Permit IL • CITY OF TIGARD ' BUILDING PERMIT
91 COMMUNITY DEVELOPMENT Permit #: PLM2009 -00157
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/19/2009
Parcel: 2S111AB03701
Jurisdiction: Tigard
Site address: 9120 SW MOUNTAIN VIEW LN
Subdivision: Lot: 0
Project: Melland
Project Description: Reverse plumbing and connect house to sewer.
Owner: FEES
MELLAND, ORVILLE E AND LOIS M Description Date Amount
9120 SW MOUNTAIN VIEW LN Sewer Service 06/19/2009 $55.00
TIGARD, OR 97224 12% State Surcharge - Plumbing 06/19/2009 $6.60
PHONE: Hourly Plumbing Rate 06/19/2009 $62.50
Hourly Plumbing 12% Surcharge 06/19/2009 $7.50
Contractor:
HOLLENBACH & HURD, INC
3430 A SW 209TH AVE
PORTLAND, OR 97007
PHONE: 503 - 591 -5987
FAX: 503 - 848 -6832
Specifics:
Type of Use: SF
Class of Work: ALT
Dwelling Units:
Stories: Height: ft
Bedrooms: Bathrooms:
Value: $0
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $131.60
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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:
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
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00157
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/19/2009
Parcel: 2S 111 AB03701
Jurisdiction: Tigard
Site address: 9120 SW MOUNTAIN VIEW LN
Subdivision: Lot: 0
Project: Melland
Project Description: Reverse plumbing and connect house to sewer.
Owner: FEES
MELLAND, ORVILLE E AND LOIS M Quantity Description Date Amount
9120 SW MOUNTAIN VIEW LN
TIGARD, OR 97224 100 If Sewer Service 06/19/2009 $55.00
PHONE: 1 12% State Surcharge - 06/19/2009 $6.60
Plumbing
1 hr Hourly Plumbing Rate 06/19/2009 $62.50
Contractor: 1 ea Hourly Plumbing 12% 06/19/2009 $7.50
Surcharge
HOLLENBACH & HURD, INC
3430 A SW 209TH AVE
PORTLAND, OR 97007
PHONE: 503 - 591 -5987
FAX: 503- 848 -6832
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $131.60
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. T IZAL Issued By: ) .Olt UCJK Y Permittee Signature: ` rl W � e I c a
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.
Plumbing Permit Application RECEIVED
Building Fixtures 1, FOR OFFICE USE ONLY
City of Tigard JUN 19 7.009 Received t y: g� ^Z01n0n9, (57
a 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Permit No. GVLJ t
° (ITY OF TIGARD Date/By:
P hone: 503.639.4171 Fax: 503.598.19 Other Permit No.a /�('j/� �'7
. T I G A R D Inspection Line: 503.639 BUILDING DIVISION Date Ready/By: See Page for �1w (
Internet: www.tigard- or.gov Notified/Method: Jr l Supplemental 2 Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: t i &Q Ap d P� I Catch basin or area drain 16.60
��
City /State /ZIP: � / t� 9 7 a, 4 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
�
/� w J Manholes 16.60
9 3 rim . I.a.+nti l a- A. s- ad. Rain drain connector 16.60
Sanitary sewer (no. linear ft.: (00) I Page 2 55.00
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
. Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
- ❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: �/j7-., C2)1-1,a) �/ � t � u,/ 4- Expansion tank 16.60
Address: Q / J O i � ( ` "j ) 4 4L� Fixture/sewer cap 16.60
City /State /ZIP: -f' fr ""--.1 "l, q y L f Floor drain/floor sink/hub 16.60
Phone: (0y) [ ( l �� iC „ .9q q Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: n „1 ,L. : - cC Water heater 16.60
Address: � '1' DTI Other: a, 2)
City /State/ZIP: Subtotal 11 ?.50
Minimum permit fee: $72.50
Phone: ( ) Fax: (5o3)648 - (OA Residential backflow minimum permit fee: $36.25
CCB Lic.: ` R cy1 Plumbing Lic. no.: 2)(4- LI 2 l Pb Plan review (25% of permit fee)
Aut
l.-1 ' ` ` State surcharge (12% of permit fee) 1 4,10
o r� , a la tgnature: t TOTAL PERMIT FEE 161. 66
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\Building\Permits'PLMF- 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 - I' 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 Medical Gas Systems:
Water Service - each additional 100' 46.40
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
. Fixture or Item Qty Fee (ea) Total additional $100.00 or fraction thereof, to and
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.
Commercial Fixture Work: • Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-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
- Bradley *Note: If the fixture work under this permit results in an
- 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:
1:\ Building \Permils\PLM- PermitApp.doc 12/27/06
Jun 19 09 02:51p HOLLENBACH AND HURD IN 503 - 848 -6832 p.1
* CITY OF TIGARD
COMMUNITY DEVELOPMENT
T T(•A F.0 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
0(060
•
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
•
Permit #: PL m 200 • OOt S7
Date Issued: lc - l q .0 q
Parcel:
Site Address: O rn ou% O' Y V L..RsA.)
Subdivision:
Lot:
Jurisdiction:1 ioNikrck
Zoning:
Project Name: t'1RQ 1 \0.,rcl.
Description: Coon,nQcA lrl6ut5.e_ -t 0 SAA.&) x M- r pt u j rrv kA r . tt
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid. please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd.. Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.7161433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
NOLAAJL 40612n fp�Q -Inds r d
)Ac1dr¢S5 ; 300 A S W 0%k' vQ.
• Phone #: Phone #: 5c't 1 - 5967
Reg #:
AN IN SIGNATURE IS REQUIRED ON THIS FORM
Signal re of Autho ized Plumber Name (printed)
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SOLD BY CASH V C.O.D EHARGE ON ACCT. MDSE. RETD. PAID OUT
QTY. DESCRIPTION PRICE AMOUNT
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RECEIVED BY
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All claims and returned goods MUST be accompanied by this bill.
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