Permit ti
8 . 0% CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00250
'' DATE ISSUED: 6/18/2007
ii1,
T 1 „ ," 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 111 AC -00500
SITE ADDRESS: 14570 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: PINEBROOK TERRACE LOT: 046 JURISDICTION: TIG
PROJECT: KLEIN
Project Description: Replace bathroom fixtures.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JULIE KLEIN
14570 SW 91ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/18/2007 $72.50
[TAX] 8% State Surcha 6/18/2007 $5.80
Phone : 503- 650 -5036 Total $78.30
Contractor:
AC CONSTRUCTION + PLUMBING
19262 MAHOGANY
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -557 -4996
FAX 503 -723 -4388
Reg #: LIC 100919
PLM PB 184
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 - RQw rules adop t by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -0001 -0010 through OAR 952 -000 -0100. You may �o.tai copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/
Issued By: �1r �-_. A � Permittee Signature: ■ 1
Call 503.639.4175 by 7:00 a.m. for an inspection that business .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.
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Plumbing Permit Applicat Y�
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Building Fixtures JUN 1 } n� n/ , ,�'r , � i; F OR OFFICE�USE 'ONL , , i ° �t�, = t-� , ,
JUN V Inn 7 Received } � "'�: . y r,?,, ,. $sv :,, ,, ,,,,, mi n.,C;_4 i s s f'hr:.14.4*, ,,,e.. .-4 iA vx',Y ,.., • i:JAq't • i.._ n:.
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- :f.,:; , ,:. i City of Tigard Date/By: . ��� / 8..... Permit rNo�i...0 ,,Z�2 .oa L r/
a 13125 SW Hall Blvd., Tigard, OR P ' 2' '" > g p
�! 1 l(jA `:p Revew
C Phone: 503.639.4171 Fax: 503 " :.l'•.OY �ateBy: Other Permit No.:
l I G R D' Inspection Line: 503.639.4175'� 1 DING D T 's : Ready /By: Juris: /® See Page 2 for
- Internet: www.tigard- or.gov u Tr l l DING lS 1 V i fied/Method: " Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. 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
riI- 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: /qS) 0 S(s y / S~7, Catch basin or area drain 16.60
City /State /ZIP: r Mg' 19 CiT 9) a 23 Drywell, leach line, or trench drain 16.60
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
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 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
REPO4c RArlia ✓h Pfrr Backwater valve 16.60
l Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT. Drinking fountain 16.60
Ejectors /sump 16.60
Name: �j� li(U icrt) Expansion tank 16.60
/L� SS f
Address: 0 .(50 CJs7- Fixture /sewer cap 16.60
City /State /ZIP: ' 7, /9✓e 9/ Floor drain/floor sink/hub 16.60
Phone: (,� ) 7K t 5 Fax: ( ) Garbage disposal 16.60
,.�,�� Hose bib 16.60
❑ APPLICANT • tS 46NTACT PERSON -
jr Ice maker 16.60
j�� V
Business name: il L (Q� Interceptor /grease trap 16.60
f
Contact name: 6 , c � / Medical gas (value: $ ) Page 2
Address: /6 3 Ci € " Primer 16.60
City /State /ZIP: ! 0 n G y < >r� Roof drain (commercial) 16.60
CC Sink/basi L'ava o _ f 16.60 /(a A 0
Phone: 1Aj3) . .5 -- -7,--V.6) 36 f Fax: : ( ) Se.f ill, P ' Tub /shower /seer pan 1 16.60 /6 CO
E -mail: j v 4.. e,ic,..,(°v 4, ,,,,,, ,.. • �7!/Lt'r _ COr� -� Urinal 16.60
O Water closet I 16.60 A 60
Business name: ,4G 6.2,1)Srgvc rkletJ f Pi..,C► 4 e//(/ - CO, Water heater 16.60
Address: ! C i a 4 a. /t'i ti. tuve 4 p /0, '? Other:
City /State /ZIP: 0/ -a 6if r v C,1? 4 7 OTJ Subtotal
Minimum permit fee: $72.50
Phone: (57/3 ) ,S,$"7_ e( fl) Fax: ( )--)1 _ ' y3 8 Residential backflow minimum permit fee: $36.25
CCB Lic.: /00 91 ' ,.7--40/0? Plumb' g Lic. no.: / 6 ! Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: I / OQ TOTAL PERMIT FEE ?9 3 0
Print name: AN 0 y y4-4),C Date: - /q-c) 7 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\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
J. Gia�`..
Fee Schedule: Residential,Fire Suppression Systems:
Site Utilities Qtr. Fee (ea), Total Square Footage: . ; ' Permit Fee:
Footing drain - 100' 55.00 O 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 VA • : 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: Plan Revie for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed
greater, except systems designed and stamped by licensed
Fixture Type: . .` Replace engineer.
• . . Previous Capped Added' Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. .
Dishwasher - Commercial
-Domestic Isometric or Riser Dix ram
Drinking Fountain g
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
-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- PermitApp. doc 12/27/06
CITY OF TIGARD cx
BUILDING DIVI -- PERMIT #: PLM2007 002.5il
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10120077
Phone: (503) 639 -4171 All- t....
INSPECTION i / 7'7
Inspection Requests (24 Hrs.): (503) 639- 4175 °__..
INSPECTION WORKSHEET FOR DATE: 6/1912007 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 14570 SW 91ST AVE CLASS 0 .
SUBDIVISION: PINEBROOK TERRACE LOT #: 046 ,, - - OF USE:, a 6
PROJECT NAME: KLEIN ) / . .
DESCRIPTION: Replace bathroom fixtures.
OWNER: JULIE KLEIN, ' ' PHONE #: ,
CONTRACTOR: AC CONSTRUCTION + PLUMBING t PHO,,,r{"". 503-557-4996
Inspection Request Scheduled For: Date: 6/19 /2007 Pour Time:
Code # Inspection Description Confirm # ontact # M- sage
3 20 Plumbing rough -in . 050484-01 503-320-5232 Y
i"E t i o / (ie-
ti
Corrections /Comments/ Instructions:
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7) &pk.2(W) V.,/_-■f j") ( friA..).. 64/1/L{ ,
I ( P ASS IAPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v' Date: /4v Phone #: (503) 718 '�