Permit a CITY OF TIGARD PLUMBING PERMIT
,71 0 • COMMUNITY DEVELOPMENT Permit #: PLM201000287
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2010
Parcel: 1S125DD02200
Jurisdiction: Tigard
Site address: 6965 SW VENTURA DR
Subdivision: WASHINGTON SQUARE ESTATES NO. 1 Lot: 13
Project: Baird
Project Description: Replacing 60 ft. of water service. Electrical permit may be required if replacement piping effects
house grounding.
Owner: FEES
BAIRD, THOMAS E & ELLEN E Quantity Description Date Amount
6965 SW VENTURA DR
TIGARD, OR 97223 60 If Water Service 08/31/2010 $62.54
PHONE: 1 12% State Surcharge - 08/31/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 08/31/2010 $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 1.800.332.2344.
Issued By: / . Permittee Signature: or
CaII 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 -28 -2010 13:32 P.001
Plumbin Permit A licatio
Building ixtures CEIVED
g VOR OFFICE lISF ONLY
. City of Tigard - 1 1 R «�ned .
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BUILDING DIVISION u. „n %.d hl,•11,,.t
i TYPE OF WORK FEE* SCHEDULE 1
■ ❑ ;'ew c' n struln'n 1 Dcmulition L Fier rpeciul ii;foimalinn uw checklist
1 Cg
— 1 Ihncripte'm 1 r:it L a I,udl _
1ddiu ttr•altcruU m. rrplacoment ❑ O111Cr' \rw I.2- fttrnil, dwellings 1 include• I'N1 11 Ii,r cad) ui out% 1.01irltotimi :
I c,tTFC.ORY OF coNSTR1. MT 111 hulk _;, , rI ”—
i . 1
I ..l ■ 1 - ,tnJ ftnlil) dwelling I ❑I:�+mntereial Indu•.trial SJR i2i bath -L •137 _ �
'Ill 1 31 bath ,
I ...ix, ;
❑ ,lttcsxn . hlnlJin C I Ahdli- fornil • - — I
Fach additional hathikwhen ,i 112
❑ Maim: builder ❑ IJthvr'
fr. prinLlr ( \q 111 Pugs 2
JOB SITE INFORMATION AND LOCATION Site utilities: _ "— •
11,h ale address: e00'7 4t-7 510V O I Catch basin or area drain - IR.71.
Cit./State/ZIP: -% /� - 1 Dnwell Ica.h line or trench drain Is 74; —
I �N� 61` J Footing drain (no linear ft _1 P age 2 . H
Suite/bldg./apt. n0.: Prujtct name. 111anufactureJ hnme utilities ;n 111
t.'t ':> :exert Jircrtiurn olio' ite. + • i
_ C Manholes _ I R 7n
Ra drmrt connector I R 7r;
- Sanitary sneer inv. linear ti.: ) Page
----I Storm sewer Ino. linear Ii . _ Page 2
Water service in'.. linvrir ft • _ . % r age 2 r •
\ubdi.viiim _. 1 t„1 m.... Fixture or item: •
I Ti . nutr%pancl no : Backflok prcvcnter 1I .. • DESCRIPTION OF WORK — Backwater valve
— ~-- Clothes hasher 25
` _ Dishwasher _'5,1)2 —
I-- �( Drinking fountain '_.1)2
1_-----. . Ejecturs/sump 25.02
ROPERTY OWN 0 TENANT Expansion tank 1'.51
AV) �- t f// Fixture/sewer cap I +c U2
Name:
Addre s: _' t 4 n: S 1/ G arb dram /fluorstnkt7wb -- 25,02
Cit.ilWLer'7,1P: 4' Garbage disposal _ 25.t1'
r / _ ...I' Huse bib 25,1)2
Phone: 1 a / • y: : 1 Ice maker 1.2.51 --~
X APPLICANT 0 CONTACT PERSON Interceptor /grease trap 2 5.02 ,
Business name: ARS dba .LACK HOWK/RESCUE ROOTER Medical gas (value. $ i Page
Contact name: J01'CF. DENNIS - Primer — 12.51
Roof drain (commercial) 12.51
Address: PO BOX 2830 Sink/basilnvaton•
ry 25
City/State /ZIP: CLACKAMAS.OR 97015 Solar units (potable water) 62.54
Phone :15031850 -3100 Fa.: • (503) 491 -2932 - Tub /shower /shower part ` 12,51
E-mail: jovice /q'jaekbo% Leven Urinal 25.0)
— CONTRACTOR
•
Water closet 25.02
Water heater 37.52 •
Business name: ARS dba JACK HOWK/RESCUE ROOTER Water pipmg/t3art� 5629
Address: PO BOX 2830 Other. 25.02
Citv/State/ZIP: CLACKAMAS, OR 97015 ^W M Subtotal �� /
Phone: (503) 850 -3100 Fax: (503) 491 -2932 _ Minimum permit fee: $72.50
j CC:R Lic.: 127325 Plumbing Lie. no.: 34-168PB _ Plan review 1254 * ofpermit rce)
e Stare surcharge (12% of permit fee) Tiff/t0
in
Authorized signature: � •-�4 « TOTAI. PERMIT FEE w
Print name: 111/ I , / 7 ,• • 4/ D.,/,:" — w ThiA Permit application expires it a permit is not obtoined wid'n .....
after it has been accepted as complete.
"Fee Inetltudalogy not by In- unty Budding Industry Service Board,
I Anidwer lnits•PLLnJ-Permilt,ppdoe IWU1." Please FAX PERMIT COPY tit: 503-491-2932 1
AUG -28 -2010 13:32 P.002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental information
1 lee Schedule: Residential Fire. Suppression Systems:
Site Utilities Qt Fee total i Square Footage: Permit Fee:
I'..•Img drain - 1'1111 1.1 1 I nl„�iw' SI21 in
I , ...ling dram - eat.li ad,ld,.m:d 11 11 -' not to 3 nth, $ f o4 o -,
tic : • n .1 Phi n'�� I ?riot u•7'nt, �' . • ',11
7 '1 and welter S;'7.a -i
— ' - end' aditilonal 1111 3• *2 -
1t Mir yen Re • 1M 1 111 ra' ;.i
t<Iedical Gas Systems:
d•tltf .e11 1u' -c.LLI, 1diIBVV1• la,,, ' '2
\Ism, ti Ram Drain • 1 i 14x1 — n . ; Valuation: Permit Fee:
9,1 nn (i'. $5 troll on Minimum tie $ ?2.50 . _
�tnrm tc, Kam Drain -each additional 11M) $- nnl no t„ bill tlfui.r' $ 7' cu far lhr first 65 (uq1 on an S I s;
Other Ins actions or Fees or). Fee (ea) total + each adddi,tn I $ I 1p) i 0 n e
_ I ra, ;t i..,1 lime* lime* f ,a,
hbprsb.wi' pIumhng or her
and,nclud,n$ )oxn
r4l : Iw?It ono no it.. $11S.5n1irlhr first bll?�)un3rrl arid bl 5 tl.)r
oInch n,. rcC it, specifically indu u,I no iw hr cn, h additional $ I(0 (10 or fracti there'll t,.
(ntrnrntwu charge - 1 ;2 hour)
and including $ :5,0011.00
Inspeetioni outside or normal husmcss - tln.oll :hr , 6 - rill 1 tin I. a $a nn1 a no 5370.50 far the first $2.5,004i uo and $ l 45 Mr
bnbooty t nunimum Ch v 2 g� - _ hate's i 1 each additional $1114)00 ar li :lcli��n Ihcrcul, t,.
krinspection I'm - on owl /hr I and mclutlin� $50 ammo. ,lddµu?nal plan act I,: b or art *Rim; ,A 1111/hr I S99,01;1.00 , and op $7 42.0o for the Iin1$in twit) nn and $ I :r liar
rnt — l;'_` hoar, I each M1%11011;11 5 Inn 00 a■r t'rpCtmn thcre..r
Subtotal:
Commercial 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 rcvim is required for am of the (
accurately report fixtures could result in increased sewer fees*. Pleas; check all that apply.
Quantity by (Fixture) Work Performed ❑ :1n;• new vommcrcial building with Crater ern ice and
Fixture Type: Replace greater. e\ccpt systems donned and stamped h licensed
Previous Capped , Added FAistiap engineer.
DapustivFonn
Mill 1'ub Jlw,vrr ID t\ew evertor plumbing site utthtiec for an. crlmplcx strut. titre
- lucunirll'hirl�u,1 as defined in OAR918- 180 -0040.
Car Wash Each irIi ❑ ledical gas and va.;uum system. Ii,r health cave facilities.
- !)nve Thru I ❑ An) multipurpose lire sprinkler system.
Cuspidor/Water Aspirator ❑ .kris cnmple■ structure. as &tined in DAR918- 7811 - 0640.
Dishwasher - Commercial
- Dcmesti Submit 2 sets of plans with any of the above.
Drinking Fountain
Wash '�'"
lEye
�•-� Isometric or Riser Diagram.
Floor L�rnitLrslttl: IJ Isometric or riser diagram is required for new buildings
�l
that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
-Industrial _ Comments regarding fixture work:
lee Much. /ketng. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang - —
-Stall
-
Sink - Bar/Lavatory
Kradlt v - '—"
-Commercial *Note: If the fixture work under this permit results in an
S increase of sewer EDUs. a sewer permit will be issued and
Swimming Pool Filter .
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet - Toilet `
Urinal
Other Fixtures•
http:/ /li ltw.tigard•or. got': city_ halUdcpartmentsied /.lacsIPI.NlP- PermitAppldoe