a.m. for an inspection that fir . ay.
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.
»lurttbing Permit Application
FOR OFFICE USE ONLY
City of Tigard R C M Received i
DateBy� p Q Permit a1 il. 2007,0 c) /gro
q 13125 SW Ilan Blvd , Tigard, OR 7 _ 3 2007 Plan Revi
/�/��
Phone 503 639 4171 Fax 503.5 60 aD Date/By Other Permit Permit No
Inspection Line 503 639 4175 w p� Date Ready/By. S 63 See Page 2 for
T 1 G A R D Internet: ww tigard or.gov CITY OF t T �� ��® Notified/Method Supplemental Information
BUILDING DIVISION
TYPE OF Wuxi( FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea I Total
XiAddition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249 20
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
JOB SITE INFORMATION AND LOCATION Site utilities —
Job site address: I �7 O O D 5 t- i �/�,J�'41r) // S C atch basin or area drain 16 60
City /State /ZIP: 0 / Drywell, leach line, or trench drain 16 60
��j „wit_ , g ��3
Suite/bldg. /apt. no.: ✓ 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 : Page 2 53 .cO
Storm sewer (no. linear ft . ) Page 2
Subdivision: Lot no.: Water service (no linear ft.: ) Page
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
V`2-r C-Q - r 1 U hi Backwater valve 16 60
Q- ( C ONiv' - J Clothes washer 16 60
Dishwasher 16 60
❑ PROPERTY OWNER I ❑ TENANT Dnnking fountain 16 60
Ejectors/sump 16.60
Name: Expansion tank 16 60
Address: Fixture /sewer cap 16 60
City /State /ZIP: Floor drain/floor sink/hub 16 60
Phone: ( ) u Fax: ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16 60
Business name: A .'Jr., I C. �� ^/YE f i24/. C . Interceptor /grease trap 16.60
Contact name: Tam )4e-r n cf.. _ Medical gas (value $ ) Page 2
Address: Q 5 D >[ c �, 177 Primer 16 60
City /State /ZIP: 1V ✓` Roof drain (commercial) 16 60
i �) O� Q Q �02 Sink/basin/lavatory 16 60
Phone: ( )6 c 6_ . y 7.3 Fax: : ( ��.q-- -513 j6-,
Tub /shower /shower pan 16 60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16 60
Business name: ,� Q c 1 ' p, E F ) �S Water heat 16.60
Address: n 6 0 x T 7 y) Other � " 150 r 7
City /State /ZIP:/ } ' t/I :1 Kati k Dr q 7� /' LLt.KM Subtotal
/ 1 - " L i ' C ! (fl / ? Minimum permit fee $72.50 // -7 5 �
Phone ) 6 ._, - 3 — 7— 7 3 Fax: Lam ) 7, q _ s3,<!� Residential backflow minimum permit fee $36 25 (i
CCB Lic.: f 7 / 4/.2 9 Plumbing Lic. no.: 3 _ e//0 Plan review (25 %ofpermit fee) *
7 State surcharge (8% of permit fee) 9.4/6
Authorized signature: 0/ / (/0 !6 7 /i /a7i TOTAL PERMIT FEE fiqt • yo
Print name: -� gad— ' /, O -(�D� a Date: o� oT This permit application expires if a permit is not obtaine w ithin
�` 180 days after it has been accepted as complete.
*Fee methodology set by In-County Building Industry Service Board
I \Budding Tomas \PLM- PermitApp doc 12 /27/06 440 -46 16T(10 /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 - I 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 - I st 100' 55 00 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
Q ty. Fee (ea) Total additional $100 00 or fraction thereof, to and
Fixture or Item 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 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, 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
Tub /Sr ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S i/ erlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Dave 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
3 that meet the qualifications above.
-4"
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
•
Bradley *Note: If the fixture work under this permit results in an
- 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\Permits\PLM- PermiApp doc 12/27/06
CITY OF TIGARD
•
BUILDING DIVISION 11 PERMIT #: PLM2007- 00180
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/3/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/8/2007 TIME: 7:03AM PAGE: I~3 '
SITE ADDRESS: 13000 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: ROSE TERRACE LOT #: 002 TYPE OF USE: •
PROJECT NAME: JENSEN
DESCRIPTION: Line work for sewer connection. Septic system to be pumped and filled or removed by owner.
OWNER: JENSEN, RON & ERI PHONE #:
CONTRACTOR: PACIFIC GENERAL P ONE #: 503 653.7473
Inspection Request Scheduled For: Date: 5/8/2007 Pour Time:
Code # Inspection Description Confirm # Cont t # Message
399 Plumbing final 047847-07 50" 718 -2426 Y
Corrections /Comments /Instructions:
N
•
PASS ❑ P • IAL APPROVA ❑ CANCEL El NO ACCESS
El FAIL I CALL FO'�••� .,fix 4N ❑ ADDITIONAL FE ASSESSED
/ 0
Inspector: Date: " one #: (503) 71
1
- CITY OF TIGARD
BUILDING DIVISION ' PERMIT #: PLM2007 -00180
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/3/2007
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175 ,_1141:r*
INSPECTION WORKSHEET FOR DATE: 5/8 /2007 TIME: 7:03AM PAGE: 19
SITE ADDRESS: 13000 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: ROSE TERRACE LOT #: 002 TYPE OF USE:
PROJECT NAME: JENSEN
DESCRIPTION: Line work for sewer connection. Septic system to be pumped arid filled or removed by owner.
OWNER: JENSEN, RON & ERI PHONE #:
CONTRACTOR: PACIFIC GENERAL PHONE #: 503.653 -7473
Inspection Request Scheduled For: Date: 518/2007 Pour Time:
Code # Inspection Description Confirm # Contac Message
5 05 Sanitary sewer 047859 -01 .. 490 =7727 Y
Corrections /Comments /Instructions:
Z - nik
X l
ASS ❑PAR L APPROV CANCEL ❑ NO ACCESS i u
A IL L FOR ❑ ADDITION FEES ASSESSED
Inspector: Date: _ Phone #: (503) 7 -
CITY OF TIGARD .A
i BUILDING DIVISION " PERMIT #: PLM2007- 001811
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/3/2007
Phone: (503) 639 -4171 Vit Ins pection Requests (24 Hrs.): (503) 639 -4175 L
INSPECTION WORKSHEET FOR DATE: 5/8/2007 TIME: 7:03AM PAGE: 18
SITE ADDRESS: 13000 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: ROSE. TERRACE LOT #: 002 TYPE OF USE:
PROJECT NAME: JENSEN
DESCRIPTION: Line work for sewer connection. Septic system to be pumped and filled or removed by oanrne►.
OWNER: JENSEN, RON & ERI PHONE #:
CONTRACTOR: PACIFIC GENERAL PHONE #: 503-653.7473
Inspection Request Scheduled For: Date: 5/8/2007 Pour Time:
Code # Inspection Description Confirm # Co act # Message
350 Septic tank 047860 -01 3- 494.7727 Y
Corrections /Comments /Instructions:
- A ,, IIP
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C aQ t „/
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PASS ❑ Pr 'TIAL APP; c ,L ❑ CANCEL ❑ NO ACCESS
❑ FAIL or ALL 'r: INSP -' TION ❑ ADDITIONA EES ASSESSED
Inspector: I ' c---- Date: �� Phone #: (503) 718
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