Permit 7 /7/i o cividedf
CITY OF TIGARD PLUMBING PERMIT
A COMMUNITY DEVELOPMENT Permit #: PLM2010 -00200
;TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2010
s _az,w Parcel: 2S111CC04500
Jurisdiction: Tigard
Site address: 15975 SW CENTURY OAK CIR
Subdivision: SUMMERFIELD NO. 1 Lot: 68
Project: Lynch
Project Description: 40 ft. of water service. Electrical permit may be required if replacement piping affects house
grounding. 6/17/10 added (2) tub /shower fixtures B.T.
Owner: FEES
LYNCH, RONALD L Quantity Description Date Amount
15975 SW CENTURY OAK CIR
TIGARD, OR 97224 40 If Water Service 06/16/2010 $62.54
1 ea Water Piping 06/16/2010 $56.29
PHONE: 1 12% State Surcharge - 06/16/2010 $14.26
Plumbing
Contractor: 25 da Plumbing Permit 06/17/2010 $25.02
JACK HOWK PLUMBING /RESCUE ROOTER 3 da 12% State Surcharge 06/17/2010 $3.00
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 235 -8784
FAX: 503- 491 -2932
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $161.11
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
^,
Issued By: : / ' Permittee Signature:
Qd�saas
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.
r ' � CITY OF TIGARD PLUMBING PERMIT
Y Q
Yo COMMUNITY DEVELOPMENT Permit #: PLM2010 -00200
Date Issued: 06/16/2010
T 1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111 CC04500
Jurisdiction: Tigard
Site address: 15975 SW CENTURY OAK CIR
Subdivision: SUMMERFIELD NO. 1 Lot: 68
Project: Lynch
Project Description: 40 ft. of water service. Electrical permit may be required if replacement piping affects house
grounding.
Owner: FEES
LYNCH, RONALD L Quantity Description Date Amount
15975 SW CENTURY OAK CIR
TIGARD, OR 97224 40 If Water Service 06/16/2010 $62.54
1 ea Water Piping 06/16/2010 $56.29
PHONE: 1 12% State Surcharge - 06/16/2010 $14.26
Plumbing
Contractor:
JACK HOWK PLUMBING /RESCUE ROOTER
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 235 -8784
FAX: 503- 491 -2932
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $133.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued 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.
JUN -16 -2010 16:57 P.001
Plumbing Permit Application
B
r i c uilding Fixtures in E fir., n ,. � ,,,
q�
1` � ' T IhL UNl }� '
City' of Tigard JUN 17 2010 R J „ � ri
": 4 I `12i `%).). I lull lift r 1 97 Oaten Permit
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t Phone 5(1 .3 ,, 4V `171 1-d.■ 5(I3 5,)S I pll° RCN ,� ` r ... r „. . ` ; ----1 /� P�/y��; ��ll ft;tt
Tt�A B h 1 r� Oalc Redd. B.
s- .. :,�-', tntcrnct x%%%%., stgarr•or BUILDING DIVISION n, nfica tit .tl „,d Ion. ,. i 1
.. L- ” . ,
Tr OF WORK '
FEE* SCHEDULE
f 0 'co% mytrm:Li . ❑ Dem■ttiti,m � Fur special Ill 677(10011 am elree41111. ` ~—'
!lc),.rt),Uun I
I Nltitfllin niallcrati mrg;pla�dlncnt ❑ Wier: l _ �
_ Non 1. - tamiO IJµrllf nag iindii -T .•. In1i t h • lt I � huUIt1 , ,un11 i {
CATEGORY OF CONSTRUCTION — ',FR t 11 hunt 312 1u
I :Ind 1- tantil) dvtcllin:l ❑ Commercial :ind+r,(ri,ll Sett 12thush fit ., - --
-
1 ❑ 1�'ct +,a,r) building ❑ Multi- (until) SFR t 3 1 butyl nti )_
___
❑ (AO additional hufh 2; Ir — 1
1 _
❑ Vld'tcr huildcr Other: - _
^ fire , prinklcr I itl It 1 I nec
JOII SITE INFORMATION AND LOCATIOrs Site utilities: —.1
Joh silt: addree�: Catch Casio or area drain 18 h —1
t_ it)i'StateilIP: � r unwell, leach liltu. or trCnch drain la 76
°� `ter ��. —. —.
1
`� F ur , ting drain rot, Coeur 1l : 2
Suite/bldg JuP1. nn -: Project tGUrtC; — 1 Page - —
Manufactured hums utilities ti(1(lt —
(_ n.s a r.2ctrdirwajnns t•s jab ,ite: t InI 0lrs - -- —
Rain drain connector l 7
-
Sanitary sewcr i it 1 Pa - - -.—
- Storm sewer t 4 J J P Pa�c
_ water sert.i
.-
Subdivision: Lot tie.: �:. _ ace 2 i
Fir Ar item: —
I ax map/parcel no.: _ - Back flow precentor - 31. 27 —�
DESCRIPTIOEY OF N ORK Backwater salve 1= 51 —
o n) �vv Clothes washer - —
Dishwasher 25 02 --
_ Drinking tbuntaul ,_ _, --
t: 0i5/Sump
25.01 ----I
(PROPERTY OWNER 0 TENANT Expansion tank f, 51 . Name: I ZI % Fixture /sewer cap 25.02
Address: i64' 7 i 1 .j / , 4 ; , r rur drat disposal r sillk.'huh 2, n ,
City /State /ZIP: �l `. „1,- ,� � arhugc disposal
��A -_ Huse bib 25 02
Phone t �' I ) •—
_ Ice maker 12.51
Aa
0 CONTACT PERSON Interceptor /grease trap _ 2{ 02
Business name: ARS dba JACK IIOWK/RESCUE ROOTER Medical gas (value: $ ) Page ,
Contact name: JOYCE DENNIS Primer 12.51
Address: PO 130X 2830
Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02
City /State /7.IP: CLACKAMAS, OR 97015 Solur units (potable waticr)
62, 54
Phone: (503) 859 -3100 Fax :: (303) 491 -2932 Tub /shower /shower pan 12.51 ,
E -mail: joyceru'jackhowk.com Urinal
23.02
CONTRACTOR Waite closet 25.02
Water heater 37,52
Business name: ARS dba JACK IIOWKfRESCUE ROOTER
Water piping/DWV 56.29
Address: PO BOX 2830 Other
25,02
City /Sta(e/ZiP: CLACKAMAS, OR 97015 -
Subtotal I .l+r
Phone: (S03) 850 -3100 Fax: (503) 491 -2932 Minimum permit fee: $72.50 MEI
CCB Lie.: 127325 Plumbing Lie. nu.: 34 -I68PB Plan review (25% of permit fee) - S. MEI
� �
PERMIT signature: , State surcharge ( - °b anemia MIT fee / +l
TOTAL MIT ' )%] i.
CZ__ / ► ,
Print narric yr� � D. L � � ((J 7/) / � This permit application expire-4 � �", /.�
tr if permit is not ubtalne,"
_ lifter It has been accepted as complete,
- -1 0M - Jarrl G a ui -tkPe- c R,tr\ -c .""- "� Budding Industry Service Board.
)
1,18u,IdirVennits,PLMV -Pe, mitApp dine rwJllO Plaoca FAX Pft? ON/Is'T' r'nn +n• cni •I tit ln,-, T -- /
JUN -15 -2010 12:44 P.001/0 03
riumb Per mit Application
Building Fixtures OF Wp
Inlcrrtcl F r • �� r k� f �� f _ ry . � ;� .
- arc. ]/ J 2 4'., I'hooc• ;503 n :I� y U N 1 5 2010 �� — J : �I I E ;j
r lanitc, r„ n linc 503 r,, . I EE V„ l
". , ;w,,A utt tt u_'ard- or � (� I ^ ;, I t _
I + i —� i1 l Not ,(1,;..(, r� ®ti c '
r • V Su t. Sur —'7
1iPE �jl�ltl_ v �tl1P���(jf,`� ) pplemcnw Inhirmatu,n
7 I
❑ ^i�11 t:l�RS1PUv1lif� FEE* SCHEDULE
❑ Dena ilMun
_ — / irr t rrciu/ rn OF CONSTRUCTION nr a�ul lrrq tcrr e/rrr (Itch
ditii ' repla,:cmcnt
Other: �
� d l h .i nl , b„n ~_
❑ Other: Lr 'It 7 I. I
Nett I-;- famdctlw cllrn�t imd,rdd< lru, tr 1 „ — I :. n.
P_(;ORS- etch alibi, 1
CAT
S!'tt r f ■ bath c, air ,;. n „ ,
1 -:mJ '- fannly dttcflin_r 11 7t, —
— _ ❑ C' N1.I 1 r hatlt
' — _ —_ —
1 U •1cca,�„ry huiidnt ' - - - -- t — — —. 717 , _ '1 t- ,K —
E ❑ Multi- fiurlily Silt ( ?1 pah
TE xlastcr kiiil,ler Lach add(' h;tlhrl ncilen — - H-- LI Other: 1 .; n -
JOB SITE INFORNRATION AND LOCATION 1 ire �pnnkler (—
` ill h r — —
Site utilities:
�1 /1 ai//� I Catch h tsin r�r arUa drp
City/State/71P: � I �/L�rif[,� . -- � — . —. —. — I$7l - --
/ dam( L� 7 rDrc lean Irate or trench drain - + I R.7r; �1
Suilc'bId /Apt 1)n .: rilin !rain __
I ruj�ct name: � y �/ b IRt, linear It.. I ,. ^ �
t ,strcetidirectinni 10 job ..ilc; — -- -- tilanufneu home unliacs —
— — zn r13
Manhuics -- -- —
_ tBJn
— — Stain drin connector — - --
_ IIS.7r,
Sanitary sciAer (11U linear ft : -- — 2 —.— �
Shinn sewer Inn linear ![ • _I —.�
—.— .— Pace
Suhdit'i ion: Water )cfl7ce (nrr l ft l,- J f `— —
(UL rap,; Fi or item: 1 Pale l i 1
Fax map /purvol mt.: —
1 liackllow' pretenler — — — --
DESCRIPTION OF WOR ~_ '
4//)/ 437 - ___-_,.r.— � valve
r �/� /�,
clothes washer 25.02
_.51 If
i r./[/ J '../ ' 15.02
!/ _ ?3.112
/ Drinking fountain T —� — -
Ejectors /sump _
ttETt
ROPERTX OWl ) 5.02
(] TENANT Expansion tank - -- _
Name: / L AV 1 i 1 7 ��� 1..51 - - -
Fixture/sewer cap - -___,--
• __ 25,02
Address / ,� y "At i f or drain /floor sink /hub
L..e `c, 1 // 5 02
tit. /Stat�rZ1Y: t: - age disposal
Lief / — ._ .
25.02
Phone; ( 5-423:`' //7 -
Hose bib `�"�
�� ( ) ace maker
25.02 APk*LICANT CONTACT PERSON 12.51 -�—
K 0 �Interceptor/grease trap —
Hasines name: :US dba JACK IIO��'I�/RESCUE ROOTER Modica! gas avatar $
25,02
- Page ,
Contact nacho: JOYCE DENNIS Primer _
12.51
Address: PO BOX 2830 Roof drain (commercial) 12.51
M
City /State/ZIP: CLACKA,MAS, OR 9701.5 Sml /bas "' /la`•uton'
23.
Solar units (potable watch 0
4
Phone; (503) 850 -3100 Fax: ; (503) 491 -2932 12 51
Tub/shower/shower pan _
E - mail: joyeer?jackhowk.com • 1_,�I
Urinal
2 -.UZ —
CONTRACTOR Water '
0 ,
Business name: ARS dba JACK HQR'h/RESC UE ROOTER Wa ter heater
37,52 MO
Address; PO BOX 2830 water pipin 'DWV r ,1
#1;46,1r 56.29 WAN"
City /State/ZIP; CLACKARI,. Other: r �,y
1S.0R 97015 _ IMO WM hone: (503) 85U -3100 Fay; (503) 491 -2932 —
Subtotal � �
____^
Minimum pemtit fee: $72.50
I C'C[i Lie.: 127325 P mbing Lie, no.:34 -168PB Plan review t25 ° to ut permit tee)
Authorized signature: State surcharge (12% of permit for
0
Print name: TOTAL PER. ~t
Dal 'rhix permit application trxplres it a permit is not obtu I �
after it ha, been rccepteti as rumple
lee methodology yet by Tn -Co 1)' Budding Industry . now Board. .
r',AUitding,p. Pt htV.Perm iAPP AOC 10/i %I
il-gs 4,,S0 TrckA,/, Fblitivc 2 2sea„ e,6-tc,
Please FAX PERMIT COPY to 50:1- 491 -7411 ' 13,
JUN -15 -2010 12:44 P.002i003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Superession System
Site Utilities Qty. Fee (ea) Total $ nave F o o t e : P ermit Fee:
Footin dr - t cc 100" �-
um 50 03 o to 2,000 $121.911
Footing dram - each additional 100' ;i7 s 2.001 to 3.600 $169
SCwW' 1st 100 3 .001 to 7.200 $233.211
------77—).5,—^,-; 7,201 and greater $327.54 — ^—
Sewer - each additional 100 37.
Water e
e
Srvic- 1st inn OW 62.54 rf r
i +'ater Service Service
-Cash additional !Hy �, - Medical Gas Systems:
37.5 , _
Storm & Ruin Drain - 1St 100" 62.54 ' ' ' PQ l Fee: —�'
Storm &kern Dram -each additional IV0' 37 c , $ to $5.000 00 Minimum tee $72.50 `
$5.001.011 to $l0.O0nJ $72 50 for the first $5.000 all and $1.52 for -
Otlter Inspections or Fees Qty. FCe (ea) Total each additional $100.00 or traction thereof: to
and including $10,000,00.
Inspection of existing plumbing Or for t
,cinch no lei is specifically indicated 90.00/hr $10,001,110 to S25,000,00 $148.50 for the first $ I0,0 0.00 and $1.54 for
lrninimum cage - I/2 hour each additional $ IO or fraction thereof, to
Inspections outside nl'nomtal business 9p ill %hr i , and including; $25.000.00.
hours (minimum charge - 2 hours i 5_ 5,001.00 a $50000.00 $379.50 tier the first S25,000 .00 and $1.45 for
- each additional $ (00.00 or traction thereof, to
Reinspectiort Fees 90 00 /hr
and including $50,000.01,
Additional plan review for revisions 90.00/hr $50.001.00 and up $742.00 fix the first $50.O00.00 and $1.20 li r
(minimum charge 1/2 hour) additional $[00.1)0 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If eyes ".
W Plan ova y of the oli Instsl laEtons
please indicate work performed by fixture. Failure to
1 tart review is required for am of the following. '
accurately report fixtures could result in increased sewer fees * . Pleasc check all that apply.
Quantal, by (Fixture) Work Performed El Any new commercial building with water service 2" and
Fixture Type: Replace greater, e.cept systems designed and stamped by. licensed
Previous Co..ed Added Lxietia•
llapustry /Font engineer.
Bath - Tub /Shower — El New exterior plumbing site utilities for and cornplee structure
1acu /li /Whirlpool as defined in OAR918 -780 0030.
- Car Wash Each Stall — Q Medical gas and vacuum systems for health care facilities.
Drive Thru - ❑ Any multipurpose tire sprinkler system.
Cuspidor/Water Aerator ❑ Any complex structure tis defined in OAR9 -7$0- 0040,
Dishwasher - Commercial
- Domestic Submit 2 eels of plans with any of the above.
Drinkin Fou„t
•
r6ye Wash I6tOA11it�trC or
Floor Drain /Sint. - 2" — met' _ Ili
3 "" III Isometric or riser diagram is required for new buildings
4" — that meet the qualifications above.
Car Wash Drain
Garbage -Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains -
Oil Separator (Gas Station) - — _
Rec. Vehicle DurnaStation
Shower -Gang
-Stall
Sink - Bar /Lavatory — —
- Bradley -
-Commercial *Note: If the fixture work under this permit results in an
- Service
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Vi'nshcr- Clothes — — fees assessed for the sewer increase roust be paid before the
water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal -
Other Fixtures:
hltp://www.tigard hall/ departments /ed /does /PLA4F- PermitApedoe