Permit n CITY OF TIGARD PLUMBING PERMIT
111
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00026
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/21/2011
Parcel: 2S102CB00900
Jurisdiction: Tigard
Site address: 13070 SW GRANT AVE
Project: GARGER Subdivision: Lot: 0
Project Description: Replacing 40 ft. of water service. Electrical permit may be required if replacement piping affects house grounding.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: GARGER, JERRY E
P.O. BOX 2830 13070 SW GRANT AVE
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 235 -8784 PHONE.
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
40 If Water Service 01/21/2011 $62.54
Specifics: 1 12% State Surcharge - 01/21/2011 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 01/21/2011 $9.96
Type of Use: SF 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 OUN by calling 503.232.1987 or 1.800.332.2344.
Issued By: / •ermittee 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.
JAN 21 2011 (FRI) 13: RR5 /JeckHouk /RescueRooter (FRX)503 491 2932 P.001 /003
PIumb Pe A licatian
Building
®. � FOR OFFICE USE ONLY
City of Tigard A . r, ? Received �-,t
y opt, 4, t. ,�\ Date/BV: I ri 1 I 1` PermitNo,: Lu #1 C�.
IN
13125 SW Hall Blvd_, Tigard, OR 972p ,, r+`
A . Phone: 503.639.4171 Fax: 503. 9fl >t9(s0 y `�0 Plan Review Other Kermit No,;
Inspection Line: 503.639.4175 ' Dnre
TIGARD -Pate Ready/By: ® See race 2 far
Internet: www tigurd- or,gov A�\\ • Su +
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❑ New construction For Special information use checklist
` Description I Qty. J Ea. I Total
ZAddttton /alteration /repinccment ❑ Other: c5 New 1- 2- family dwellings (includes 100 it for each utility connection)
1 - and 2 - % �,,� �G t �� u r " , ,, (mo w q 1 , I .. , ' , ' �� 1, 1, / / ,, , , 1 , l ( r l y � , •, SFR (1) bath 312.70
tiHtd"- ip r S • r. u 17:'' 1, ici i7 2L�S. � t , I , b � "1 .hL U u AC1.A 51, �r 1 1 ' 5 ��1 rU (fri� 1rrWi _�
II family dwelling ❑ Commercial /industrial SFR (2) bath
❑ Accessory building 0 Multi - family SFR (3) bath 500.32
Pa e 2
❑ Master builder Each additional bath/kitchen 25.02
. r � .) g
mi� Other- Fire sprinkler ( sq. tt
{{�� rr
� ItIS1; � a 1"',. �E ° ' 1 1 �� E' ttl,„,,,, „( '1x Url' si utilities:
Job site address: Aiwar I ��` r r Catch basin or area drain 18.76
Dtyweil, leach line, or trench drain NMI
City /State/ZIP: Dv- f Imo)
F oot in g dra ( no, linear ft. :._ ) Page 2
Suitc/bldg. /apt. no.: Project name: / 'i O" Manufactured home 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.: .__) Page 2
Water service (no. linear ft.: * .4 46' Page 2 1r 'fir
Subdivision: Lot no.: '��~
Fixture or item:
Tax map /parcel no.: 8ackflow preventer 31.27
,. , ,
t n „' ai'' 11 �'i ., )// 1 a,�der� 5 a �' ra i �luly�� 1' l VPI `/ t 1. Backwater valve 12.5]
d r / ttal ' Ili')�fiF' crtlxc a .m"dt' atiti �tatllelkiitc i' Ntlakr''�iNst1l?,,lu �� r 't' CloWcs washer MU
�' .Fr i1L`� _�" .� 25.02
Dishwasher 25,02
r+..i. Drinking fountain 25.02
Ejectors/sump M 2 .oz rnarryN tG`t,Mi I 1' ��r' a l r.i'4 �i I Y %C ¢' 't* I l`a. F U r +_' r 12.51 =
x :Ir' pnh� T 1. ( y ' u tf�t rs` Lrrl Iii r 1i E ungi n Tank t. . �t��,� �lli� ����I��.�.�����>�,��.'°��, A�v����?� ;.1� ^�?i p o tat
EMI r r Fixture/sewer cap M 25.02
r J � Floor drain /floor sink /hub 25.02
Address: ,940 ' I� J "Pr _
Garbage disposal 25.02
Ciiyl5i31e/ZIP' �� 1° ' .�
" - Hose bib 25.02 MN
Phone: ( •
�; �aS p a'4 y Ice maker NM 12,51 MEM
114 da,1 1 iv,.:�., sl i 44111 li {`i 11 ,141.'4 i� ' %i% % '''d en ., r ai � g u, r l r ±th 'i Interceptor /grease trap 25 -02
Business name: ARS dba JACK IHOWK/ItESCUE ROOTER Medical gas (value: $ ) Page 2
- Contact name: JOYCE DENNIS Primer 12.51
Ruo£ drain (commercial) 12.51
Address: P.O. BOX 2830
Sink/basin/lavatory 25 02
City /State/ZTP: CLACKAMAS, OR 97015. Solar units (potable water) 62.54
Phone: (503) 8503100 Fax: : (503) 491 -2932 Tub /shower /shower pan
E-mail: JDENNIS@ARS,COM
Urinal �MI 25.02
t� fi P tt t lti r t ii 11,4 11 ,7!1 r l M 371" / 1 h�^UI / 1 1 / k' v 1 i t i, 111 R Wa1eY Ceale1USCt 25.02
,r i 1 1(� 2 fi t/ l tali r�� � � dtAik ` x /11 G � Rtil? at �� f � Water f I,�
37 -52
Business name: ARS dba JACK IIOWK/RESCUE ROOTER Water piping/DWV 56.29
Address: Y.O. BOX 2830 Other: 25.02
City /Stutc/ZIP: CLACKAMAS, OR 97015 Subtotal gr,
Phone: (503) 850 -3100 Fax: (503) 491 -2932 Minimum permit fee: $72.50 ►
CCB Lie.: 127325 Plumbing Lie, no.: 34 -168PB
_ Plan review (25% of permit fee)
State surcharge (12% of permit f A i ,
Authorized signature: +rJ 0,
TOTAL. PERMIT F J ' J4 )
Print name: JOYCE DENNIS Date) 1 This permit appileution expires ifs permit ty not obtnlnc w . .
after it has been accepted .is cnmpletc,
r t "Fee meth. ..logy set by • rri- County Building Iitdg:ary Service Board, 1
I 1IIudding1Permttx U- 1'cnnliapp,d I O N I/O� 4aMi(16T(10 /0 OM / `-
JR11- 21- 2011(FRI) 13;35 ARS /JackHouk /RescueRooter (FAX)503 491 2932 P. 002 /003
Pl_umbina Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: ggg t {t ] Residential Fire S p tl J u � 1 ress S } stems t( �(}] {{
�MYf ( i Il i1 t�(� k�lil9�i ,� { Id �A � 7i1 ': w iE ;W t1 Y yr t A, V A 4 N .. . 04 '1 t I Y VY is l ..,I r + yAti} � AM K.�r{(Y. WY ,'. + 1;MG Y � {�'�'
Footing drain - 1' 100' 0 to2,000 _ $121.90
Footing dram - each additional 100' 37,52 I= 2001 to 3,600 $169.69
Sewer - 1st 100' 62,54 3, t to greater $233.20
7 201 and greater $327.54
Sewer - each additional 100'
37.52 ME
Water Service - lst 100' IMIIILIZINEPOR Medical Gas S stems:
Water Service - each additional 100' �' ►� a r , r •
1► /l.{'r/A i arr ` y r, , (1 , r1�Ir V 1 Y . `•� %' h Flat 1 ' r yt ' ''' ( ,, ( �(! ,�, "
Storm & Rain Drain - 1st 100' Y i lia 1 .ebl if 4,, io ) 1 1 ref ' ;li u � � ( !9 � ot4 ,,,, .„ „,. � ' 11 , C #
$1.00 to $1000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' NM 37.52 MI 55,001.00 to $10,000.00 $7150 for the first $5,000.00 and $1.52 for
l ; " , ",' o " " 1 : �. 5 1 .t , ° ti'' • each Additional $100.00 or fraction thereof, to
° rf,� r� , �, ���a . , d ( �t t and including $I x004.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $I.54 for
which no t'ec is specifically indicated 90,00/hr each additional $100.00 or fraction thereof, to
(minimum char a -1/2 hour and including $25,000.00.
Inspections outside of normal business 90.00/hr - $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum char a -2 hours each additional $100.00 or fraction thereof, to
Reinspcetion Fees 90.00 /hr and including $50,000.00.
Additional plan review for revisions 90.00 /hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum eft +e- 1/2 hour) each additional $100,00 or fraction thereof.
11.11.1111111Maigi 112g1-01v
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", n 1 MiT m f r:l I r+� �a s('" + f
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accuratel re .ort fixtures could result in increased sewer fees Please Check all that apply.
N" M �1 ;' jill, 91.4 i 1' + t1 � "�P I IF a fu "4 ❑ Any new commercial building with water service 2" and
Va 1 ,h � i i t `' , w6;1i is . � ite lit., � I greater. except systems designed and stamped by licensed
B tistry/Font engineer.
Li Bath Tub/Shower New exterior plumbing site utilities for any complex structure .
-Jacuzzi/Whirlpool — " ' as defined in OAR918- 780 - 0040.
Car Wash Each Stall • ❑ Medical gas and vacuum systems for health carc facilities.
-Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Wuler Aspirator ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain , {
Eye Floor Wa Drain/sink - 2' , srri` i( ; . tl t , d u ,. 'r . -r . � ;r, _, ;. ... i A r tk! J.
3 .. II Isometric or riser diagram is required for new buildings
4 „ that meet the ualifications above.
Car Wash Drain _.
Ciarhagc - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work: ,
Ice Mac11./Refrig_ Drains
Oil Separator (Gas Station) - -
Rec, Vcbicic 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
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet •
Urinal
Other Fixtures;
http: / /www_tignrd -or. guv/ city _lial1 /deparlmen ts/cd /docs/PLMF -perm itApel oc