Permit CITY OF TIGARD PLUMBING PERMIT
ii
111 11 2 COMMUNITY DEVELOPMENT Permit #: PLM2010 00378
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/22/2010
Parcel: 2S111AD03900
Jurisdiction: Tigard
Site address: 14595 SW 89TH AVE
Project: Webber Subdivision: PINEBROOK TERRACE Lot: 36
Project Description: Replacing 80 ft. of sanitary sewer.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: WEBBER PROPERTIES LLC
P.O. BOX 2830 12155 SW WILDWOOD ST
CLACKAMAS, OR 97015 PORTLAND, OR 97224
PHONE: 503 - 684 -5522
HONE: 503 - 235 -8784
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
80 If Sewer Service 11/22/2010 $62.54
Specifics: 1 12% State Surcharge - 11/22/2010 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 11/22/2010 $9.96
Plumbing
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
NOV-19-2010 10:08 P.001
Plumbing Permit Application "q
Building Fixtures
,,V
.. _ . . . . .
. .
,. ,.. ..., ,.
c\ ‘t , ,,..,... - — ... . • '
. . F OR ovErct usE; (*IA
. • • City of Tigard ks,,‘ \I r izx r , 3 c.....1 . 1 lei is
•
! ' 44111)010-0 037 g
. . q l
1 r., ' ' , y.s. H.,11 [(I d I t(sild. i .1 Q7222. ,•-
11 11 ‘
o PIP :
In r
“
VII 1
, .. . ph 1.a „,h; ::,(1 ,,:;..14 f 71 N .'” ; r .j' ‘ . 1 '''' Ov .0:1Val, .. rYWC e.
- - •t-',.(1,0 1 I rv. , 5 1.,: 11 P
,
_:A
RD a x\■\CID : 'ilt. Pcad, I1, i 1 '1 . ._ 55 Sc4: No 2,
Interne( u q t inrd•or ,:, v0.9 i - - Supplemont.i inriirm,,,,
1 N PE OE WORK' FEE* SCHEDULE
0 No■ con El strumon 1 Derri.,liti,(1 For cpeCial iqurniertion in,' cho..4liq
- • Dmriptif ■I1 I L)l■ _ i 177 - —
—
X .. .Aaldiiion'all‘...ralom•Nril.nivni ± 0 ()ILL,.• .0, t, 2-raimi. dv. din. iincluilc, I 00 11 I t•di,li 111110 I./ qknvytirm 1
CATEGORY OF CONSTRUCTION 1 SFR r I hall+ 1 ! LI 7 11
,
1 _and _-,amil <, ..■don!; 0 t.ornmercia!`induNtrial ')FR (211101h l:i 7 7k .._ -- •
- ' c■I:R ( bath : —
CJ \oxstFor:. huildirr2 0 Nlulu. 1 a111k - -
_ _.. • Lich additional bath/kitchen 1 2,5 02
III Nlaq.et• Imildix
0 011ior Fi
----....---
re sprinklur i —,(! '--
I
•B O SITE INFORMATION AND LOCATION Site utilitiek::
1 lob ik 0 ,1,.1resi 5W7:1*--A7Z- Catch basin or area dram
_____
, —I _ .
13.7h
_____ . 1.)11.1v,711. leach line. or 'Tench ,,min Ix "Ir. 1
‘..'it.ISMIC/7.1P. 77 " 4 7 2034
1,lin4 drain (no linear
_
Ibldziapt. n4.,.. Protect name; (4/ • ,,
N lanu hawed home tad ttic,1 5 03
c. rft::::. strco,:dirdii Iv lo i iie. .fie-eP 71zE Ntanh,les -- _...... • 1 .. _
...
Rain dram . connee(1.r .._...._. 11.7r;
• - -. ___...... ._
.),tnitttry svwcr (no limar ft c"
Pat:e '
- St.= sewa (no, I liri _ =_ A,, ' • :4 ,:;f42 ,.. ). ._ . .
,"
..-. Ivater sc IV 10.: I nu liar It.:
L. Lot 1 m..: Fixture or item:________ .
.,
i tiackilow revenicr. 1 1 '7
1
1 tl.% MaP/parvel n-. .
_ _ ., -
----
DESCRIPTION OF wonK 1 i'. Back,,atr valve 12.5 l
.... 1
-- — • t,:lothc-s IA aslicr 2 , .1. .. —
p • ." ' •
Dishmushcr :: J.
2 4 )::
,, jiir io e: A g 4 . 71" . Alli , 0 07 4#,
Drinking fountain
-
Eiectorsisump - -- - •
• --1
1
4 PROPERTY OVIiNER 0 'I" ENANT Expansion tank 12.51
__
Nante: 7 /7.. ' 7- 7 kiO40 ....a; ......__
Fixture/sewer Lap k 25.62
2 ,
41e. Floor drain/floor .41/huh
, k(Airey;: L'emzov 5 a 41/1. ,_.
.._.,. ilarbagc disposal
City/Stai&Z IP: "rt. 6,C_.-' _97,,,..7,
H„se,,,b _ .. _
'ho;- _, 0A;p7 ) 1i:4:maker 12.51 _..
- -. • 1 ,.
9(APPLICAn 0 CONTACT PERSON intmcptorigros,.. trap 25,02
. . — gas
Business name: ARS dila JACK I40WK/RESCUE ROOTER Nledical i value. S Page 2
Prirncr 12,51
Contact name! JOYCE DENN'IS • - _
_._ Roof drain (commerciall 12.5)
I Address: PO 130X 2830
[ - Sinkfbasin/lavator■
._._, 25.0'
Cir./State/ZIP! CLACKAMAS, OR 97015 Solar units (potable watcr) 62,54
._.. - _
Phone; 15031850 Fav ! (503)491 Tub/shower/shower pan 12.1
-
Urinal 25.02
E-mail; joyceilduckhuwk.e0m — .,— .,,..- • -.
' --- Water closet 25.02
CONTRACTOR . . .
- , — - -- \Kam heater 37.52
Rosiness name: ,ARS dba JACK ROWK/RESCUE ROOTER __
Winer pipirpz/1DWV 56.29
Address: PO BOX 2830 Other /5.01
Citv/State/ZIP: CLACKANIAS, OR 97015 Subtotal .
...._ ,. 49 A t0
1'11°m:1503) 850 Fax (503) 491 Nlufnual permit f: $72 50 ,,
CCB Lik:.; 127325 I'l Plan re% Inv (25 Or permit fCC) ing Lic. no.: 34
State surcharge (12!D of permit fee) lipiji
- —
Authorized signature:
TOTAL PERM! mam ma
(name: ( Dabirt1/2a4 ,ht5permit applicntion expires if a permit is not obtai cd win .1 (,) .: .
1___ nftcr it has been accepted as COlik pie
• rtlethiodviU • set ' i'-COl1111;. Building Ind,,,,tr. Semcc Bo
1 \B I A SIJ-Perrnii.App.doc I Ow LAI 131.-.... 17 A `41 Dr EP MIT' CI tilt z■ (11-1191 -2912
NOV -19 -2010 10:10 P.002
Plumbing Permit Application - Cite of Tigard
Page 2 - Supplemental information
Fee Schedule: Residential Fire Suppression Svsteni.s:
I
� Site Utilities Qty', ' Fee lea) rntal --
I , „ , - I 1 Ir,' Square Footage: I Permit Fee:
r n d t n
;ri(i + t +2 nr'tli 5111 00 I
I" X 2∎Jrarn _ach.111rwu - , __ .Ipur,.,r,nl' _ ll n v + +'a
'hl Anil ',rc I ; i t
,,.... .jil. 14?' -
ssc • catch •rdditinrEIl Inn 17 ;, —
' A,1lir ( +kr,l),. • 14 11H, 6 ;c1
,\ , IrGr .�r ..,�h irtn - , ;, Medical Gas Systems:
‘t & Baru C - ! ,t 1')n I ,, ; J Valuation: Permit Fee:
$ I 01, po 55100 n Minimum Ice S: . _ . .0 ,
'storm & Ram Dram -cacti addltninal Irrr) i7 5:: ••
n11 ,� , .
D' l 1)ui,rnlni, 1,7- ?r 11 i?rlllr firil ' nti 01/6 On an d \1 5,ri
Other inspections or Fees Qty, Fee (ea) Total cachaddnnn , „ r rradii,n,h uu ,1 p.
n • . ecn• at <,f r r: l r and m(lodiT, C (,l l (la) HI.
I
l 11 plUnlhrn� r rill — 11r ttll t rte lr, \ i i)rill i i tiff r, the flr\t mono l)1 '44 , ; I
which n• Ice r; (peiili+,alh Indic:Ned vrlun,hr bl l)i lot 1 In.l XI. a f',.1'
(Minimum 4h(lfg_I - I:,, hr
each additional 61ni , :q . Ii ;I41u n Illrre)I R
and inClltllirt” $'- S.111)0 ( )I ) Inspections iwhtdr of n ;tl l +Ugni•, ; . — 9 - .."
1,2; „, - � 1101 i,ll to 'h50,01411111 bJ7 i(t Ii 1311 Orst $25,0 oh and $I. I lnr .,
h atr5 InnnunUn :hdr_c - ? 1 1 , q,r5)
1Zcmipicnon Fees 9+1 rin /l,r l i
u :ICh add ru.,rl,tl alern onin'iiac,lnm fhurd,t_ pi
• and including $;1) Ou+ 00 1
\ddlGr ?nal plan r� vt „ 1; .1- ri, a ) ).) 1 1 : . uu r o'hr 1•.'•h LIU 1 00 and of I � 111 tor the rr,15511 (041 nr,, $1 2rl -
I. •r
(minimum chars - 1,2 hour) -- _ Rauh ldlldirnal'61OO.on l,r Irautli)11 therc,,l.
N titrbrntal: . ,t J
Commercial Fixture Work:
Are you capping, adding or replacing fivtures If •'vec”, Plan Review for Plumbing InstallA ion
please indicate work performed by fixture. Failure to
Plan review is required for any of the following.
accurate1 report fi t could result in increased sewer fees'. Please sheik all that apply,
aanti b Fixture) Work Performed ❑ .ail\ new commercial huildin,r with water i1'( c 2 and
fixture lype: Replace greater. c' cepr. ; designed and ctalnper.! h) I ircn -, d
t'revioui Ca, ed Added Vesting
Lilp(ISln(Pont en�incer.
Bath - 1ul ?'Slio%,.er ❑ l' \1 lxterlC +r pilllll�,ln Sile 11111101' ;: r1 cilrYlplei sh u;0irc:
-
lacuzzu�' hir[I ool as derided in OAR 780 -OO40.
Car \k; ash -f. aci, .stall - ❑ hlcdieal gay and xa.1uurn systems fin health care faci lilic-.
-Drive Thn, ❑ Any multipurpose tiro sprinkler y
Cosp,dordWuter Aspirator _ [1] An:: complex. strlrcl.ur. as defined in (IMO! 8-7S0-00.141,
Dritwasher - Cortlmercill
Domestic Submit Z Sets of plans with any of the Above.
Dnnkine 1rOt111tatrl
E" u as'' Isometric or Riser Dia ram
Floor Dr11n1 inh 2- -- Isometric or r iser diagr is required roe new buildiruzs
that meet the qualifications above.
Car Wash Drain
Outage. - Domestic
Disposal -C OmMerCial
- Industrial Comments regarding fixture work:
Ice h1ach. /Rtfng. Drains
Oil Separator (G Station) �' _
as
Rec. Vehicle Dump Station -" -- _
Shower -Gang -
-Stall �+
Sink - Brir /Luvator) __ -
- 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
Salrrin,lr,t! POO Filter
Washer Clothes I _ fees assessed for the sewer increase must be paid before the
Water Extractor
plumbing perntl[can beISSlle(I.
water (lose[ - 10l let _
Urinal
Other Fixtures:
http:// www. tigard- or.gu /city_halGdrpartmcnts /cd /(toes-. /PLM - PermitnpPdo4