Permit r �! CITY OF TIGARD PLUMBING PERMIT
'' I , COMMUNITY DEVELOPMENT Permit #: PLM2011 -00008
Date Issued: 01/12/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S104BCO5800
Jurisdiction: Tigard
Site address: 12985 SW ASCENSION DR
Project: Clark Subdivision: MLP96 -0011 JEFFERY Lot: 1
Project Description: Replace 100' of water service.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: CLARK, DON
P.O. BOX 2830 12985 SW ASCENSION DR
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE:
503 - 235 -8784 HONE: 503 - 819 -7756
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
100 If Water Service 01/12/2011 $62.54
Specifics: 1 12% State Surcharge - 01/12/2011 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 01/12/2011 $9.96
Type of Use: SF Plumbing
Class of Work: OTR
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: ��, �/ -
• .� / / /l_ • Permittee Signature: /iii? .9 , et/ OA/
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 11 2011 (TUE) 15: RRS /JackHouk /RescueRooter (FAX)503 491 2932 P. 001 /003
Plumbina, Permit Application
Building Fixtures ,t C�Tv FOR OFFICE USE ONLY
i .1.
1114 - City o Tigard Re
I 4 131 25 SW Halt Dlvd., Tigard. OR 97223 , N 11 2011
Da : � �j Permit No/O 0 20#.-- e0G0
P hone : 503.639,4171 Fax: 503,598.1960A Riff' Rcvic
Inspection Line: 503.639.4175 .�.�/ p p
!]nte/By: Other Pafuit No.:
TiGARD I l a TIGARD Date Ready /By: ® See Page 2 for
Interact: www tigurd- ctcgov OF
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❑ New construction ❑ Demolition . Per special Information use checkl/sl.
Description I Qty. j Ea. 1 Total
, , Addition/alteration/replacement 0 Other: New 1- 2 2 -fumil dwellings (incIudeS 100 tt, for each utility connection) -
t �q�, 1114a�1�')'1 p St y � r�� .. fir � r f r r d r r
g1�p� { ! 1 rl {{��1 { ��" �� d i1" 7 "Itt f'y 1 + f t. },�r1'"i ,��,1" t fn�l
I t�1 41s` �i1(Ga�MPtdl «. "ar f iiqi ;11 %l *tt e + g� Y BSeg ,; w r :i �1 �k�d ! F (t'J«�b i « M lrri SFR i as i v t. u t 1 « r) at :t ;' 312.70 u r. FR 1 bath NMI
Ai I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
Accessory g ❑ Multi- family
eaoh additional bath /kitchen 25.02
{] Master builder El Other:
Fire sprinkler ( sq. IC) Page 2
y' r' y ! r tty r tft to Yr "a a r �� L� U t "Nf t�Y �2�4 y r 7 )YS(� Ij� C k 'n N N
P a 'r n 4l 1 11 VE t �`' r W 1 1{ �v'�� i�1� 1 1t1{v
„ VY l Gr„ ra u $ 1 s, It.w ; .o,tad 1�, A r 1 { 1 { , Site n t it l tie s .
Job site address: /0 8 YV 1� s 0 T/ C basin or area drain 18.76
.I / , Drywell, leach line, or trench drain 18.76
Fouling drain (no. linear R. ) En Page 2
Suite/bldg./apt. no.: Project name:
.." .. leAC-. _ Manufactured home utilities 50.03 Mill
Cross street/directions to job site: Manholes M I8.76
Rain drain connector 18.76 MEM
Sanitary sewer (no. linear ft.: _) EMI
Storm sewer (no, linear IL: ) Page 2
Water service (no. linear ft,: _) , Page 2 6
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no lS� Duckflow pm-venter _ 31,27 Mill
aN !;r ;a trg t 't >r ss�u " +nr ?,c ^xa t 1 �H t «
51
,rs,) rb i t rl'� l �f r 11 3l�a ++tt at at�s' fl �itipiA1 }�ty,4y74rajV r�)i 8ackwatervvlve 12.51
r>!dt(u'rt$Ia11 u -i ;.h p.d v«,al d. b�' yV ''� t11S.r,�111 .:r. _444r;i . (r. r o
w Clothes washer M 25.02
Dishwasher 25.02 MEM
-.0,411 Drinking fountain 25.02
tixir d ({ rw I a r, S+ n A r r P °»a y y�. mr y r Electors /sump 25.02
Nr~'`1' "ti�lrtlil�rc'+, +n,1 S ty r . ?a� i1a,�ar,I�i i ;() r1 �r"'rikli2%lS llf , • 1 "(r r k� "� (� i t➢a" +' '� 4f�1 i�1� 15 / I n ' 1r' 1? Ex � �
181 .1!�1�!t1$ t,lldu,•'.t. a l �ma..._ '.,fir p>Zttsion rank
Name: APIOIA • Fixture/sewer cap M 25,02
`�� Floor drain/floor sink/hub 25.02
Address: l a ice -
City /Stttte/LTP: '1° - Hose bib Garbage disposal 25.02
Phone: ( . + .-, OR:, ' 25.02
f
p(� ( i ,y ) Ice maker 12 -51
ly e{ Il R yI'p FI Ir"A' }w' dr d>I! ',t �r(i+N4 ia+} i yrr t� � 1 i ), yv aril tIT 10 p UI.y fII^ yutyt 3 �tJ � i r y ' i`+ Inlerce for /tease trap a1.�Pmnrrf��l�tS�t,'{�a115�,� p $ p 25.02
Business name: ARS dba JACK !LOWK/RESCUE ROOTER Medical gas (value: $ ) MEI Page 2
�p
Contact name: JOYCE DENNIS M12.51 —
Roof drain (commercial) 12.51
Address: P.O. BOX 2830 Sink/basin/lavatory NM 25.02
City /State/ZIP: CLACKAMAS, OR 97015 _ Solar units (potable water) = 62,54
Phone: (503)850 -3100 Fax :: (5(13) 491 -2932 Tub /shower /shower pan 12.51
E-mail: JDENNIS rr ARS,COM Urinal
_ IN 25 02
}�9Mi?I ilt +(gi 1 a ) i lr i ! t t r Si< s 1fi +1 1 t f)ci if v ra ' nt r} (t, ail P rt. I a n r r Y w t , ,I' _W Ini closet 25 02
_
4444, /lA1).l4,, {u'44,∎ ,�r,r '5sl�wfl + � r % ` � r'Whn.�wt t ,40164ra r , { 1ibeaN '. :Mt6 .4.ttr V t ;,,gIlit'iY watcn
Business name: ARS dba JACK HOWIURESCUE ROOTER 37.52 I N
Water piping/DWV 56.29
Address: Y.O. BOX 2830 Other. 25.02
City /Suite/ZiP: CLACKAMAS, OR 97015 Subtotal
'hone: (503) 850 -3100 Fax: (503) 491 -2932 Minimum permit fee: $72.50 t�ii l
,. • 'r CCB Lie.: 127325 g' r ' Plumbing Lie, no.: 34 -168PB Plan review (25% of permit fee)
/ State surch %of permit fee) /�
Authorized signature: 1 ' i/ / / /1 / /I TOTAL PERMIT r � � •
Print name: JOYCE DENNIS Date•` 'I ma permit application expires if a permit ix not obtahae p1 : a •�
after h has been accepted r,x complete.
I)1, 'Fee methodology set by Tri.County Building Industry Service I)oard.
I; 1HailJinalPermifsla 'LMU- 1'crinlfApy.do I 1 44 wtGi4T(10/ 0 2 ON1 / 1 yt:B)
JAN- 11- 2011(TUE) 15:04 RRS /JsckHouk /RescueRooter (FAX)503 491 2932 P. 002 /003
Plumbing Permit Application •- City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression S stems:
K i)1.' ' i n l r 4 l it, �� r 1fi',+1" ° r r vilr k� `Z ,S, y {ry' R tr �i n ; ; t t Y ,r h {y, r 1 1', ",1, t yy V1 }'�t { �. l uI ,E .. ,.yy2 11 {�j a ` y' r ' ( ' �4 '• ""`1't` Ir l r }M y t ��/�Jr .,
V1 :11d :1 ,1+161�i1,1�r�4 1igke klltti'r�ri'114 iitlal�l lr r , J 4 1.14 ° - ' !,Liti 4 lio4 r{ r,41r A �`rAi)4 .. Wsi i 1 ) . 1.,�lilu
Footing drain - 1' 100' 50.03 MI 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 MI 2,001 to 3,600 - $1(,y 69
62.54 3,601 to 7.200
Sewer- 1st 100' 7,20I and greater $327.54
Sewer - each additional 100' ME 37.52 1
Water Service- 1st 100' dirr 62.54 �r
Medical Gas Systems:
�t�
Water Service - each additional 100' 37.52 W a of Er "rill ,.,�„ , { � p '
s r Trvl 11, r � •',5th e,l21 Nr;, ,,'1 r 14iri ,'y1�V V'
Storm & Rain Drain - lst 100' 62.54 MI
$1.00 to $5,000,00 t llia� 1sf�Mini mum fee $72. , > b� ; 50 - y3 dl� &it "i t1➢c' l W9: {
_ Minimum
EI{ Storm & Ruin Drain - each additional 100' �W( p {���y AAA ( 1 y $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
YI'AW �IiAi N M � .1.. N YF � 4 6l', P1lla'14 ��Gla
0 J i , 1 „i each additional $100.00 or fraction thcttof, to
"� and including 510,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00 /hr each additional $100.00 or fraction thereof: to
minimum char :e- 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 .e - 2 hours each additional $100.00 or fraction thereof; to
90.00 /hr ME and including $50,000.00.
Additional plan review for revisions 90.00 /hr MI $50,001.00 and up _ $742.00 for the first $50,000.00 and $1.20 for
minimum ehar•c- 1/2 hour each additional $100,00 or fraction thereof;
Subtotal: � 4tv
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? .If "yes", '"'l'lv.:"'rr 'Irrl �t!'p'tti+k a r r ". rr l r ievn f«rw 1
fir r �, r i '54 4 � i, R 'io tn h p 4 � r „a ”
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurate! report fixtures could result in increased sewer fees * . Please check all that apply.
ale ', 1 1' r 1 ; °f + " r., i, tt Itklli h r 1.061‘1.0.0 ,ze r.6. "11 1=1 Any new commercial building with water service 2" and
, it p r 1 h 4 a, t ,, pr , r� . 1 T., r. ,
°bF1CtY, "o�ir� 5 r , '.G r S 1 r ; 1. p , � r 1 w t d � ,;{ Iwo .'" greater, except systems designed and stamped by licensed
Ba fist /Font � � engineer.
Bath - Tula/Shower ❑ New exterior plumbing site utilities for any compl structure
�acurzi/Whirl -oo1 as defined in OAR918- 780 -0040.
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities,
-Drive t art El Any multipurpose fire sprinkler system.
Cuspidor /water As irator 11111111111111MINIMM ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic�� Submit 2 sets of plans with any of the above.
Drinking; Fountain
E a Wash 41l grx i!t��1 "i7 r 1 i ra y rn
2' ' 1 1 l ,rdir i 1l ,r r,: " rM ; r r � �, St1, 1°'' i�
Floor Drain/sink l ii i ' Drain/sink ■
_ 3" Isometric or riser die gram is required for new buildings
. 4 that meet the9ualifications above.
Car Wash Drain
Garbage - Domestic
El lll
Disposal - Commercial
Industrial Comments regarding fixture work:
lee achJRr (Gas Drains ���
Oil Separator il parator (Gas Station)_
Rec. Vehicle Dump Station
Shower -Gang I -
-Stall
Sink -Bar/Lavatory In
-Bradley
-Commercial If the fixture work under this permit results in an
- Service
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water CInget plumbing permit can be issued.
Water Clnaet Toilet Toilet
Urinal '
Other Fixtures: 1111111
ihllp: / /www "tignrd- or.gov /city hall/ departments /cdldocs/P1.MP- PermitAp oc