Permit CITY TIGARD PLUMBING PERMIT
1 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00100
DATE ISSUED: 3/15/2005
---' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 BD -03200
SITE ADDRESS: 09790 SW PEMBROOK ST ZONING: R -3.5
SUBDIVISION: CLOUD CAP LOT: 014 JURISDICTION: TIG
Project Description: Installation of new gas water heater.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KRANZ, NEAL Description Date Amount
9790 SW PEMBROOK
TIGARD, OR 97223 [PLUMB] Permit Fee 3/15/2005 $72.50
[TAX] 8% State Surchar; 3/15/2005 $5.80
Phone : 503 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone :
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
952-0001-4 ! 'rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling .43- 246 -66• or 80 32 -2344.
Issues By: Permittee 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.
Plumbing Permit Application '. •
FOR OFFICE- USE ONLY`
City Of Tigard
Received la J ft Permit No.: I S - _
13125 SW Hall Blvd., Tigard, OR 97223 P a Re V
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 y /b A aa t Date /By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 t ..li B .. y
'; ,.W Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: [ Supplemental Information
` REDUCE
❑ New construction ❑Demolition For special information use checklist
Description Qty. I, Ea. Total
2- Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION-4: .. SFR (1) bath 249.20
121- 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 ,` .y , F " " Site utilities
Job site address: l l O S(A) Pe i vi h c k s f Catch basin or area drain 16.60
City/State/ZIP: 7 v a l 62 c Z2- l'-\ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
n 1� Manufactured home utilities 110.00
Cross street/directions to job site: IS
l �/ / A.�. t 1 (7t +0 f Manholes 16.60
�.e i4.t 1 P' C D 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 rption valve 16.60
. ,, DESCRIPTION OF .WORK `� ',,%,:::.--.`, „ Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
•
Dishwasher 16.60
" ® PROPERTY : ! ' '® TEN
Drinking fountain 16.60
E /sump 16.60
Ale., Name: l I / Y( Pi `z Expansion tank 16.60
Address: ! 7.7 0 S u1 , �� l . , c , O L 5-4- Fixture /sewer cap 16.60
T
City/State/ZIP: t Ii Floor drain/floor sink/hub 16.60
c e
Phone: (5 )5 - J (5 d 30 )5 Z 7_ to q k. Garbage disposal 16.60
oe t
H s b "b 16.60
: 0,: AANT , .z ® CONTACT P
.
.. PPLIC ;1;',,,,',;„ _. .:.; .:, 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
Phone: ( ) I Fax:: ( ) Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
s r - , CON CTO Water closet 16.60
Business name: J Water heater F 16.60
Address:
Other:
City/ State/ZIP: Subtotal �J�
Minimum permit fee: $72.50 -�J�,J V
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: , Plumbing Lic. no.: Plan review (25% of permit fee)
e: y �ij State surcharge (8% of permit fee)
Authorized signs
/ / 1 /// TOTAL PERMIT FEE '7g, 30
Print name: / Veil / � i4 Date: 3 -/ O3 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:\ BuildingTermits \PLM- PemdtApp.doc 12/03 440- 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 - 1 100' 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 Valuation • Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
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:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
N Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
Car Wash Drain
Garbage - Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains p
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
is\ Building \Pemuts\PLM- PermitApp.doc 3/03
•
CITY OF TIGARD I
BUILDING DIVISION �J PERMIT #: PLM2005 -00100
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2005
Phone: (503) 639 -4171 � e +dp
Inspection Requests (24 Hrs.): (503) 639 -4175 �_ ` __.. w�/
INSPECTION WORKSHEET FOR DATE: 4/6/2005 TIME: 7:10AM PAGE: 10
SITE ADDRESS: 09790 SW PEMBROOK ST CLASS OF WORK:
SUBDIVISION: CLOUD CAP LOT #: 014 TYPE OF USE:
PROJECT NAME: KRANZ
DESCRIPTION: Installation of new gas water heater.
OWNER: KRANZ, NEAL, PHONE #: 503 -598 -1150
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 003869 -01 503 - 598 -1150 N
Correct /Comments /Instructions:
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'- PASS ❑ PARTIAL APPROVAL MI CANCEL ❑ NO ACCESS
❑ FAIL E CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
,, (U Inspector: Date: _ I & ' f/ Phone #: (503) 718 -