Permit . , _ .,.a CITY OF TIGARD
PLUMBING PERMIT
° .' COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00157
DATE ISSUED: 4/16/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134CA -00717
SITE ADDRESS: 11930 SW SUMMER CREST DR ZONING: R
SUBDIVISION: BURLWOOD NO.3 LOT: 006 JURISDICTION: TIG
PROJECT: KOENIG
Project Description: Replace 20' of sanitary sewer service.
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: 20 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
RAY& LAVON KOENIG
PO BOX 410 Description Date Amount
AURORA, OR 97002 [PLUMB] Permit Fee 4/16/2008 $72.50
[TAX] 12% State Surcha 4/16/2008 $8.70
Phone : Total $81.20
Contractor:
PRO DRAIN & ROOTER SERVICE, INC
3300 NW 185TH AVE #213
PORTLAND, OR 97229 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -533 -0430
FAX 503- 715 -4989
Reg #: LIC 108504
PLM 26 -776PB
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 a 'n OAR 952 - 0001 -0010 through OAR 952 -0001 -0100. You may obtain copies of these rules or direct questions to OUNC
by calling 3.246.6699 or . 00.33. • • .
Issued ° / / � �� '�" u-0 Permittee Signature: � 7 7.7,...__ ___/
Call 503.639.4175 by 7:00 a.m. for an inspection that business d .
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.
..tbing Permit Application
n r f 4 .FOR'O FFIGE ' ;USE ONLY ,.>vt,v t t
us
t ' . tit" City of Tigard Date/By: 1(o og I Permit No.: L taw -06 57
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t ' a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
, :. ,t a : Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
t DateBy:
G A' R D` Date Ready/By: Inspection Line: 503.639.4175 D Read �Jn � ® B
� See Page 2 for
9 T I . pP
0.4,% ,. ,,,0 Internet: www.tigard or.gov Notified/Method: ( Supplemental Information
'TYPE OF WORK FEE *:SCHEDULE . •
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (1) bath 249.20
P. - 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: t • 0 5" by W c - F D✓- Catch basin or area drain 16.60
City /State /ZIP: 7--- --c,-7/ `' 7 Z Z 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 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
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
S e-, , ., - `e/ 4 ;',---- 0 „t .7-,...› ,Q/ Backwater valve 16.60
/
Clothes washer 16.60
Dishwasher 16.60
O ROPERTY OWNER ) ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: O f ,LC � �}� J v LA-060 x)t Expansion tank 16.60
Address: 1 _ a -� • Fixture /sewer cap 16.60
City /State /ZIP: A u &LA I OR.-- ''� � ap 9 . Floor drain/floor sink/hub 16.60
Phone: ( ) 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
Sink/basin/lavatory 16.60
Phone: ( ) I Fes ' ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: /:/v 4, 7` J„ o/- f ,� �� fi _ Water heater 16.60
Address: 33 w1 ,, / g - Y` o 24 Other:
City /State /ZIP: ,-/ - D rr - 7 - 2 Z ? Subtotal
Minimum permit fee: $36.25 )
Phone: ' ) � ( - / / 0 � Fax: ( ) Residential backflow minimum permit fee: $36.25 r
�' Plumbing Lic. no.: Plan review (25% of permit fee)
CCB Lic.: 0 - U g
State surcharge (12% of permit fee) g, 7a
Authorized signature: -----
TOTAL PERMIT FEE 8
Print name: (74_ -/ /2. is C .-.-. A , Date: l. -p 6 , This 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 Industry Service Board.
I:\ Building \Permits\PLM- PermitApp.doc 12/27/06 440-46I6T(I 0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site �Jtilit es Qty. Fee (ea) Total Square Footage: Permit: Fee:
Footing drain - Is` 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 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 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
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
❑ New exterior plumbing site utilities for any complex structure
- Jacuzzi/Whirlpool 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
3 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 ermit results in an
- Bradley p
- 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- PermitApp.doc 12/27/06