Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00323
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 1S125DD06200
Jurisdiction: Tigard
Site address: 6655 SW VENTURA DR
Subdivision: WASHINGTON SQUARE ESTATES NO. 2 Lot: 70
Project: Privitera
Project Description: Replacing 60 ft. of water service. Electrical permit may be required if replacement piping affects
house grounding.
Owner: FEES
PRIVITERA, PAUL Quantity Description Date Amount
6655 SW VENTURA DR
TIGARD, OR 97223 60 If Water Service 10/07/2010 $62.54
PHONE: 503-297-4169 1 12% State Surcharge - 10/07/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 10/07/2010 $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:
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.
OCT - 06 - 2010 11:20 P.001
,,,
Plumbing Permit Application
Building Fixtures t�: - �u `�� ' n ,'• 0'�Q
volt t)hhl(F USF ONLY
C'in or Tigard
%,1, Reco.0,l
Illg v I; I.'_? ill Hall FtI +J l u_anJ r!� ') -,,; O� � f\�V to tt: n, J (D MN._ Fenno n" ` � —cx�3 )3, 1: Moth: !11. I . SO i'+X v,r.t r S Pare,,
ire u, 1 •ncmr I', mat •.
T 1 -kRD In'hc<m.tr brie qtr; 00'i a17! G \ 0% . \ r - -
V\P°\ 1 N'i ct I) 1 I r®pee Ptet'en't +
Intern 1 for
�t %%%%%% rr;arJ -or nt v �(�I r.fl �I 1 mrntal lnfi.-mnhon
I 11 PE OF WORK 0 ( FEE' SCHEDULE
L
1 Ca Nt construction ❑ C1cmt: itit I For spec/a/ information use eh ecAtisr-
flc.cnhp,m ,nt C.1 1 1.141 1
' `3f .1:IdlLll') I(Cratitt)Prc ❑ Other New 1 2-Ninal. dwehin_ ttnvltt.lci IONl R R.1 eavh omits coonccld
CATEGORY OF CONSTRUCTION I tit R r l i halt r - �„ t
M R (Z t hdth
i 1`
I- and lamil+ dtWlling ❑ (.ummcrcial'industrial
__._.._.. _...— _...... —. SFR.t3) hath �.. I aim t, -
❑ ,1r.c�«n „ huildiut; r_ &Iulri Ltmil; _
F:t_h additional halhAilchcn 1 25.11
❑ MMlastcrbuildt:r 0 othcr - —r--
rite �prinhlcr 1 <<I 11 i I Nth: 3 1
JOH Stth INFORMATION AND LOCATION Site utilities: —�
$g'' (� / C ant basin or area drain _ �— I R 7t,
Lrl+ site addrrNs: . -
Dr, Well loch line. or ItYn h Jrain I R •n
Farting drain mr� linear It i Page 2
SuIIL.Ibldg /,ipl n.. .. Projec � � / G -- —
..,, „_,,., �I ionic tallow'. .0 (1 ^•
II (. n) ,; ■trcct- 'dirct,tinn's to 10h isle. I hlanli IR ,(;
Rain drain connecI r I Ic.7(• —
i
—...—:
Stinker) sewer too. linear it.• _l .� Pane 2
S tnim %euertno linear ft.. 1 Pao
r
} Water service IttO linear fl. 0Q • - � Pugs. -`
11 - — Fi�turc or item: k.
Tax map /parcel n,,. 13at kflmv prevt nttr — I — ,31 �� 1
4
y DESCRIPTION OF' WORK' r Back% mter valve - — 12 t
5
— .. -...42 ��Rl-di Ls•4'�,/ /� i /#2al� Dishm aqua Washer tie - -
.. �C� J Diiha sher - • v c ,02
. Urinkmg Fountain sc t1,' •
,
' Effectors /sump -: ,02
U PROP ATV OWNER e. l 0 0 TENANT Expansion tank t2.51
Name: •�� fivlure /yr %cr cap 1 - 25.02
Floor drain /Fluor sinikr 25,D2
AddreV: IF r i _... _
� ?f Gurfingc disposal 25
City /Stah:'ZIP; /l / O _
I t [lose hill 25.02
7 „i ) Ice ranker I I
APPLICANT 0 CONTACT PERSON Interceptor /grease trap r 25.02
Business name: ARS dba JACK HOWK/RESCljE ROOTER Medical gas (value: $ )
Primer
Contact name: JOYCE DENNIS .
— ROOF drain (commcrciall 12.51 -
1. Address: PO BOX 28..10 Sink/basin/lavatory 25 02
Cif.' %Stute.•7IP: CJ..- CKAn1,1S, OR 97015 t Solar units (potable utter: 62
Phon Fay: 1503) 491 -293? Tub/shower/shower Pan _ 12 51
E -mail: jovicejjackhowk.com Unnal 25.02
CONTRACTOR Water closet - 25 07
Water heater 37.5
Business nine: ARS dba JACK HO\%'KIRESCUE ROOTER Water pining/OWN'
Address: PO BOX 2830 Other.
�
City /State /7TP: CI.ACKAM1 S, OR 97015 Subtotal Mara
Phone: 15031 850-3100 Fax: (5031491 -2932 — Minimum permit lee: $72.50 '
CCB Lie.: 127325 1 Plumbing Lic. no.: 34-168P0 Plan reelew (35a of permit fee)
State surcharge (129. of permit fee) IIIMIIIhr
Authorized signature: . i
n /0 TOTAL PERn1
r�li Apo, r '4 -e I V
Print naive: t t) O This permit application expire, if � !� v Pe PP 1 trermit is not ubt: WE e-,410 />FTitT:.
after It has heen accepted as complete. i
aunty Building Indastry Service Boa(d 4j 1 t n)
1',3ulldi�:>' liniw.PLN1L'- PctnutApp lu,t,.` Please FAX PERMIT COPY t4 503 - 491.2932 vv
OCT -06 -2010 11:20 P.002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental information
Fee Schedule: Residential Fire Suppression Systems:
I Site Utilities Qty. Fee (cal -total I Footage: Permit Fee:
• F�). *.tin drain - I'' I l m in 113 • n to 2 uwl $121 o :n I —
I •ungJrlm • eit h ,idJrtrnn l t t� , ,,:, 1 `vu103h1 $Ir
1 ;v,(
r ' — —
�c++Cr - 1 :1 111(1 h' 1 6+1 to 7 h int t y , -- —. —_
n' i.t jI
1 / 4 c +,cr - cueh aJdm m11 R+n t- c, l 7 2 lint ;r:.itcr I S_ ," 4 -
1 \ ,ticr'.�r‘tc, • I.l nn � � � • - - --
�� r Medical Gas Syste
11.uer' -c.n 1 -iJdnt n.l Ion, _7 _
storm & Ram !train • La inn - r , 2 t4 uion
- $1 Val un pi $ at ii(rn q Permit Fee:
n Minimum Ice $72 !"()
Sion) k Pain Dram - c 1dJur,.mai I np 3 5' s; rail 1r(1 ,. $-7'2,5116,1- — ,
1 sill thefirilbcrnairn. dyl <2 h+r —
Other inspections or Fees Qty Fee (en) Total cacti additional c.1111) 011 or lia .11 1ln:rod
Insp Ii,+n , )1 Casing plumlong .«r tor
and mcluihn� $I(1 pnn In n
$' 111 0iii non 1 /12> ilea n,) 5 144.5ti l lrrdt12 rlIA , Iii uu n nil r
+%I1ICh 111 Ice is )pecitihall■ indicated vnnn:hr md.$I .�d h r�
(minimum charge - ! '2 hour)
I arch aJJitiomui $10.00 r (ration n IhcrCr,l m
Inapectivn■ outside of m.rmal bultne:% on and inCludmtl X2 Illlrl on
r) rl
$2? Itt1l (n o.: $ � +i OOti Tai l $170 tin O le lir 52s ilia) on and S 14` for
hnurs (minimum charge 2 hour:, i
h¢tnipecunnFeo ,, r)I , rt /fir e a c ha ddi r+ pnl +`;Inn,rur ofli.rcu•r,there,.t v.
-_. r _� and including $S(l.0iin. )n
1dJn,nnal plan R view for rcv: 4p nn $4, nn I.po 411‘.1 up $712.00 for the rim w'u ) in) ;
'minimum charge -1.•2111.40)
b and $l._U f,.
- , rurh udduiunal ti11UI ltli .Ir tract Uteri ,t'
Subtotal: Al Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", please indicate work performed by fixture. Failure to Plan Review for Plumber) Installations
Plan review i5 Required for an rf the following.
accurately report fixtures could result in increased sewer fees'. Please cheek ull that appl; .
Quantit by(Fixtur "Work Performed ❑ Any nos commercial hui wi +sate, c c
Fixture Type: Itcplace r Cr let: anJ
PrevIOUS lapped Added l�,+iatine greater. except <+ik stems Je,r� and itaI1111CJ b. licensed
Baptr.itn /FOrlt
engineer.
Bail' I'ubl$hot,er ❑ �'e1% exterior plumbing site utilities tit, an; <ornplC� lurc
slruc
- .lucun cser p�w - as defined in OAR918- ?RU•UUaU,
Car ‘lash -Each Stall - ❑ Medical gas and vacuum s,■stertrs fur health care facilities.
Urn: Tlvu ❑ Any multipurpose fire sprinkler system,
Cis odor/Water Asprruh)r ❑ Az* complex structure as dclined in OAR91$ 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
DrUikinir Fountain '�
`` Wash -
Floes Dram sink Isometric or Riser Die ram
0 isometric or riser diagr is re quired for new buildings
• t° that meet the qualifications above.
Car Wash Drain -
- Garbage - Domestic
Disposal -Commercial '
-industrial Comments regarding fixture work:
lee Mach.//Relhg. Drains
Oil Separator (Gas Station) -
Rcc. Vehicle Dump Station -
Shower -Gang _ " • - - "�
- Stall
Sink -Bar/Lac atom - .
- Bradley
Commercial
*Note: lithe fixture work under this permit results in an
Swimming Pool Filter — increase of sewer EMUS, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must he paid before the
Water Extractor _ plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures- '
http : / /wet w. tigard• nr. govk ity_ hallidc partments icd/tiocs(PLMF•PetmitApraloc