Permit /15 G c-lote-d
CITY OF TIGARD PLUMBING PERMIT
a • COMMUNITY DEVELOPMENT Permit #: PLM2010 00324
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2010
Parcel: 1S134BD11300
Jurisdiction: Tigard
Site address: 10911 SW 118TH CT
Subdivision: PENN LAWN ESTATES NO. 2 Lot: 41
Project: Goodell
Project Description: Replacing 75 ft. of water service. Electrical permit may be required if replacement piping affects
house grounding. 10/15/10 added backflow for irrigation.
Owner: FEES
GOODELL, CHRISTINA M & SHAY Quantity Description Date Amount
BY LSI - NORTH RECORDING DIVISION, 5029
DUDLEY BLVD 75 If Water Service 10/08/2010 $62.54
1 12% State Surcharge - 10/08/2010 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 10/08/2010 $9.96
Plumbing
Contractor: 1 ea Backflow Preventer 10/15/2010 $31.27
JACK HOWK PLUMBING /RESCUE ROOTER 4 da 12% State Surcharge 10/15/2010 $3.75
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 $116.22
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.
O
Issued By: Permittee Signature:
i I LAC
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.
CITY OF TIGARD PLUMBING PERMIT
0 COMMUNITY DEVELOPMENT Permit #: PLM2010 00324
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2010
Parcel: 1S134BD11300
Jurisdiction: Tigard
Site address: 10911 SW 118TH CT
Subdivision: PENN LAWN ESTATES NO. 2 Lot: 41
Project: Goodell
Project Description: Replacing 75 ft. of water service. Electrical permit may be required if replacement piping affects
house grounding.
Owner: FEES
GOODELL, CHRISTINA M & SHAY Quantity Description Date Amount
BY LSI - NORTH RECORDING DIVISION, 5029
DUDLEY BLVD 75 If Water Service 10/08/2010 $62.54
PHONE: 1 12% State Surcharge - 10/08/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 10/08/2010 $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: / J /4IJPVIV 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.
OCT -14 -2010 11:55 P.001 /002
Plumbing Permit Application R e r , IVEP
Building Fixtures Foil OFrlc litir. ONLY
City of Tigard OCT 14 2010 Bashed
Dele e !� '] i d Perm Ni �M
r r J il / ' "t (j —�Q 3�- j
13125 SM Hall Blsd , Tigard, OR 97223
1 Phone: 503.630.4171 Fay: 503.598.I0t ITY OF TIGARD Dare pevye" Other Permit Np .
Intipcctlon Line: 503 630.4175 BUILDING E. a
DIVISIO" Dale Ready.'Be
r I ; .n Internet uw w.tigard.or.got i 5cc Page 2 for
Non1 Supplemental Information
. .T'X'P'lE:. OP -WtR . . . PEE* • tea`.: .
❑ New construction u Demolition For spcdalIn ormariun use checklht
Descnpiiun c On'. Ea 1'ptal
rAddition/ultcratiowreplacemenl �] Other: er: New 1- 2- Camil) dwellings 1 includes I lNl R. Fur each utility connection)
CATEGORY OP coNNtiatreItaN • • ' SFR ( I 1 bath 712,70
lir 1- and 2- family dwelling [] Commercial /industrial SFR (21 bath 437,78
❑ Accessory building 0 Multi - family SIR 13) bath Spp 31
❑ Master builder Each additional bath/kitchen 25 02
❑ Other: Fur sprinkler t sq. Il.) Page 2
J013 SITE INFORMATION AND LOCATION • Site utilities: _ _
Joh site address:
_
, Catch basin or area drain 18.76 -
Ors -well. (each line. or trench drain 18.76
City/State/ZIP: i `. I.W, 'r /' , , -
Fooling dram (no, linear ft.. 1 Page 2
Suite/bldg 'opt, no.. ) t Manufactured home utilities 50.03
Cross slrcxddircetions to job rite: .4 '' • 1. to Manholes 18,76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: —i Page 2
Stone sewer (no. linear It.: 1 Page
- Water service 1110. linear ft.: 1 Page 2
Subd Lot no.: Fixture or item:
•lax map/parcel no.; Back'tlow preventer . — j 31.27 •
•
DE Backwater valve 1 12.51
..0,k I' . . _ • Clothes washer 25,1)2 r
All ... . ._.1 % I 10-003, Dishwasher 25 02
1
t. 1- �
_ ■ A _ , _i. ! . ' A.L., Drinking fountain 25.Q2
it 'IA . ► 1, 1 1 1 ./Al .. 1-Jectorsesump 25.0'
PROPER QWNER S . 0 ' ANT . . Expansion tank 1'.5 I
Name: l t As /- 1 I Fistarelsesser cap 25.0
`/1ii _ i j Flour druin/flour sink/hub -g 112
■1 Wain /lfitgf���� Zr
Garbage disposal 25.(12
= ��ffi� ak; /I Huse bib 25
Phone: . I � C ,. T I h Fax:1 ) leg maker 12.51
•
• . . m is. ' Eit?'I<:it''APC� . . . Q tC.oNTAO'I' PERSON Interceptor /grease trap 2 5.02
Business name: ARS dba JACK HOWK/RESCIIF_ ROOTER Medical gas (value: $ ) P age 2
Contact name: JOYCE DENNIS Primer 1151
Roof drain (Commercial) 12.51
Address: PO BOX 2030
S ink/bZ>51Meyatun' 35.02
City /State/ZIP: CLACKAMAS, Olt 97015 Solar units (potable water) 62.54
Phone: (503) 850 -3100 Fax: : (503) 491 -2932 Tub /shower /shower pan 12.51
E -mail: joycela:jackhnwk.conl Urinal 25,02
. Water close 35.02
C115F1filAtulQIt : ' .
Water healer 3 7, 52
Business narne: ARS dba JACK HOWK/RESCUE ROOTER
-
Water piping/DWV 56.29
Address: PO RO\ 2830 Other: - 25.02
City /State /Z.IP: CLACKADIAS, OR 97015 Subtota �
Phone: (503) 850-3100 Fax: (503) 491 -2932 Mi nimum permit fee: 57 2.50
Add-
CCR Lie.: 127325 Plumbing Lie. no.: 34-16: PB Plan review (25 % nf pctmit fee)
Authorized signatu ql,
{ 1[ W - State surcharge (Ira of permit t .1
r TOTAL PERMIT FE I' r
Print name: w F' ` — Date: �� s P erm it application expires If a permit i, not obtained within 180 dace -
m ! i a f ire it • hsa been a ceePtcd as complete
"Fee methodology set by Tn- Count) Bmldmg Industry Sen ice Board.
1'03uildirtte■Permits'PLAII - PermitApp 10'01/0 Please FAX PERMIT COPY to: 503- 491 -2932
OCT -07 -2010 18:15 P.001
Plumbing Permit Applicatio I' j
Building Fixtures OCT 8 2010
• City of Tigard - R°witca
il =CITY OF TIGA r' q B". ( .O o� — I'rnmt N. -
I'
M l : l2! 11,tll uI.J f,?,,,1 (.,:17, 11- p ARD 1. a P pi/vale ._
Ir .rte
l'..' i•\'' 11-1 f a, b 5l 1 DIVISIO i a t y val.r i'•nnd t.. I
'�111LDING i ° I net, �.
T I G A R D i r" It P L', '• . fee Pace : I
•
Intcrht t lt'.% a ue7N •r n . I t.r,ulit t t.l.• h' -1 al 'apnicment•d tni,
I fl'Pk Of KORK I'EI*
SCHEDULE
l ❑ >:c tt �„mttittli..n ❑ Dctn,Jitir,n For spend iry -- orm rtian use tltt'eJ;litr,
-- Doc,riptu L .:4:. 1 I_,t • 1 i ,ail -- '
rig \W it tri (spit( mien( j] Other Neu I•.•ft d I ir1 I t c• I I I
J I rw i ni t V uUl,t'■ :
CATEGORY OF CONSTRUCT ION Srp 11 ■ h,t 12 711 1
' 1 1- and 2- (111111)dt∎ellina ❑i•i,mmcr'ial.jnJtt: trial SF1' I.)halh -- - l .l ';g
... Sfk, }! bath 1 ; 3
1 ❑ \ect.rNir ■ htidtlin; ❑ 'lulls - tinii ( I _
l=ash additional haih,l.itt;litn I. 2:n2 t
1 ❑ � :71 builder ❑ r Rber I [ire P I ISmt: 1
e nnkler i ,e 1 I - -- 1 —
' JOB SITE 1NFORMIATION AND LOC.\ ION X ^M^ Site utilities: - _
1 O n r � �� I (Melt I . •_r area drain I R 7r,
toh :de address' `� C i o- —Melt basin ----- - drain - -- —
—. - - -. ` � . . — _ .. _. . . . . . . . - . . .._._. 1)m■l. leach laic ur trench dram I S 7h
ci1v/State,Z1P: I) 6,11/14) , Cry ?2,7_,6
Gua drain t nu. lineal ti ) Page
huite9) /aiu nn. I Project mine: c� ` ; t - 1 E l (� —
Manufactured how ubliuc , 50 03
- (rv,,, slrei&directi t• j■h Ate. ,)(: /1 //q.•1/14 Nanliole% - - IX 7e. -
R in dram i;uitecdur I R 7r.
I I Sun nary scwcr Inn linear tt. ,, Page 2
I
- Slvmi seer ■ inn lineal A. i
I _... .. -_ ........ . ,,, -- -_ f \\'4ter service ' e Mu linear h.: l j I _ , LA I
I Suhdi,i:: — Fi stare ur
x ,n: 1 Lot nu.. � -..- it _ t �-
I
T a� maprpanal m• I Bud ili prcvcnter .z 1 7:7
DESCRIPTION OF y WORK Backwater �alte 12.51
`'7 c ^ ( .� - Y 1C L I1. ,611 iG t�� - -- D cs washer 25.112
( \ 1✓ P , Dishwasher `
02 1
Dunking fountain 25 02
1 — Ejeclor.Jsurnr _;u:
I
.3 PROPERTY OW'ER /1�� `l 1:1 TENANT E'pansion tank I2,
Name: � Lr G� Eel )� Fi.ture /Newe rc,ip. 5I _..... .... — ..._ — t).. —
Address: ` C C1 l i v(�,J 4 1 e, r71 C 1 — Floor drain /Door sinlJhuh __ 2:t.02
_ Garbage disposal 25,02
City /State/ZIP: 71 (hr) /L // t Orl 5 9 2-23 y ( Hose hih 25.02
Phone: 1 t) ') C7 •• ,Si /1p Fax: 1 ) Ice maker _ - 12.
® APPLICAN1` ❑ CON•EACI• PItR.SON Interceptor!grcase trap -- ~ 25.02
Business name: ARS dba .LACK HOWK/RESCIIE ROOTER I Medical gas (value: $ 1 Paige? 1
Contact name: JOl CE DENNIS t'nmcr 12.51
Roof drain (commercial) 12.51
Address: PO BOX 2830 -
Sink/basin/lavatory ?.,q2
C it. 'State,Z1P: CLACKANIAS. OR 97015 Solar units (potable water( 62.54
—
Phone: (503) 850 -3100 Fax:: (503) 491 -2932 Tub /shower /shover pun 12.51
' E -mail: jovec: r'jackhowk.eom Unna — 25 il!
CONTRACTOR \ \'uler ulutiet 25.02
Water heater 37.52
Business name; ARS tlba JACK HOWK/RESCLIE ROOTER ..
Water pipinE/t)\\'v 56,29
Address: PO BOX 2830 Other: 25.02
I City /State/ZIP: CLACKAMAS, OR 97015 Subtotal ..y. 1
Phone: (503) 850-3100 . Fax F (5031 491-2932 - Minimum permit fee. $72.50 W "'►/
CCD Lie.: 127325 _ Plumbing Lk. no.: 34 -168PB I plan review" 12; ° •, of permit feet
1 State surcharge (12 °° of permit fee) . 4
Authorized signature: Ayr �,� ✓' TOTAL PERMrr FEE Date: C
Print name JyjJfl C.,� r
f . t- �•, , L , mix permit application expires if a penult is not wit 80 days
� � > /� �L ja4 y C L'LI after it has been accepted ,ta complete,
jy /I per Q :_ / "tee melliudoloYS set by 'In-County Building Indust). Scrtice hoard.
J CiC"t 1'rVO _ le P *
.
lAi O'1"irs.PLNU- Penni"PPdoc Please FAX PERMIT COPY to: 503 -491 -2932
OCT -07 -2010 18:15 P.002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
fee Schedule: Residential Fire Suppr ession Systems;
Site Utilities Qt,'• fee teal Total ' Sq u a re Footage: Permit Fee: • -
14vdin dram - 1 n In jrJ n1 I 0 I' ..rNNI 5121 n,1 .. i - —� �
1 ," .hilq drann - c:0.1, ddditmnai h . V ' 52 I '....o .it t t nihi S IM' 11.,
1 : Am tl i '1111 y_l t .... J
1
\F•.ier • 1.4 11111 n ? i4 -
\c,tcr - each addnn n,d inn
,' t + a � // & qq _ ,._
As "Lrl i. L - 1.t WI . '7 11 n'_ is tL .
■l aicr \a% Kt. -atlh addthutol lure - .; i\ICdlCal Gas Systems: —
\umn S. Rain I learn - I .I liar n` c{
Valuation: Permit Fee:
>nxm A Ram Dram - each additional I1h, z , ;. SI nntrS5,41110 S1 nil Minimum rev S
`-
- $5 thil !Kip spool. oh $7! :h li liras: 1NN an d 'It ■:. on
Other Inspections or Fees QQ, Fee (ea) Tutal each additional $16( I 011 nrfraction Ihot. r u
and Includinf! Sin 11t'O till
IH <►kllnNl r 4'CxISIIpI' pluinhmel or list C lr 101 111 U1 Q.',. HP $1413 5014 the lira $Iu,INal uu and Id g { fur
t,h,lh n lit is specltienllJ ind, .'lI (I )n r N); iu each additional b Ir riu. frac:001i thercrd: In
t minimum char - 1/2 hour'
and rrlcludln . $25,non on
1n.tic.Unnb truts.ide nfnnrnial bu ine1 on (Inmr 52$ girt no ii. $ 1
1 537 ).gin for the first 525.01)0.0u and $1'45 lar
Rows (minimum L1targr - '_ hours' - _ ,peh additional $1(10 rin,u fl uunn thcrvrt. 0
kcin'pectinn Fees 91),nnlhr and includin , $50.90).00
Additional plan rc. rctr h . r nit 141 r With/. ' 1 pl' and ui $7 1: 90 tin the f i r s t I l i o n o 110 :md $1.211 Mr
(minimum ehai!_c ••• 1:2 hood _ I_ Filch add ii $1 (.1' li;Klinn (here 1.
.�tibtnral: -- .—
Commercial Fixture Work:
.i re you capping, adding or replacing fixtures? I f "y es". Plan Review for Plumbin ation
Installs
please indicate work performed by fixture. Failure to Plan review k required for and of the Allowing,
aeeurately report futures could result in increased sewer fees'r, Please check all that apply.
QuaotitZ by (Fila Work Performed ❑ . \■ new commercial building: with a atcr servile and
Fixture Type: Replutc greater. ewept 1 tent' designed and stamped by lieenied
Prr,itrnli Cit. , •d Added F.cistin_ engineer.
Ba ustn Tont
H;1(h 1'uh /Sh,nrvr El New exterior plumbing ; nubile:, fr an) cr,mpk. structure: 1
lacuc�i!lf - .. as defined (0 OA R9
Car Wish -Each Stag ❑ Akdical gas and Vacuum sy stems 114 health awe faciIirie. ;.
Dmr fhru ❑ Any multipurpose lire sprinkler system.
Cuspldorurarcr Aspirator ❑ Any complex stntcturc as defined in O 918- 7811- Ut0.1u.
Dirhutrsher - Cnmmered
- Dtmlesuc Submit 2 sets of plans with any of the above.
—
Drinking Fountain
Wash l ve Wash _ Isometric or Riser Diagram -'
Floor Drammnk ❑ Isometric or riser diagram is required for new 1=
s r q buildins
a • that meet the qualifications above.
—
Car Nash Drain
—
Garbage - Domestic
Dlspusal - Commercial - Comments regarding fixture work:
- Industrial
tee klachJRefng. Drains
011 Separator 1Ga5 Station;
Rec. Vehicle Dump SW= —
Shottcr -Citing — w —
-Stall
Sink -Bar/Lavatory
—
- Bradley
- Commercial _ - *Note: lithe fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Sttintrning Pool Filter — fees assessed for the sewer increase must be paid before the
washer - (: inches
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
http! /tt ww.tigard -or. gut• /eity_half /departments/ d /docs!PLM1,'- ItermitApadoc