Permit CITY TIGARD PLUMBING PERMIT
4 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00644
. - 13125 SW DATE ISSUED: 11/21/2005
H a l l Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135AA-90002
SITE ADDRESS: 10303 SW 87TH AVE ZONING: R -12
SUBDIVISION: THE DEODAR CONDOMINIUMS LOT: 002 JURISDICTION: TIG
Project Description: Move water heater & add tub.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SFA WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GORDON STEWART Description Date Amount
19010 SW 87TH
TIGARD, OR 97223 [PLUMB] Permit Fee 11/21/200E $72.50
[TAX] 8% State Surchan 11/21/200E $5.80
Phone : 503 259 - 1336 Total $78.30
Contractor:
SORENSEN PLUMBING
19010 SW BONNIE MEADOWS REQUIRED ITEMS AND REPORTS
ALOHA, OR 97006
Phone : 503 642 - 2110
Reg #: LIC 116063
PLM 34 - 415PB
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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344. '
Issued By: ,C,d P ermittee Signature: PI i i
a IL . 2 ,". 4
I
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.
. Building Fixtures
Plumbing Permit Application I OR OI I I(I 1' 0 NI.1
City of Tigard ��ds� // f -a-..) � Y <.✓ Permit Noo \ . 7 /� i O /d 4'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 'i 11 Date Ready/By: Jnris ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: I IV- Supplemental Information
.
TYPE OF WORK FEE` SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
'lr!91 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: /0 Catch basin or area drain 16.60
City /State/ZIP: s L,v 23 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2
• - 4l' . , ¢(i [/(,eG j c1/ - i • l) A 'el Backwater valve 16.60
• (i,L6 / Clothes washer 16.60
Dishwasher 16.60
WI PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
n 5/1-0,„,/e,(47(
Ejectors/sump tank 16.60
Name: * / ' ,( v i„ `'� , ` Expansion tank 16.60
Address: / O c 3 l
� 1' Fixture /sewer cap 16.60
City /State/ZIP: • L1r f� � Floor drain/floor sink/hub ■ 16.60
Phone: 3) 9 (o l - 52;3? Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan i 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Rtt. -a 5 t ti0-n / /_ C l L Water heater / 16.60
Address: 'iV (b S w 13011'1 rT _I' ` Other:
i f OA q7 CO ubtotal
City / State/ZIP: -
/ ` � 'r R' � Minimum permit fee: 572.50
Phone: (S? 9 ) � -qr. - / 3 to Fax: ( ) Residential backflow minimum permit fee: $36.25
_ `
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: FA c _ , J TOTAL PERMIT FEE
Print name: L) Date: This permit application expires if a permit is not obtained within
D 4 1 w � r 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pennits\PLMF- PennitApp.doc 06/05 440-4616T(IW02/COM/WEB)
Plumbin>1 Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su 1 1 ression S stems:
Site Utilities Qty. Fee (ea) Total / Square Footage: Permit Fee:
Footing drain - 1" 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:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each addition: 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee F () Total ea T l additional $100.00 or fraction thereof; to and
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
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal:
I $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failu e to system that meets any of the following criteria.
accurately report fixtures could result in increa d sewer fees *. Please check all that apply.
Quantl by (Fixture) Wo Performed Any new commercial building.
Fixture Type: Replace ■ Any new exterior plumbing site utilities.
Previous . ea Ueda _ ❑ • commercial building with installation, alteration or addition
Baptistry/Font of ' e (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medi . gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providin! . - rvicestohumanbeings.
Car Wash - Each Stall ❑ Plumbing in . lations, alterations or additions to food service
- Drive Thru - facilities wher ew plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator - are being installe• or the food service area.
Dishwasher - Commercial - ❑ Any new residential . ilding containing three (3) or more
- Domestic -� dwelling units.
Drinking Fountain
Eye Wash .I ❑ Any NFPA 13 - D multip ..se fire sprinkler system.
Floor Drain /sink - 2" . Submit 2 sets of plans ' any of the above.
3 ..
Car Wash Drain II Isometric or Riser ■ 'a : ram
Garbage - Domestic / Isometric or riser diagram is requir- • or new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial A
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is\ Building \Pennits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM2005.00644
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2005
1/2005
Phone: (503) 639 -4171 a H�3111
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 1 J2/,00b TIME: /.19AM PAGE: `1
SITE ADDRESS: ' 0303 SW t3/ 1F1 AVE CLASS OF WORK:
SUBDIVISION: THE DEODAR CONDOMINIUMS LOT #: 052 TYPE OF USE:
PROJECT NAME: S 3'EWAR 1 -
DESCRIPTION: Move water heater & add tub.
OWNER: STEWART, GORDON PHONE #: SQ- 259 -1336
CONTRACTOR: SORENSEN PLUMBING PHONE #: 503 6417 310
Inspection Request Scheduled For: Date: .1200 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 lisc. inspection 022859-01 503 -522 -2052 N
Corrections /Comments/ Instructions:
-d . / /�.1 Ar■ � � 1 llie/AIlli
/ '
i iPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL _ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION b _ PERMIT #: PLM2005 -00644
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 1/2112005
Phone: (503) 639 -4171 . ,�,aH
Inspection Requests (24 Hrs.): (503) 639 -4175 �_'
INSPECTION WORKSHEET FOR DATE: +2/1/2005 TIME: 1'08AM PAGE: 25
SITE ADDRESS: 10303 SW 8n H AVE CLASS OF WORK:
SUBDIVISION: THE DEOL)AR CONDOMINIUMS LOT #: 002 TYPE OF USE:
PROJECT NAME: STEWART
DESCRIPTION: Move water heater & add tub.
OWNER: STEINART, GORDON PHONE #: 503 - 259- 1336
CONTRACTOR: SORENSEN PLUMBING PHONE #: 503-642 "2110
r
Inspection Request Scheduled For: Date: 12/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misr. inspection 022764-01 603-522 -2052 N
Corrections /Comments /Instructions: ' 7- j
V
1 L'
s
„
q / 4 , -. ,p
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL [CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / 7 Phone #: (503) 718-