Permit
q CITY OF TIGARD PLUMBING PERMIT
o COMMUNITY DEVELOPMENT Permit#: PLM2010-00048
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/16/2010
Parcel: 1 S136AD01500
Jurisdiction: Tigard
Site address: 10530 SW 69TH AVE
Subdivision: VILLA RIDGE Lot: 2
Project: Webb
Project Description: Replace 80 ft of rain drain, kitchen and laundry drain line replacement with new washer and sink.
2/19/10 ADDED 100 feet sanitary sewer line replacement.
Owner: FEES
WEBB, ERIC G Quantity Description Date Amount
10530 SW 69TH AVE
TIGARD, OR 97223 80 If Storm and Rain Drain 02/16/2010 $62.54
PHONE: 503-866-3500 1 ea Clothes Washer 02/16/2010 $25.02
1 ea Sink 02/16/2010 $25.02
1 12% State Surcharge - 02/16/2010 $13.51
Contractor: Plumbing
JACK HOWK PLUMBING/RESCUE ROOTER 0 12% State Surcharge - 02/19/2010 $7.50
Plumbing
P.O. BOX 2830
100 If Sewer Service 02/19/2010 $62.54
CLACKAMAS, OR 97015
PHONE: 503-850-3100
FAX: 503-491-2932
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $196.13
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
~
Issued By: Permittee Signature: 3~s
C
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.
CITY OF TIGARD PLUMBING PERMIT
r f x O
Q COMMUNITY DEVELOPMENT Permit #: PLM2010 -00048
T t GARB 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/16/2010
Parcel: 1S136AD01500
Jurisdiction: Tigard
Site address: 10530 SW 69TH AVE
Subdivision: VILLA RIDGE Lot: 2
Project: Webb
Project Description: Replace 80 ft of rain drain, kitchen and laundry drain line replacement with new washer and sink.
Owner: FEES
WEBB, ERIC G Quantity Description Date Amount
10530 SW 69TH AVE
TIGARD, OR 97223 80 If Storm and Rain Drain 02/16/2010 $62.54
1 ea Clothes Washer 02/16/2010 $25.02
PHONE: 503-866-3500 1 ea Sink 02/16/2010 $25.02
1 12% State Surcharge - 02/16/2010 $13.51
Contractor: Plumbing
JACK HOWK PLUMBING /RESCUE ROOTER
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 850 -3100
FAX: 503- 491 -2932
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $126.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notific. •. - nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct .uestions to 0. C b a g 503.246.6699 or 1.800.332.2344.
Issue. By: / / Permittee Si ature: /
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.
P.001
FEB -15 -2010 12:27
Plumbing Permit Application PE O RECEIVED
Building Fixtures 9 � i ; m1
�"� �* � � r oR r)r h�USFs.(JIyI'Y � � : � "'
•+rt Sat ; . t + F}'a.r ' +�.tF '1,'w'�" 3 ` e ' Y�i+r°A r '1 ,�
Fi f, City of'Tigard FEB 16 2010 Rt,ei cd u 19' I`":1C �,, �.k --
i fit ai )312 sW Hall BIN d. Figard.012 07_'_3 Datr,R Q �(D �t7 Prnmr �J7 /D /�•
Ems.:. '. , Plt. ;p? r,1" 4171 Fay 5(j >48 I) , Plan He „gu ■
�iTY QF TIGARD Date t1, )user Permit N.
i . ?: Inspection Lute. rh.3 f, P a i 7e
T r t n it, r BUILDING DIVISION o�r� l<�aJ li. Ore Page 2 . rur — f • h ern
rtcl' to o u usarJ•i r+ t I ' •M1l
- - l �, SuPptementut lnG,rmanun 1
7- WORK �
FEE* SCHEDULE
❑ New runstnlctino ❑ Demolition For spce:iul irrJnrmrtlirrrt rite ih c'klitt. 1
Uc.cr,uon 1 11('
1 ( . UdIi, ;ahrrati ❑ Other i 1 I - ' fnl ;d
New 1 - 2, aniitt dn en a is iinclude InU fl h.r each molt% co
CATEGORY OF CONSTRUCTION Sf:R 11 I hush I 3 f' 7r� —
I • sine ' - Falky J«t:IIing ❑ Commereiul!indu,tru,! til'K 111 path 737 7x
—' ~ S FR e 3> bath al
❑ Acc•es. m burldi [] Multi - taint) soli ?
•
Each addnnmal hathrl,nj«.n ,5 ., — --
❑ Mader hu iideS ❑ Oilier: — = n
- Fire .pr,nkler 1� stl 11) Pnec _2 — -
4
JOB SITE. INFORMATION AND LOCATION Site utilities: -- —
Joh site addres. /r0 5' - - -- -- //� / r /J�f / ,® Catch harm or area drain I8.7G
(:It } 'SI ;itC /ZIP: �_ "V - Dr1.acll.leach line or trench dr IX 7n 7
FowtirT drain (no. linear II. 1 _�
f'Itec .
Sulle/bldg,lapt. no.: rvl Project Waite; __I
Manufactured home utilities in n
t` street/directions loiuh site' Manholes
I __ - I x 7ti
_ Rain drain connector ' �' - I x 7 If � r
r,
Sanitary sewer (nn. line It : I f,
- - Stour, SC■er (nu. linear U. 1 Paae _2
Water service lin). linear lt. l Page 2
Subdivision: _ 1 Lot nu.: Fi or item: _
la . mup!purccl no.: I�acktlocs prevcltter 31.27
— —
•
DESCRIPTION OF WORK Backwater valve 12 ;1
#0 / /�� /}‘ ` f ' Clothes washer ` 25.U2 , ij �-
1 ` I1���� / , 4 l(� Dishwasher 15.)13
�� liF Drinking fountain 25.02
r 14.14. �� 7 % f Ej slurs /sulti 25.02
►5 PROPERTY OWNER ' 0 TENANT Expansion tank 12.51 1
, TV, . "f' Fixture/sewer cap 02.
Nam /`�! /"
/L"lig_ilvI I � r Flootrdrain/floor sltth/hub 2i11?
Garbage disposal 2502
City /State:7..1P. /.4 � - ► .
.dgi Hose bib 25.02
Phone; ( )
• /-•. ��tri� ) Ice maker 12.51
r APPLICANT T 0 CONTACT PERSON Interceptor/grease trap 25.02
i
2
Business name: ARS dim JACK HOWIURFSC'UE ROOTER Medical gas )value, • 5 1 Page
Contact name: JOYCE DENNIS - Primer 12 Sl
Roof drain (commercial) 12,51
Address: PO ROX 2830 Smk/basin/lavatury Ili 25
City /State /ZIP: CLACKAMAS, OR 97015 Solar units (potable water) r 62 54
Phone: (5031850.3100 w
_ Fax: : (503) 491 Tub /shoer.'sho>.cer pan 12 51
E-mail: joyce@jackhowlt com Urinal 25 02
CONTRACTOR °— Water closet 25 02
/ Water heater
‘ Husiness name: ARS dba JACK 140WK/RESCUE ROOTER W ii�C�
Water pipiny4)WV 56.29
Address: PO BOX 2830 Other
- _ ?S.U2
City /State /ZIP: CLACKAMAS, OR 97015 Subtotal /
Phone; (503) 850 -3100 Fax: (503) 491 -2932 Minimum permit fees 512,50 ('�
CCB Lk,: 127325 PI bing Lic. no.: 34- 168PT3 - plan review l25% of permit fee)
Authorized signature: - \ T ! I/ State surcharge (12% ofpermit fee 1l
" FEE • P
/
Print name: l f � l�J I D . z/J 1 , This permit application expires if a permit is not obt Wed w , i ,ys
l Y -- fter it has been accepted us contplc - O
"Fee methodology set aunty Building industry Service Board. AL
L lBuildmg1rennets ,PLAW- PcimnApp.doc IWc,A Please FAX PERMIT CO • 03-491-2932 ) a�
Zr�
FEB -15 - 2010 12:27 P.002
Plumbing Permit Application - City of Tigard plaizolo___00Qq"
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty.. Fee (ea) Total Sqquare 'aotage: .Permit Fee:
Footing drain - 1" 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100 37.52 — 2,001 to 3.600 $169.69
3.601 to 7.200 $233.20
Sewer - 151 10(1' 62.54 -
_ 7.201 andxtiatcr $337 54
Scucr - each additional 1011' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
water Service -each additional 100' 37,5 2 .
Storm ec Ram Dram - 1st 100' F 62.54 ' a retlCillyfl!t'ra�+:
A $1.00 to $5.000.00 Minimum ice $72.50
Storm Sc Rain Drmn - each additional 100' t 37.52 $5.001.00 to $10.000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees • Qty. " (ea) Toial each additional $100.00 or fraction thereof. to
and including $ I O,OOt }.t10.
Inspection of existing plumbing or for $10.001.00 to $2 5.000.00 $148.50 for the first $10,000.00 and $ 1.54 for
which no fcc is specifically indicated 90.00/hr each additional $100,00 or fraction thereof, lu
(minimum charge- I/2 hour) and includin $25.000.00.
Inspections outside of normal business 90.00 /hr $25,001.00 to $50.000.00 $379.50 fur the first $25.000.00 and $1.45 for
bourn (minimum charge - 2 hours) - each additional $100.00 or fraction thereof, to
Rcinspectton Fees ' 90,00/hr and including $50,000 00.
Additional plan review for revisions 90,00/hr $50.001.00 and up $742.00 for the first $50.000.00 and $I.20 fisr
(minimum charge - 112 hour) _ J each additional $100.00 ur traction thereof
Subtotal: 6;e Ci/
Commercial Fixture Work:
Are you capping. adding or replacing fixtures? If "yes", ' t yt l iiiii v Ql"lt 141$1 I iOIIB
please indicate work perforrned 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 (Fixturer Work Peribrmed ❑ Any new commercial building with neuter service 2" and
Fixture Type: Replace greater. except systems designed and stamped by licensed
__ Previous Cappelli Added Existing engineer.
Baptistry /Font
Bath - Tub /Shower III New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 - 0040,
- Jacuzzi /whirlpool
Car Wash •Each Stall ❑ Medical as and vacuum systems for health care facilities.
[)rive •Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator .� ❑ Any complex structure as defined in QAR918- 780 -0040.
Dishwasher - Commercial _
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Ey!. Wash — . I� t►Nn+etrie vt Rs ;quire'
e r. I rant
Flour Drain/sink 2" Isometric or i'iser diagram is required f01' new buildillg5
3"
that meet the qualifications above.
Car Wash Drain
Garbage - Domestic -
Disposal - Commercial
—
- Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drams
Oil Separator (Gas Station)
Rec. Vehicle t)ump Station
Shower -Gang '
:Stall -
Sink - Dar /Lavatory
- Bradley _
• Coininercial _ *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter tees assessed for the sewer increase must be paid before the
Washer - Clothes p
water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
http: / /www.tigard- ar.gov /cite hall/ ilepartments /cd/docs /I'I.MF- PermitApedoc
P.001
FEB-19-2010 14:42
Phimbillm Permit Applicadon
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r l 4sht,.t,he1- - -
91N, it
i tlilihlnE. tuu<<ld?- - - 112
~ PtiOPERTY OK'NER- Q TENANT [.pale 1:_n - -
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1PPLIC:4NT ❑ C't)N"1'ACC PERSON lua:rccptor`~IC.t;, rr_ap _ ?3 a^--
Aletii-dl 1a (lnlue'
Businem name- ARS Jba JACK HOWK)RI SCUE ROOTER F Inc'
l'I utter 2.51-
- -
Cuutu,1l lidnte: JO)'CL 1)ENN15 (
Rwfdr,uu ltatttuloitl;,t) 11-51 -
Address 1'O 110V 2830 - )n I :L,shl'tatuwry'-_ _ z5.0?
Cite/Stale/ZIP: CLACKAMAS, OR 97015 Suldr unrls Ipul blc tt,ltu) ti~.54
Phu,, (303) 83o-31 U0 (503) •191-2932 TubAIIuncr'~Iwu'cr pall - 12 51
E-mail; jnyevejackhovI k.com llrtntl- IS.U'
CQNTft>iCTOtt 25,Q
1'l';t[Cr hr glee _ 31. j2
Business nanle; ARS dba JACK 11OWKIMCCE ROO"I ER ~1' lc[ piping i111'~ 56 ,y
Address: 110 BOX 2830 t)LhCf: - 2j.U_
Ciq<<Iasly/ZIP: CLAC CAMAS, OR 97015
Phone: 003)850.3100 Fax: (5CS3)-t91-293? A(itturwmpuulitthe: $7250
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