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Permit • / 6 ?/ ' n CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00253 Date Issued: 09/16/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112CB05400 Jurisdiction: Tigard Site address: 15321 SW 82ND PL Subdivision: ASHFORD OAKS NO. 2 Lot: 68 Project: Lalonde Project Description: Replace 45' of water service. 9/16/09: Add residential backflow device for irrigation system. Owner: FEES LALONDE, TIMOTHY Quantity Description Date Amount 15321 SW 82ND PL TIGARD, OR 97224 45 If Water Service 09/16/2009 $55.00 1 12% State Surcharge - 09/16/2009 $8.70 PHONE: 503 - 624 - 9375 Plumbing 18 ea Minimum Fee Adjustment - 09/16/2009 $17.50 Plumbing Contractor: 1 ea ' Backflow Prevention - RES 09/16/2009 $27.55 JACK HOWK PLUMBING /RESCUE ROOTER 0 12% State Surcharge - 09/16/2009 $3.37 P.O. BOX 2830 Plumbing 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 $112.06 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: D ` V 19, el 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. 11 CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00253 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/16/2009 Parcel: 2S112CB05400 Jurisdiction: Tigard Site address: 15321 SW 82ND PL Subdivision: ASHFORD OAKS NO. 2 Lot: 68 Project: Lalonde Project Description: Replace 45 of water service. Owner: FEES LALONDE, TIMOTHY Quantity Description Date Amount 15321 SW 82ND PL 45 If Water Service 09/16/2009 $55.00 TIGARD, OR 97224 1 12% State Surcharge - 09/16/2009 $8.70 PHONE: 503 - 624 -9375 Plumbing 18 ea Minimum Fee Adjustment - 09/16/2009 $17.50 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: /ralge7j-14--- 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. 1EB -15 -2005 13:30 P.001 • • Plumbing Perm APPIicat E CENED Building Fixtures FOR OFFICE USE ONLY City of Tigard S E P 14 2009 Received , 13125 �� Date i �f : Permit No.. Pui,,2O a 9 ,. / /as n 13125 SW Hall Blvd.. Tigard. OR 97223 Plan Re%tel • Phone 503 639.4171 Fax: 5()354 OF TIGARD Dale0Y Other Permit No Inspection Line: 503 639 4175 BUILDING DIVISION - Nu TIi_;ntii Da t e Ready By thod -- J 0 SeePt e2for Internet: wNw'.tigard- or. gov nfed Me �/ Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special inform use cNeck(i,t Dtecn�tion I Qt'. J 1 Tntal� ( XAdditinn /alteration/replacement ❑ Other: New 1.2- faotlly dwellings (includes 100 A. for each utility connection) CATEGORY OF CONSTRUCTION SFR i i i bath 249,20 - il 1- and 2-family dwelling ❑ CommercialVmdustrial SFR (21 bath 350 00 ❑ Accessory building ❑Multi - Tamil} SFR (3) bath 399.01) El Master builder ❑Other, Each additional bath/kitchen 45 Fire sprinkler I sq. ft.I Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: /'� ,S e / / ^` Catch basin or area drain 16.60 — Cit)iState/ZIP: "41,4 / Dowell, leach line, or trench drain 16,60 Suite/bldg. /apt- no.: Project name: .. 44/_ ,I) -- Footing drain (no. linen ft.: —) Page 2 ` Cross street/direclions to job site: Manufactured home utilities 1 10.00 Manholes 16.60 — Rain drain connector _ 16.60 — Sanitary sewer Inv. linear It ► Pugc 2 Storm sewer (no linear it.; Page 2 Subdivision: Lot no.: Water service (no. linear R, 45 0 Page 2 Fixture or Item Tax map/parcel nu.: Absorption valve _ 16.60 �/�� DESCRIPTION OF WORK Backflow pry cater Page 2 gt d y ^ �C t/ ,(// Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 _ VPROPERTY OWNER . I • 0 TENANT Drinking fountain 16,60 Name: 11,/4 I Ejectors /sump 16.60 �� Expansion tank 16.60 Address: • �C t j ° " if Fixture /sewer cap 16.60 City/State/7,1P: r /1 0a ■ Floor drain /floor sink/hub __l 16.60 Film �; `V, ax: ( 1 Garbage disposal 16.60 ■ APPLICANT , n CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name; ARS dba JACK HOWK /Rescue Rooter Interceptor/grease trap 16.60 Contact name: JOYCE DENNIS Medical gas (value: $ ____ 1 Page 2 Address: P.O. BOX 2830 Primer - 16.60 - City/State /ZIP: CLACKAMAS, OR 97015 Roof drain (commercial) 16.60 Phone: i (35-4-- i Fax: : (503) 491 -2932 Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: JOYCE<a:JACKEOWK -COM - Urinal 16.60 Ca `a a ■ ` ` NI a Water closet 16.60 Business name: ARS d' a JACK IJOWI /Rescue Rooter Water heater 16.60 Address: Y.O. BOX 2830 Other. • City /State/LIP: CLACKAMAS, 011 97015 Subtotal $/ Minimum permit fee: $72,50 5�-- ( Phone; 6,� - DO Fax: (503) 491 -2932 Residential ba:kflow minimum permit fee: $36.25 ` t ' CCB Lie.: 127325 ✓ . P bing Lic. no.: 34-168 P Plan review (25% of permit fee) Authorized signature: / State surcharge (l2 %of permit fee) z 6 /f/ • TOTAL PERMIT.*ri Print name: 4. / L /j� IME Dote fiat/Li , This permit application expires if a permit is note .R 1 If 180 days after it has been accepted as comp ete. ' *Fee methodology set by Tri- County Building Industry Service Board. ti&iildingNermlu\PLMP -P' Please FAX BACK. :. 13 -491-293 • w FEB -15 - 2005 13:30 P.002 • ' Plumbing Permit Application - City of Tigard `. Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities — Qty. Fee (ca Total Squa Footage: Puotrn drain - I 100' — lw Permit Fee: ?� UU 0 [0 2!000 $115.00 Footing drain - each additional 100' 46 40 2.001 to 3.600 $160.00 Sewer• 1st U)n. 55.00 3.601 to 7 .20r) 52±000 Sower - each additional 100' 46.10 7.201 and *miter cut = Water SCR ice • 1st 100' i ' • . 55 00 _ !� -� A ater Sell, ice - each additional 1 04' 46.40 Medical Gas stems: — Storm d: Rain Drain - 1st 100' Sc oq Valuation: Permit Fee II 00 to $5.000 04 Minimum fce $72.50 Storm R Rain Drain - each additional 100' 46.40 $5.001.00 to $ 1 $72.50 for the first $5,000.& and $1.52 for each Fixture or Item Qty. Pee lea) Total additional $100,00 or fraction thereof, to and mcladin $10 000.0(1 Commercial Back Flow Prevention Device 46.40 S10.001.00 to 525,000,00 5148.50 for the first $ I0.00DA0 and $1 54 for Residential ilackfiow Prevention Device each additional $100.00 or fraction thereof. to (minimum +ermit fee $36,25i 27.55 and includin_ 525.000,00. Ram Drain. single family dwelling 65,25 £25,001.00 to $50000.00 $379.50 tbr the first $25.000.00 and SI.45 ti)r 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 f�Y 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 11: t►,v (Firiur Work Performed greater. except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Elledag ❑ New exterior plumbing site utilities for any complex structure Baptistry /Fort( as defined in OAR9 18-780-0040. Beth - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. !acu, JWhtrlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complet structure as defined in OAR918- 780 0040. -Drive Thru Cuspidor/Water Aspir Submit 2 sets of plans with any of the above. Dishwasher - Commercial P Y - Domestic Drinking Fountain _ Isometric or Riser Diagram Eye Wash Q Isometric or riser diagram is required for new buildings Floor Drain/sink - 2"" that meet the qualifications above - - 3° ._ -4 ., Cur Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial g • - industrial — Ice Mach/Reno. Drains - Oil Separator (Gas Station) ' Rec. Vehicle Gum. Station — Shower -Gang - -Stall Sink -13m/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial r 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 � g p Water Extractor Water Closet - Toilet Urinal Other Fixtures: i lB +>;rding,PrrmiiglrLm.Permanmeoc 124_7/06 FEB -17 -2005 15:07 P.001 • PlumbinLPermit Application i Building Fixtures �� fOR OFF ICE USE ONLY City of Tigard Received $1�' H, l igl 7223 Date B n 1 4 1 - LT I'hi +nc. 3125 :b3.b34 all Bl d 171 d. fay 5-1133978221L.16 2p09 D '1'1 • 4 :1 1 1 V, f Inspection Line: 50.1.639.1175 c C` 3 ' / I �� . T I C A fc U J Date eddy': Internet; WNW. tigard -or goy , ' I * 1 _ Ng +u�a _ � , �[tiliiit<,rrrlri7��+.t� TYPE OF 1i► r ' l FEE" SCHEDULE DI cc+mtruClfun n'1 1g molitinn I Far specter! information usecheck/ist , Descr jltion use checklist Fa Total lddil ion/al tend ion /replacement ❑ Other: New I- 2-family dwellings (includes Inn I). for each Ultlit) cunnecliivu Ti' CATEGORY OF CONSTRUCTION SFR (I i bath 240 t) _ -nod 2- family dwelling ❑ Commercial /industrial L SFR (21 bath 351).((II El Accessory building ❑ Multi - famil) SFR 131 Hath 11221 _ ❑ Master builder ❑ Other "' •�- Each additional bath/kitchen 45 nn - Fire sprinkler ( sq. ft. Page 2 JOB SITE INFORMATION AND LOCATION Site i utilities ' Catch basin or area drain 14.60 Cit)lState!7.IP: /AM Ar Drywv;ll. leach line, or trench drain 1 6.60 • Suite/bldg./apt. no.: Project name: .... Footing dram Inn. linear f)^: I Page — — Cm.s'.trcet /dircc bons to job site: Manufactured home utilities 110.00 Manholes 16.60 r .. Rain drain connector 10,60 1 Sanitary sewer No. linear It.: I Page 2`~- I Storm sewer (no. linear ft.: _ I Page 2 $ubditi ision, I. no.: Water service (no linear It : I Page 2 Tai mltp /p(Incl no.: Fixture or item Absorption valve 16.60 —.___,_ /r y DESCRIPTION OFD WORK Backflow presenter En Pa gc 2 ,. "r� ~' " �/� * Backwater valve 16.60 G� (9 1/4 `" __ Clothes washer 16.60 —,— Dishwasher 16.60 il PROPERTY OWNER El. TENANT Drinking fountain _ I6.ti0 r', j p -- Ejcetorslsump 10.60 Name: /%rL J / 'C./ i Expansion tank 16.60 Address: A ,F rolAi , Fixture /sewer ca — L _ EnWw , Floor drain/floor 16.60 City/State/ZIP: /�/ �� Nfloorsink /hub 16 60 - Phone: I /� fi ) Garbage di: , s' _ - 16.60 Hose bib 1 � . ` • ��'^ ;APPLICANT D CONTACT PERSON � .__-■,a Ice ma II 16.60 MI Business name: ARS dba JACK HOWK/RF.SC[fE ROOTER Interceptor/grease trap 16.60 Contact name: JOYCE DENNIS Medical gas (value: $ ) IMIIIIIII - - Address: P.O. BOX 2830 Primer '- 111119M City /State/ZIP: CLACKAMAS, OR 97015 Roof drain (commercial) Phone: (503) 850 -3100 ['ax:: (5031 491-2932 Sink /basiMavaton 16.60 -- Tub /shower /shower pan 16.60 E -mail: JOYCEaDJACKE[OWK.COM Mina/ 16.60 • CONTRACTOR Water closet • --- 16.60 Business name: ARS dba JACK HOWK/RESCTJE ROOTER Water heater 16.60 - Address: P.O. BOX 2830 Other: NMI City /State /ZIP: C :LACKAMAS, OR 97015 _ Suttrolal J Mt ""' - Minimum permit fcc: $72.50 Phone: (503) 850 -3100 Fax: (503) 491 -2932 Residential backflow minimum permit ice! $36.25 CCB Lie.: 127325 Plumbing Lic. no.: 34-168P13 Plan review (25 %ofpermit fee) Authorized signature: State surcharge (12% of permit fee) r _ TOTAL PER ml '� Print name: JOYCE DENNIS _ ," This perm application expires if a permit is nut + bt; : i • '� /� /� 180 davx after it has been accepted as co kit. 7 // d-t*rethlfe n nun • i in dusty Service Board. i 1auJdineenninIPLMF .Perm;lA0p6oa 12127106 440 1616T(IOroJ(aj51M'EB) �'�