Permit 1, CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00431
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/17/2008
PARCEL: 1 S136CA -02009
SITE ADDRESS: 10900 SW 78TH AVE ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: RONNIE
Project Description: Installing 300 ft. of storm sewer line.
•
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 300 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
JULIE MARKWELL
10900 SW 78TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 111171200E $147.40
[TAX] 12% State Surch 11/17/200E $17.69
Phone : Total $165.09
Contractor:
OWNER
• REQUIRED ITEMS AND REPORTS
Contact # : •
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow r - . adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0101. o May obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i ��
Issued B. �;� 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.
lill -
v CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00431
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/17/2008
PARCEL: 1 S 136CA -02009
SITE ADDRESS: 10900 SW 78TH AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: RONNIE
Project Description: Installing 300 ft. of storm sewer line.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 300 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JULIE MARKWELL
10900 SW 78TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/17/200E $147.40
[TAX] 12% State Surch 111171200E $17.69
Phone : Total $165.09
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow r - . adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100 o ay obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
/0
Issued B � ��:� Permittee Signature:
,Al
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.
= Permit Application
Site Utilities FOR OFFICE USE ONLY -
i' ^_ R ec'e'ive d
Cl Of Z 1 and Permit No.: i /ji A bq/
q 13125 SW Hall Blvd., Tigard, OR 97223
r r •; ; Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Nov ; l / ' Date/By: Other Permit No.: ��c S
T I G A R D Inspection Line: 503.639.4175 Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov ( %r \Q OPTh vole �Z'A Supplemental Information
5 q �tt 1
'TYPE. OF WORK 1/11111"11 n1 U 1S1ON - ... " FEE*` SCHEDULE • -
`"" 6.- e For special inforntalfon use checklist
❑ New construction ❑Demolition
Description 1 Qty. I Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
,CATEGORY OF CONSTRUCTION • , - SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
.. JOB .SITE INFORMATION AND - LOCATION. - - Site utilities
Job site address: i 01 0 O S,-.„ 91,174. -. Catch basin or area drain 16.60
City /State /ZIP: Tnc-q4._ n 1c , 2 5 43_13 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: - 1 L( Foo drain (no. linear ft.: _) ■ Page 2
n l �� Manufactured home utilities 110.00
Cross street/directions to job site: 4,4 /�� Manholes 16.60
V Rain drain connector 16.60
Sanitary sewer (no.. linear ft.: _) Page 2
Storm sewer (no. linear ft.: Page 2 P/7 it
Subdivision: 1 Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
' ' DESCRIPTION' OF WORK ' Backflow preventer Page 2
/- 111;4 Sv t_ 7 °IAA -∎;./ S l�7?..zr` -• og..0 ,. r (J-1 h't Backwater valve 16.60
S'T'���[[t S Clothes washer 16.60
��, Dishwasher ■ 16.60
- . Drinking fountain 16.60
PROPERTY OWNER h • • , - E1,- T , .
Ejectors /sump 16.60
r
Name: ._ p.....) , ,i Co d J � t e 40 „, ti Expansion tank 16.60
Address: t 9 J J std Fixture /sewer cap 16.60
City /State /ZIP: rn ErAl2_V , o/-_ 9 a3 Floor drain /floor sink/hub 16.60
' Phone: (51)7) 3L. / cl, 5 S- Fax: ( ) Garbage disposal 16.60
-:. Hose bib 16.60
. . ❑ APPLICANT ' 0, CONTACT P ERSON -
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: tt' ('Z PrC Primer 16.60
City /State /ZIP: w..j`R - Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Q .IN �� / Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 l
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.:
Plan review (25% of permit fee)
f / r State surcharge (12% of permit fee)
Authorized signatur TOTAL PERMIT FEE MN
Print name: S" -�t /2_ ,,, �� Date: i /, pi, k This permit application expires if a permit is not obtained within
(r 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\Building\Permits\PLMU- 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:
Qty.. Fee (ea) T otal
Sate�Ttilities � � Square Footage � • , 'Permit,Fee: •
Footing drain - 1s 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 •
Storm & Rain Drain - 1st 100' ( 55.00 Valuation: Permit, Fee: •
p $ 1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' ? 46.40 l�. 1-/C.) $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
y Fee'(ea)
Qt y:. Total, . additional $100.00 or fraction thereof, to and
Fi%tllre° or.Itelll' 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: �1 $50 and up $742.00 for the first $50,000.00 and $1.20 for
J , "t(/ each additional $100.00 or fraction thereof.
Commercial Fixture Work: s' ` Plan;, Review •for. Plumbing I>lastallations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. El Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type:.': ` � engineer.
' '� `` `� Replace' g
P revious_ Capped. Added . Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
-Domestic .
• Drinking Fountain '.Isometric Ri$er 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:
I:ABuilding \Permits \PLMU - PermitApp.doc 2
q Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\ Building \Permits\PLMF- PermitApp.doc 12/30/05
11 .111.1111111.11111. M.
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701. (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
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Permit #: / 73
This form is supplied to building aF . /0 71e7 56(/- ,722—�i/-�
permit offices by the Oregon Address:
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as required by ORS 701.055 (6) .'7 ���' "��
Construction Contractors Board, �� , 7-7.00
Issued by: /5'.7= Date: / /�
This copy to issuing permit office
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CITY OF TIGARD ' -
BUILDING DIVISION AO PERMIT #: PLM20O 01 31
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 /17f"'f0ftf3
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Phone: (503) 639 -4171 u i _ - • -
Inspection Requests (24 Hrs.): (503) 639 -4175 AIL _
INSPECTION WORKSHEET FOR DATE: 12/312008 TIME: 7 :00AM PAGE: 17
SITE ADDRESS: 10900 SW 78TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: RONNIE
DESCRIPTION: Installing 300 ft. of storm sewer line. '
OWNER: MARKWEI..L, JULIE PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/312008 Pour Time:
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Code # Inspection D- ion Confirm # Contact # Message C y
335 Rain drain 07873(} -01 503 -311 -5695 Y
340 I ;
Corrections /Comments /Instructions:
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Au PASS I - ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector: Date. Phone #: ( ) 718 -