Permit CITY OF TIGARD PLUMBING PERMIT
Ip
: ° • COMMUNITY DEVELOPMENT Permit #: PLM2010 00261
T t G,A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/09/2010
Parcel: 1S133CD16800
Jurisdiction: Tigard
Site address: 13832 SW ASHBURY LN
Subdivision: PEBBLECREEK NO. 3 Lot: 58
Project: Bewersdorff
Project Description: Replacing 75 ft of water service. Electrical permit may be required if replacement piping affects
house grounding.
Owner: FEES
BEWERSDORFF -BARON FAMILY TRUST Quantity Description Date Amount
13832 SW ASHBURY LN
PORTLAND, OR 97223 75 If Water Service 08/09/2010 $62.54
PHONE: 503 - 313 -3953 1 12% State Surcharge - 08/09/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 08/09/2010 $9.96
Contractor: Plumbing
JACK HOWK PLUMBING /RESCUE ROOTER
P.O. BOX 2830
CLACKAMAS, OR 97015
PHONE: 503 - 235 -8784
FAX: 503 - 491 -2932
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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.
AUG -09 -2010 09:50 P.001
Plumbing Permit Application ,
Building Fixtures ' ti � �o `I OR (i141 ( E `USr`ONl
C5
i a a, ,
City of Tigard \ J R ecency
^ ® Darr rN I Pcnnn No
' a I } 125\'.1 Ilan I11,1 LrurJ 1.,r. ' vG `•'
i. ..orer C Plan Re lc•, -.
_ Ph„rte 5111 b.'' 1 ' 101 :P* 1v4.1' r `� C J \ o I f)ale'A, �. - -- -- -- , ngrr•:nn El tr r.,:. I It A Rr' p.
In,cn.,nI inc 951? 1,3+, 41'5 e I , .1 , {� m 1lMPILC'Irlr •
t� b.,. [..,,I, tt, i,...
-. - IOW( 11C1 u ,.% ■.. DU rd 10% 0,\0, c\ \ \ V" te.MuI ,I. ?,I.II .1 /lb Supplempntallnfoem;Nu,n
1 r TYPE OF WORK %,\)\‘'- FEE* SCHEDI LE
u>nstnt.
Ne F or s e cial in ° madon nWW thcr. - /isr. _
0 tc• ucar ❑ Danolitiun
1 H -
fh iii ,loco ■ u
1 �— •-• - - - -- I - L. ..�...,. I . t I:u - 1 )co
f t2if At1 d,INlPaher.rtinn n t cn .. t .... I ❑ (later . __ . I \ea 1- 2- farnth dµclliri . t mdhtdey t' "1 11. I■r each Milos ‘ IinCi(
1 CATEGORY OF (ONSTRU(TION i tirk 1 I 1 hail 312 ' 1 I
Ig j - :Intl '- flood, ds,,vllrn�: ❑ C mm�tcrcial•'indus trial SrR r2 I hash , _._.___.._. 1- 7R ... _l
SFK 1. i bath •t
1 ❑ •\tCCs't huih.tin : ❑ 1lulti -tmul
.,.. f
- • - .. [aCh additional hotluhnehrn 2: u?
[] Master l +uild4r 0 t tther: •uc sprinkler 1 It i 1 _ Parr . - ,.
1
JOB SITE INFORMATION AND LOCATION Site utilities:
�1A -�� Z4/ t_ tlkh basin or araa drain I R 71, r i
fob site uddrzs�: ` �,J 4 V
L - % Drywell. leach hoe. •a trench drain IR 7n
, • (its /Statc/7IP: _J 4 "/' .._.._�. -...._ ..-
rioting drain (nn. linear 11 _1 Pace
Suite/bldg. /apt. no. 'rnlect name, • f�� / • ::- , ' -
/ ,) ht anufacturcd home unbar? 54,4)2
lr•)i: arcet:directions b. Ir +I „ilk' Atnnhnley 111 71; --
Rain drain connector - I g 1 ,,
Sanitary sow' utn. linear lt.' i Pact:
!- - ....._.. ....._ -. - ........._ _........__.. -_..- I • Storm setter 'no. linear tt i Pa�c 2 --
I. -- - - - - -- Water service (nu linear it : ) l'iicr _'
tiubdn t,ion I.A. nr. • Future or item:
lax map'p;,trvel no._ Itacktlu c prcvcntcr 31 .. )
DESCRIPTION OF WORK Backwater cuIve I'.� I
• ` '� W Clothes washer - 21;.1 1
I_ -... _ ly � s Drinking 2j. -
t ( y r n l , ' ! Drinhtg fountain .. q
• 1:,jccters /sump 2S 02 _ ]
--
P' 'ROPERTY OWNER ❑ TENANT Cspansiun tank 12.51
Name. "�LLf i
v, It 1 '� /l' Fi\hu•e /sewer cap 25.02
I / Floor dram/Boor amkr9ual — 25.0.2
Addrec.' / ' A. -
Garbage disposal 25.512
1 City /State;Zll': / ` Hose bib 2
Phone: ( ' ^, 43.0# FLi.7Z Ice maker T 12.51
•
APPLICANT • 0 CONTACT PERSON Interceptor /grease trap 25.112
2
Business nume; ARS dba JACK HOWK/RESCUE ROOTER tiledieal gas (value: b ) p
Contact name: JOYCE DENNIS Primer I?
Roof dram (commercial) 12.51
Address: PO BOX 2830 �"
S inlJbt>cin /lavaton 2$,1)3
7
City /Stale /ZIP: CLACKANIAS, OR 97015 Solar units (potable is•aterl 6).54
Phone: (.503) 550 -3100 Fax:: (503 491 -2932 fuh /shower /shnncr pan 12.51
E -mail joycerg)jackho..k.vum Urinal - ~w :5.47
• CONTRACTOR Mater closet _ ?5.0'?
Water heater 37,52
Business name: ARS dba JACK H0W'K/RESCUE ROOTER Rater piping/DN'V 56.29
Address: PO BOX 2830 Other: 2
25,
Cit /SluLe /ZIP: CLACKAMAS. OR 97015 Subtotal
Phone: (503) 850 -3100 I Fax: (503) 491 -2932 Minimum permit Ice: $72.50
W
CCB Lie.: 127325 I Plumbing Lic. no.: 34 -168PB Platt review (2_ °0 of permit fae)
. State surchnr�e (1l' o of permit [cc ' /,f1
Authorized signature: Jam / L 1�A / IOTA!. PhfM1T FE I gra, ,r l
♦ / /� = This permit appllcadon expires if a permit i not obtained . ith ,i ; ' , �/ /
//)�r / �_ 1 � 1 Date' . A after ft has been accepted w com pletr !!!
Print name: ��
"Pee methudolup set by Tn- County Bwldntg Industry Service Board.
t Zuildini !Wm ivi.1'1 t(I- Perni;iApp la i(vAoi+ Please FAX PERMIT COPY to: 03 -491 -2932
AUG -09 -2010 09:50 P.002
Plumbing Permit Application - City of Tigard
P.i;e 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression Systems:
Site Utilities Qt Festal - -__
Square Footage; Permit Fee:
1''- , ten^ dram - 1 • inn. Mill
11 k, 'fHH • $t�l N1
1 „ •l u ,g dr.,in- ,)vhadJlu"u.11 inn t ^ - b)..e S(i $Inei
Svter IitI :r ;ellt'' ±rill S2 - --
211 antl ,;renter '- .. $; .1 it
'Nowt - each additional It?n : ^ : v ..
• �k,,(cr l,,'1 t r�c • each ,�dJnnvn:,I Ion � Medical Gas Systems:
Voris, Ram Drain - 151 Ino r ,� ;a "aluatiOn: Permit Fee; —
IMEISEI C? i_
- ii On it, $S,iino on Minimum fev 572.50 •'`
t $; rp11 ii(, to Sill utlfi hu $72 50 ti'r 111c first $ • no ' t;i 5_ , r
Ir
Other Ins eetions or Fees Qry, Fee len} � I udh additiinal $Ins? 11x1 or trat,U•a, tllerco,f u, S.
Inspect!' nt o of c tiling plumhino .)r lot. ;tnd inihldr l e I I }t nO
first $inontin.uu ilni
1111 on 5..52 ptiII nit $fa.5h lOr h�
which no fee is arrtically indicated un Millie the ti '5.4 tvr
p
I minimum dlarne -- 1 hours each additional SInO no or fraction thereof, to
ln,.licitiuns o ,v f nor hu.me.s co oniIle Indlldrn� $25,000.00. 1:2i.9(1l or, l $.I? 0111)?iu $ $3 37 +.;n for tot: tirst ss.0 Si .1i G
,u ,r ..—
I ho r> (nl niflhilnl charge - hours)
Call, additional $1(u? hoot fructu'n rhereo,f, r.
Reinspectrun Fees - -� va.0l
and including $50.00.001.
Additional plan rvvict For Yr.l <u ns of i O' .'h 8517 nu 1 on anti ut` $742.(18 live the first $ ±u Om I.011 and $1.26 t�?r
ununmum char ?e I;- h, cacl, addiii■ 5 194 00,, rractlom thercol
Subtotal!
Commercial Fixture Work:
Are you capping. adding or replacing tixturec? If -yes", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan revie is required for any of the Ibllnwinl;.
accurately report futures could result in increased sewer fees Pleast: check all that apply.
Quantity by (fixture) Wurk Performed ❑ .\n. new conunercial building tt , hater service and
Fixture Type: Replace granter. except systems designed and stamped ht licensed
Previous Capped Added Faiating
Baptiste) rFont en�inccr.
Batts - TuhrShot:cr '— ❑ New exterior plumbing .ate utilities ti)r'an) tnntplc% Structure
- Jacuccutvhirlpowl - :u defined in OAR918 -78Q uv40
Car Wash Each Stall ❑ Medical ga:; and vacuum sy'stt nis dire health care facilities.
Dove flee ❑ An multipurpose fire sprinkler cy stem,
c: u;pldvr /17t'at r nspnatur - •'-• ❑ Any complex structure as defined in OARS 1 8 -?80- (?040,
Dishwasher - Commercial
Submit / sets of plans with any of the above.
- Dnmesuc
Dru , k,rtg Faunturn
-
E,` Wash Isometric or Riser Diagram
lsotnetric or I iser diagram is required for new buildings
3
a that meet the qualifications above. •
('ar Wash Drain
Garbage - Domestic _ —
Disposal - Commercial
_ Industrial Comments regarding fixture work:
lee (vlach.JRcfrtg. Drams
Oil Separator (Gas Station) ---____
Rec vehicle Dutnp Station
Shover Gang - - -
-Stall —
Sink - Har /Lavaton • •-
-Bradley
— —
-Commercial
Note: If the fixture work under this permit results in an
-Service
Swimming Pool Filler increase of sewer EDUs, a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
water I .\tractor plumbing permit can be issued.
Water Closet - Toilet
Urinal —
Other Fixtures
h ttp: /?Isis u•.tigeud- or.gnt•: city'_ hall; departments /ed/docs(PLA4F- 1'ernli tAprndoc