Permit • CITY OF TIGARD PLUMBING PERMIT
' ° . COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00076
•1"r ;' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
• DATE ISSUED: 2/28/2008
G
PARCEL: 1S125DA
SITE ADDRESS: 09035 SW 66TH AVE ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: COURTNIER
Project Description: Replace 30' of exterior water service, repipe house and install (2) backflow preventers for
irrigation.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: R3 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: 200 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
FRANK COURTNIER
9035 SW 66TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/28/2008 $156.50
[TAX] 12% State Surch 2/28/2008 $18.78
Phone : 503- 644 -1339 Total $175.28
Contractor:
PLUMBERS INC.
90 NW 150TH AVE
BEAVERTON, OR 97006 REQUIRED ITEMS AND REPORTS
•
Contact # : PRI 503 -519 -6644
FAX 503- 469 -4540
Reg #: LIC 177214
PLM PB447
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 o.tain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. _� t L /LL ./_ / / Permittee Signature: `
_ lr
Call 503.639.4175 by 7:00 a.m. for an inspection that busy ess day.
This permit card shall be kept in a conspicuous place on the job site un completion of the project.
Approved plans are required on the job site at the time of each inspection.
Platibepg Permit Application
" `l'OR OFFICE;USE ONLY
City of Tigard R eceived �/ g' Permit No.: 6,,A( j` *. - 4
Date/By:
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
IIII C Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
I 1 A Rt p Inspection Line: 503.639.4175 Date Ready/By: Ju ' ' ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 1 tr Supplemental Information • TYPE OF WORK FEE*. SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. Total
Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
/_ 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: 10 35 Sw (Q Co -+I telore Catch basin or area drain 16.60
City /State /ZIP: -- I U a � . O Q q 7 -* Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ( J 1 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.:p 2 )� Page 2 /Q(' fey
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
. DESCRIPTION OF WORK . Backflow preventer a Page 2 55) /0
ref - (thirbs 4- Al-to A+4 5-rue Backwater valve 16.60
( Oil A �' S Gv\1 Clothes washer 16.60
`� 1 J Dishwasher 16.60
KPROPERTY OWNER I 0. TENANT Drinking fountain 16.60
n I 1 v n Ejectors /sump 16.60
Name: �raitk. C ti /L _, f I F!2_ Expansion tank 16.60
Address: 9n $'s� S(,) 6 (p 6 46- Fixture /sewer cap 16.60
City /State /ZIP: "77)2 92 ,,..j, b� 9-7 7 Floor drain/floor sink/hub 16.60
Phone: (c3) �O y ,( -(339 F ax: ( ) Garbage disposal 16.60
Hose bib 16.60
, 5(APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: - ii, b6 6 �'t(r Interceptor /grease trap 16.60
Contact name: , \2\ A Medical gas (value: $ ) Page 2
Address: 1 6 Ai GJ (Co d L A Primer 16.60
City /State /ZIP: „f ( E 0 h 6 700 6 Roof drain (commercial) 16.60
r !b C Sink/basin/lavatory 16.60
Phone: ( j 3) 4(1,G c (-4 Fax:: (50) 1 C - 119(6
` Tub /shower /shower pan 16.60
E -mail: ud J., _ill- p' �k..r, r(S)` f �oE letal t C G 4 Urinal 16.60
CONTRAWEIR Water closet 16.60
Business name: f_ ?) u vt.b6 Lis Water heater ^ , 16.60
Address: 1. , /fit , ( gypFin 1/ L _ Other: Subtotal
City /State /ZIP: ,,_Nfff 14,,E 0 R 4' '] al (..
Minimum permit fee: $72.50 ) 'g',.)
Phone: ( 3 ) i C _ (.9(r7 ( t( Fax: (�a3) .1(6 y..4s'z O _ Residential backflow minimum permit fee: $36.25 k„ _
CCB Lic.: 4/ 7 4 Plumbing Lic. no.: p6 4 Plan review (25% of permit fee) -9
1 State surcharge (12% of permit fee) / g•.2$
Authorized signature: G ' 7 / / 6 8
TOTAL PERMIT FEE ' X7 .
This permit application permit is not obtained hin ea expires if a wit
Print name: `�� rn y � E Date: ���C Pe PP P P
V u ( 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLM- PermitApp.doc 12 /27/06 440- 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 X00
Water Service - each additional 100' 46.40 i/o, Aft Medical Gas Systems:
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
additional $100.00 or fraction thereof, to and
Fizture;or. Item Qty, F ee (ea) Total 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
• 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.
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate.work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type:, Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
• Baptistry/Font
Bath -Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Tub /S i/Whirlpool • as. defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial"
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3' q
that meet the qualifications above.
- 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 *Note: If the fixture work under this permit results in an
Y
- 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