Permit CITY TIGARD PLUMBING PERMIT
r.i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00101
A dj. DATE ISSUED: 2/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 102DC -01700
SITE ADDRESS: 09200 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 014 JURISDICTION: TIG
Project Description: Extend sanitary sewer line.
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: 300 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GEORGE TENY
9200 SW EDGEWOOD ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/17/2006 $281.30
[TAX] 8% State Surcha 2/17/2006 $22.50
Phone : 503-970-1811 Total $303.80
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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: f.
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.
. '' Building Fixtures , i, Ell.
Plumbing Permit `�" i�. "4, f J . ; ' 0 , 4, ul' O FI I (al. . �)5i o,�l .. ._I ; P -1
City of Tigard 1 � / / P N 2 7 ') J
11
13125 SW Hall Blvd., Tigard, OR 97223 R e � Br.� l 7 �C 6 ?\ � c. C i
Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.196(L /ia« ff'6.. '
• a Date/By.
24- Hour Ins • ection Line: 503.639.4175 4` `'ilil} s 1
p I ` 1 r: »� t7 Date Ready/By: luris: El See Page 2 for
Internet: www.ci.tigard.or.us , irtA V� Notified/Method: 1 /( Supplemental Information
�, `1..6 T { . FEE* SCHEDULE
F s information use checklist
For special in
❑ New construction ❑Demolition P f
Description • I Qty. 1 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
❑ 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: y•? QQ S' t, E e • 2ea.00d pl. Catch basin or area drain 16.60
City /State /ZIP: 1 Q4 �•d Ok. q'7i 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: (j I Project name: 7t/14/ P R71 770A-/ 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 n.41'00 ) 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
Back flow preventer Page 2
L YT • S ?it"; T4 R V S Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER • ' ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name:
OF oeC Es Tr NY Expansion tank 16.60
Address: eiAco S & kL / t .oce S7' Fixture /sewer cap 16.60
City /State /ZIP: 'T/ 9 qkzi 19k 1 723 Floor drain/floor sink/hub 16.60
Phone: ( V3 ) 970- am f 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: ( ) Fax: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR . Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72•50 // 3a
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 67U 11 , &-e---- Plumbing Lic. no.: Plan review (25 % of permit fee)
State surcharge (8% of permit fee) .JD
Authorized signature: C�/ r� . t' 7 - � TOTAL PERMIT FEE 3 >Q
Print name: C. t O248 / "/Y y. Date: 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 \Pennits\PLMF- PermitApp.doc 06/05 440-4616T(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 - 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' I 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 & Ram 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
•
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: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantitrby (Fixture) Work Performed ❑ Any new commercial building.
❑ Any new exterior plumbing site utilities.
Fixture Type: Replace Y P g
Previous • Capped Added • Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 - D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3 „
-4 „
Car Wash Drain • Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this ermit results in an
Water Extractor p
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Permits\PLM- PennitApp.doc 07/06/05
CITY TIGARD PLUMBING PERMIT
Ak DEVELOPMENT SERVICES PERMIT #: PLM2006 00101
DATE ISSUED: 2/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 102DC -01700
SITE ADDRESS: 09200 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 014 JURISDICTION: TIG
Project Description: Extend sanitary sewer line. 6/26/06: Added 200' of water line.
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: 300 ft
WATER CLOSETS: WATER LINE: 200 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GEORGE TENY Description Date Amount
9200 SW EDGEWOOD ST
TIGARD, OR 97223 [PLUMB] Permit Fee 2/17/2006 $281.30
[TAX] 8% State Surcha 2/17/2006 $22.50
Phone : 503 [PLUMB] Addl Permit 6/26/2006 $101.40
[TAX] 8% State Surcha 6/26/2006 $8.11
Total $413.31
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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: ' . 7 1 ..e_ t
- 7
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 projec .
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: a2•064- 6 0 1 c� /
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 - 4171 .. 11 ' � J
Inspection Requests (24 Hrs.): (503) 639 -4175 ":_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 9 o Z 00 E[ ° v2-- iP Jt CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6— Z 8 — 0 (o Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 kiet - 20 9-3 c ito
Corrections /Comments /Instructions:
•
47-7(111://-L)
rp ASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I I FAIL 1 I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ft 'e Date: If i� 1 Phone #: (503) 718- 2y7/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 14 . M200 1010 i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2117.1:1.00G
. .
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/260006 TIME: 7 : /k PAGE: :16
SITE ADDRESS: 09200 SW EDGEWOOD c;1. CLASS OF WORK:
SUBDIVISION: EDt.- EWOOf3 LOT #: 014 TYPE OF USE:
PROJECT NAME: 91 .l�!'t PARTITION
DESCRIPTION: Extend ;..:Rita . = :: RJer fine.
OWNER: TEN'Y GE PHONE #: 9/0 1011
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 412G/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Jf� . mil ry . 020731 -01 603-W01011 N
Corrections /Comments/ Instructions:
PASS 4 PARTIAL APPROVAL ❑ CANCEL 1 I NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4/1 4 / : Date: 6-, Phone #: (503) 718 -
�v