Permit CITY OF TIGARD PLUMBING PERMIT
.71
• COMMUNITY DEVELOPMENT Permit #: PLM2010 00332
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2010
Parcel: 1 S125DC00500
Jurisdiction: Tigard
Site address: 9655 SW 74TH AVE
Subdivision: BOULEVARD HEIGHTS Lot: 27
Project: Jeffs
Project Description: Replacing 60 ft. of water service. Electrical permit may be required if replacement piping affects
house grounding.
Owner: FEES
JEFFS, JERRY L AND PAUL I Quantity Description Date Amount
9655 SW 74TH
TIGARD, OR 97223 60 If Water Service 10/14/2010 $62.54
PHONE: 1 12% State Surcharge - 10/14/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 10/14/2010 $9.96
Contractor: Plumbing
BEAVERTON PLUMBING INC
13980 SW TV HWY
BEAVERTON, OR 97005
PHONE: 503 -643 -7619
FAX: 503 -643 -7620
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 0 NC by calling 503.246.6699 or 1.800.332.2344.
Issued By Permittee Signature:
.0/41P
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 13 2010 1:O1PM BEAVERTON PLUMBING INC. 5036437620 page 2
•
Plumbing Permit Application
Building Fixtures CY® 1 i, i< l, l 1 i( 1 1
10
1 SW of H� B l v d ., Tigard, OR 97223 C • ` , r i r .1 1
Phone: 503.639.4171 Fax 503.598.196 ® See Page 2 -C\( O Review OmerPmmr<No.: •
1 1 , 1
Inspection Luce: 503.639.4175 0 . - �` \ \`S Date R Avis: lbr
Internet www.ngard-or.gov 0 Notified/Method:
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❑ New construction
❑ tion spend Wormed= use checklist
® Addition/alteration/replacement ❑Other- D 1 Qty. I Ea. 1 Total
New 1- 2- family dwellings (includes 100 0. for each utility connection)
i!..4,, ' ter �,• T. T c ' y_ 7 '- Y z , !� , 0/i^ ( )
4 O. 1.' , t 4 h 1 , '�;'^ .7 { ,.•r k3 i { SFR l bath 312.70
. f 3•':' l ... n�- rlif,, s.. flv_. c.. ...,:i,'J.,.3bLi,.Yx'Y3.y.1.s, r..�w. ._t. ry _L. ,.... {t��e:1x..,:,.,. ri._ •.��..7;A.yh;zz: t
® 1- and 2- family dwelling ❑ Commerc al/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
l ,, s 7 Ls :r y , 1 ❑Other kc 'S l Fire sprinkler ( sq. 0.) Page 2
£ r �:et. ,. ... ,;x:;,' ` ,::wirer. 1.4 : .C41..o...•r�a:.i 4teztiita t7,: a i v1,clib its. 4...e. : . .4 1 'L y : ' 3ilE nodes:
kb site address: 9655 SW 74 AVE Catch basin or area drain 18.76
City/State/ZIP: TIGARD, OREGON 97223 Dryvvell, leach lira, or trench drain 18.76
Footing drain (no. linear R.: 1 Page 2
Suite/bldg./apt. no.: I Project name: PAUL & JERRY JEFF'S Manufactured snore utilities
50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft: _) Page 2
Storm sewer (no. linear ft.: _J Page 2
Water service (no. linear R: ¢I) 1 Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: BaCl flow prevertter 31.27
2 .L(`o a; {�41� .: s3: . . V 4 , r, i y4 it , .r :., Backwater valve 12.51
' ''i .- ksRc; ..rl.. t. :t....c..:;:......._._._ :n.
..shell.:,. t t r 7 kilt 4.t;,2,1 '•4
REPLACE WATER SERVICE Cloth washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/amp 25.02
k . i:.0/ . ub tLA'., .nr,..• ..z..k'...n:,...,- ,._. - -:ter laailU.I 3 ll "K r f „�_ : �$., y .�yii ;r::c ...A: i!C i�,�t 8R41dI tank 12.51
Name: PAUL & JERRY JEFFS Fixture/Sewer cap 25
Address: 9655 SW 74 AVE Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /StateJZIP: TIGARD, OREGON 97223
Hose bib 25.02
Phone: (503)224.9186 Fax ( ) Ice maker 12.51
tin .: t 0/ ` 1 l /grease trap 25.02
�'r. Me,1,Lr -1:.i _ :p ic.. .,... _... c :1-`.n.._: y r , .... _ ` r,,. 7 . Ate.!•. :..3, LzL..
Business name: BEAVERTON PLUMBING, INC Medical as (value: $ ) Page 2
Contact name: JOE RANDALL 12.51
Roof drain (commercial) 12.51
Address:13980 SW TIJALATIN VALLEY HWY Sobory 25.02
City/State/ZIP: BEAVERTON, OR 97005 Solar units (potable water) 62.54
Pima (503) 643.7619 I Fax: : (503) 64J.7620 Tub/shower/shower pan 12.51
E-mail: Smegbeavertonplamb1aa coat Urinal 25.02
«v r
.i'�: zz T y5S RtQ"'.''; -` 74,----1.'71-:14:',,z.;--7---,.: �.,;. >a%,,,t - `S : .. ,0, �", ,,, �syty yti!;'� Water closet 25.02
-`A t 1.,4 - .l:..y?�1kt.:t..44: e+l. £i.'k `- , :,_.:, ..'..4., . 6;i�`al i ` ` t • ' �' iiket::L.1 2
Water heater 37.52
Business Warne: Beaverton Plumbing, Inc piping/DWV Water t i 56.29
Address: 13980 SW Tualatin Valley Hwy Other: 25.02
City /State/ZIP: Beaverton, Oregon 97005 _ Subtotal 62.54
Phone: (503) 643.7619 Fax: (503) 643.7620 Minimum permit fee: $72.50 72.50
CCB Lie.: 12889 Plumbing Lie. MO.: 34-4PB Ply Mery (25% of permit lee)
Authorized signature: In �
State (12% of permit fee) 8.70
TOTAL PERMIT FEE 81.20
Print name: Susan Dean I bate: 10/13/2010 This Permit application expires K a permit to not obtained within 180 days
after
i *Fee methodology set Tri- County �
I
tv ? Service Board.
1 : dluilCmgWamiu)PlMtl n;tApp.doc 10/01/19 I 44O.4616'010/02/COM!w
Oct 13 2010 1:O1PM BEAVERTON PLUMBING INC. 5036437620 page 3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ' ' ression S ms:
,. ... st �, ` J Tt' t 7 ,F ;M
� .if 4 „k ,$f.. . 3.,. +. &` l Y � ''i L 2!~15 li :' L;.�... $1
.._N..._..,. .lz... y' a. . �
Footing drain -1 100' 50.03 0 to 2 HO 21.90
Footing drain - each additional 100' 37.52 2 001 to 3 600 $169,69
Sewer - 1st 100' 62.54 3 601 to 7 l o $233,20
Sower - each additional 100' 37.52 7 Al and er $327.54
Water Service - 1st 100' 60 62.54 Medical Gas S tams
Water Service - each additional 100' 37.52 e ,
Storm & Rain Drain -1st 100' 62.54 $1.00to 55 000.
Storm & Rain Drain each additional 100' 37.52 $5,001.00 to $10.000.00 S72.50 for the first $5,000.00 and $1.52 for
+ rgV,Ch.. -" .art''" 17 S�i `4 �I.
red io `l
S, i sr, tea' each a itional$100.00 orfraaction thereof, to
_.... .
inspection of existing plumbing or for and mchtdin _ 510 rat $1 00.
$10,001.00 to $25,000.00 $14830 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof; to
(minimum charge - 1/2 hour)
Inspections outside of flannel business 90.00/hr 5 .50 for _ the fi 000.00.
hays (minimum charge -2 hours) 525,001.00 to 550,000.00 $379.50 for rho first$,25,000.00 and $1,45 for
each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and includin _ $50 000.00.
Additional plan review for revisions 90.00/hr 550, 001.00 and up 5742.00 for the first $50,000.00 and $1.20 for
(minimum charge -1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If ' es ", ?4.11-AL:' � Y i
please indicate work performed by fixture. Failur , to p review is required for any of the following
accurate re . ' rt fixtures could result in increased sewer fees *. Please check all that apply.
❑ Any new commercial building with water service 2" and
l;htisro �3'Pe' t },: r3 , �, , , � 1 L r � +.� . greater. except systems designed and stamped licensed
engineer.
Baptistry/Font 1 ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in 0AR918 -750 -0040.
Car Wash
-Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
-Drive Stall
El Any multipurpose tire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher -Commercial
- Domestic Submit a sets of pleas with any of the above.
Drinking Fountain
Eve Wash 3 +a .t , „ r
Floor Drain/sink - 2" • Isometric or riser diagram is required for new buildings
a.. that meet the ' ualifications above.
Car Wash Drain
Garbage - Domestic
Disposal -Commercial
- Industrial Comments regarding fixture work:
lee MachJRefria. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
water Extractor plumbing permit can be issued.
Water Closet - Toilet 20000
Urinal
Other Fixtures:
http: / /www.tigand- or.gov/ city halUdepartmentslcd /docs/PL/VF- PermitAptdoc