Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00686
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 4171 DATE ISSUED: 12/12/2005
PARCEL: 1S135DA-02702
SITE ADDRESS: 11230 SW 90TH AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: 60' line work to connect sewer. Septic system to be pumped and filled for removed.
CLASS OF WORK: OTR 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: 60 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
NATHAN GATES Description Date Amount
11230 SW 90TH AVE.
TIGARD, OR 97223 [PLUMB] Permit Fee 12/12/200E $72.50
[TAX] 8% State Surcharl 12/12/200. $5.80
Phone : 503 905 - 5147 Total $78.30
Contractor:
MICHAEL MCBEE
3039 SE 174TH AVE. REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97236
Contact # : FAX 503- 254 -1070
PRI 503- 239 -2707
Reg #: PLM 55821
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-y. or 1- 800 - 332 -2344.
Issued By: APO !i . AP / 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.
Builc�it' Fixtures E ' JE 4 . _.
Plumbing Permit Application FOR OFFICE USE OiNI.X
City of Tigard DEC 12 201 Date/By. /2 /ttia< Permit No.�j� j/j/1c2� .5_ /�(l�
13125 SW Hall Blvd., Tigard, OR 97223 _ l' �/YLM Plan Review
Phone: r H� / tvv
Phone: 503.639.4171 Fax: 503.598.196 1 7 �/ O Vd' `t Q Other Permit No.:
�1 1 I r . . 1 11 Re D a t e
24- Hour Inspection Line: 503.639.4175 a i. Date Ready/By: / El See Page 2 for
Internet: www.ci.tigard.or.us . BUILDING y ,)
,_ �'. Y Notified/Method: (.� 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 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Ei 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION
� AND LOCATION
Site utilities
Job site address: 1 1 230 5L2 I (/ t ✓e • Catch basin or area drain 16.60
City /State /ZIP: . G Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 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 n 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
•
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2
Sewer 'P V(GP t o 14 r 1 ro C..hoir Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY .OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: C7 le.-.0 Expansion tank 16.60
Address: / ( '3e) ( j (� o f - A(e • Fixture /sewer cap 16.60
City /State /ZIP: T ryrc Floor drain/floor sink/hub 16.60
-
Phone: %3) 9 5 _57 yt 7 Fax: 5v3 7451_28"g- D Garbage disposal 16.60
/t Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name:
/ t''( C Q , a , E
Interceptor /grease trap 16.60
Contact name: pel 1A K- k i ri 5c k7 Medical gas (value: $ ) Page 2
Address: , 0,3 Q S E- f 79. tai A Primer 16.60
I
City /State /ZIP: I , � ��
��V1c-4 7Z 9723 Ro of drain (commercial) 16.60
/ ^ Sink/basin/lavatory 16.60
Phone: 2i? _ 2 7�1r (�7 1 ' Fax: ) 3 ) 2S /0 7! J
/ VV / Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
' CONTRCC OR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State/ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) 3 4/, old Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 5 • Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) Y 'I
TOTAL PERMIT FEE ` yp /
Print name: p N l G 1 , c L Date: 12 12.,n � This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Pernits\PLMF- PennitApp.doc 06/05 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities .. - , , Qty. Fee (ea)` Total Square; Footage: -, , Permit:Fee: , ..
Footing drain - l 't 100' 55.00 0 to 2,000 $115.00
Footing drain - each addi . onal 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 -
Val ation: Permit. Fee:. ' .
Storm & Rain Drain - 1st 100' 55.00 $1.09 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 10 46.40 $5,401.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item , . Qty. Fee (ea) Total 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 Back flow 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 ki and including $50,000.00.
Subtotal: $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 _Rev for Complex Structures'-
Are you capping, adding or replacing fixtures? f "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. F. lure to system that meets any of the following criteria.
accurately report fixtures could result in inc , • ased sewer fees *. Please check all that apply.
I
uanti b Fixture ork Performed . AnY new commercial building.
S
Fixture Type: ' I Replace • Any new exterior plumbing site utilities.
Previous Capped Added Existing . ❑ commercial building with installation, alteration or addition
Baptistry/Font o qine (9) or more new or relocated plumbing fixtures.
A Bath - Tub /Shower ❑ Mesi .1 gas and vacuum systems for health care facilities
- Jacuzzi/Whirl cool provide • ! services to human beings.
Car Wash - Each Stall ❑ Plumbin • 'nstallations, alterations or additions to food service
- Drive Thru _ facilities w' - e new plumbing fixtures, including interceptors,
Cussidor /Water As•irator are being inst. ed for the food service area. _
mer
Dishwasher -Commercial IF
❑ Any new residen building containing three (3) or more
Drinkin_ Fountain dwelling units.
Eye Wash Pr
Any NFPA 13 - multi. rpose fire sprinkler system.
Floor Drain /sink - 2"
3 „ Submit 2 sets of plans h any of the above.
-4' .
Car Wash Dr.. n • Isometric or Rise I . ram . -
Garbage - Domestic in Isometric or riser diagram is required new buildings
Disposal - Commerci. three (3) or more stories in height.
-1 ndustri .
Ice Mach./Refrig. Djra�ins .
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.
i:\ Building '.Pertnits\PLM- PermitApp.doc 07/06/05
CITY -OF TIGARD
BUILDING DIVISION. PERMIT #: PLM200S -00685
13125 SW Hall Blvd., Tigard, OR 97223 "' DATE ISSUED: 12/12/2005
Phone: (503) 639 -4171 u7ro , iigl "
Inspection Requests (24 Hrs.): (503) 639 -4175 , ' - ''L .
INSPECTION WORKSHEET FOR DATE: 12/13/2005 TIME: 7:02AM PAGE: 13
SITE ADDRESS: 11230 SW 90TH AVE CLASS OF WORK:
- — SUBDIVISION: — SUBDIVISION: -- - - LOT #: TYPE OF USE:
PROJECT NAME: GATES
DESCRIPTION: 80° line work to connect sewer. Septic system to be pumped and filled for removed.
OWNER: GATES, NATHAN PHONE #: 503 -905 -5147
CONTRACTOR: IvICBEE, MICHAEL PHONE #: 603
Inspection Request Scheduled For: Date: 12113/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 023390 -01 503 - 481 -534B Y
Corrections /Comments /Instructions: /�
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71-PASS 1 I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 9 271. Date: ! /j 1 Phone #: (503) 718- """ 4 3i
l
e �i `, Jeremiah , Inc.
810 E Main - 4 ULNLIILV
T
x , 4 Molalla, OR 97038 DATE
'yi *' `., .a. ® 6' (503) 829 -7600 P `I q\-()S)
Dave's cell: (503) 209 -7641 NUMBER
°' sib Newberg (503) 538 -8808
fg Silverton (503) 873 -7622
1 -866- 939 -7600 CCB# 158543 DEQ# 38346
Complete System Installation 9? c:3 3‘
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9 1 , 6 dj qt, /
TERMS: Net 10 Days. A service charge of 1'/2 (18% per annum), $2.00 minimum will be applied to past due accounts.
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $
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