Permit , f PLUMBING PERMIT
V
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00587
wni DATE ISSUED: 12/13/2006
T 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
>..y PARCEL: 25111 BC -02800
SITE ADDRESS: 10445 SW CANTERBURY LN ZONING: R - 3.5
SUBDIVISION: LOT: 3 - JURISDICTION: TIG
Project Description: Install 280' of water service and double check valve.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: UNK 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: 280 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PRESBYTERY OF PORTLAND THE Description Date Amount
CALVIN PRESBYTERIAN CHURCH
10445 SW CANTERBURY LN [PLUMB] Permit Fee 12/13/200E $194.20
TIGARD, OR 97224 [TAX] 8% State Surchari 12/13/200E $15.53
Phone : Total $209.73
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 624 -4880
FAX 503- 624 -2173
Reg #: LIC 81837
PLM 26 -445PB
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 dired questions
to OUNC by calling 503,246.6699 or 1.800.332.2344.
K Issue By: & pi, ,4 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.
Building Fixtures •
Plumbing Permit Appl' -, . %i t ic O k "
City of Tigard t " EWE .. Received
q
Date /B f� P ermit No.:
13125 SW Hall Blvd., Tigard, OR 97223 y De / L„ e.�I �' / "� � J � � ;
DEC 1 3 20 Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 r / y�r�r�y. I ��, Date/By:
24- Hour Inspection Line: 503.639.4175 ' ' y
CITY OFF TIG _ `k _ _: Date Ready /By: � El See Page 2 for I
Internet: www.CL r .
tigard.ous BUILDING 1)1V110 1- Notified/Method: / 1 dr Supplemental Information
TYPE ;OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. Ea. 1 Total
XAddition/alteration/replacement ❑ Other. New I- 2-family dwellings (includes 100 11. for each utility connection
.'(CATEGORY'OF. , SFR (1 t huh -. .`-s•= :'t 1
❑ I -and 2- family dwelling ^Commercial /industrial �ty� I SFR (2) bath 350 U0
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: i
Fire sprinkler ( sq. 11.) Page 2
-. JOB STA'E . " I ORMATION AND LOCATION Site utilities
Job site address: -_mi -la, s 5 ///) / �/� g b t � Catch basin or area drain 16.60
City /State /ZIP: ) ` 1,......4,--a l/�f (/�/ L Drywell, leach line, or trench drain 16.60
��
Footing drain no. linear ft.:
Suite/bldg. /apt. no.: Project name t// //1 (. C4/ � 8 ( ) Page 2
v r `�� Manufactured home utilities 110.00
Cross street /directions to job site: _-
Manholes 16.60
Ram drain connecter 16.60
Sanitary sewer (no. linear It.: 1 I'a,e
Storm sewer (no. linear 0.: ) Page 2
Water service (no. linear f1..�� Page 2 11.4-7, S
Subdivision: Lot no.'. _
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60 •
' DESCRI " "OF WORK Back tlow preventer Page 2
V L1' ) / 2 &J S d- Backwater valve I - 7 - 676C 7- 4i 7 74 - 0
t �/b
„ �tpl bit ��� i, Clothes washer 16 60
W�`K+I Dishwasher 1 16.60
Drinking fountain 16.60
❑ PROPERTY`OWNER " , '. �. . . ❑ TENANT
Ejectors /sump 16.60
Name:
Expansion tank 15.00
Address: Fixture /sewer cap 13.60
City /State /ZIP: Floor drain /floor sink /hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.00
❑ APPLICANT ; ❑ CONTACT PERSON Hose bib 6.60
Ice maker 16.60
Business name: Interceptor /grease trap lo.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 10.60
Phone: ( ) Fax:: ( ) Sink /basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60 ' • . _- ..._.... CONTRACTOR
/t � Water closet 16.60
�
Business vmaiL ri /,� b ,.. > Water heater 16.60 __
.Address: � � ��[ _ , ( Other:
City /State /ZIP: T / ( ---70 O : $72. Subtotal �LE� �
!! ", . t Minimum permit fee: $72.50
Phone: 03) ! - 1 - 1_ L_/ 29 o Fax: ( 3 (a) Z./ -3q E� Residential backtlow minimum permit fee: $36.25
CCB Lic.: / 7-3 '7 Plumbing Lic. no. :0( L /i/h/ Plan review (25 %ofpermit fee)
State surcharge (8% of permit fee) I 5 5
Authorized signature: ,
� -� - TOTAL PERMIT 000 i
/
Print name: 1 � ey,"44 Cam Date' k/ a./ + Ot� This permit application expires if a permit is not obtained ��ith
III 180 days after it has been accepted as cumplej� , 0
*Fee methodology set by Tri- County Building Industry Service i.
i'. tsuilaingPermits 'PL.MMF•PermitApp.doc 06/05 440- 101511 L0 /02 /COMM'En)
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Plumbing Permit Application - City of Tigard . -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site. U lit1E'3. Pn ata s .•z QtY • Fee (e Total.
A.. - , •:SquareiFootage: Permit Fee:.
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
I
Footing 2,001 to 3,600 $160.00 ng drain -each additional 100' 46.40 i
Sewer - I st 100' 3,601 to 7,200 $220.00
55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' • i 55.00 �J Medical Gas Systems:
Water Service - each additional 100' 46.40
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Storm &Rain Drain - 1st 100' 55.00 Cg Valuation Permit F
$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'•or1tem':. ` • . Qty.. . Fee,(ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device / 46.40 Li 6 6 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device r v each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including 525,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $ I.45 for
Inspection of existing plumbing or each additional 5100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
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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.
.r.••..:- r.
- Quantittby (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type „t : • y Replace ❑ Any new exterior plumbing site utilities.
- - - - • 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 fix the food service area.
Dishwasher Commercial ❑ Any new residential building containing three (3) or more
- Domestic , dwelling units.
Drinking Fountain
E e Wash ❑ Any NFPA 13 - multipurpose fire sprinkler system.
Y
Floor Drain /sink -2"
3•• Submit 2 sets of plans with any of the above.
-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
lce 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
Water Extractor *Note: If the fixture work under this permit results in an
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 g permit can be issued.
i `. BuildingTerrniu \PLM- PermiWpp.doc 07/06/05
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CITY OF TIGARD ;.-- - -
BUILDING DIVISION A t, PERMIT #: PLM2006-0K87
13125 SW Hall Blvd., Tigard, OR 97223 .# (itil?' DATE ISSUED: 12113/2036
Phone: (503) 639-4171 ,Z1 ni k
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/2/2007 TIME: 7:00AM PAGE: 12
SITE ADDRESS: 10445 SW CAWTERBURY LN CLASS OF WORK:
SUBDIVISION: LOT #: 3 - 4 TYPE OF USE:
PROJECT NAME:. CALVIN PRESBYTERIAN CHURCH
DESCRIPTION: install 280' of water service and double check valve.
OWNER: PRESBYTERY OF PORTLAND THE, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503-624
! Cid
Inspection Request Scheduled For: Date: 1/2/2007 Pour Time: , 1 j 1 -
Code # Inspection Description Confirm # Contact # Me - - se
330 Water service 041692-01 503-624-4380 ,,,
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Corrections/Comments/Instructions:
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PASS n PARTIAL APPROVAL 0 CANCEL 111 NO ACCESS 4
1 FAIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: Vtk-Irle-----. Date: 7 Phone #: (503) 718-