Permit v.
CITY TIGARD PLUMBING PERMIT
,Tr I DEVELOPMENT SERVICES PERMIT #: PLM2006 -00492
�.� 1I DATE ISSUED: 10/20/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135DC -07000
SITE ADDRESS: 11675 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: CHARBEN LOT: 8 -9 JURISDICTION: TIG
Project Description: Water heater.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JOHN W. DRENNAN
11675 SW 91ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 101201200€ $72.50
[TAX] 8% State Surcha 10/20/200€ $5.80
Phone : Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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.
g i
Issued By: � �� ^��
� _ Permittee Si nature: d
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busi ess 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.
Plumbing Permit Application
. A Building Fixtures roll 0 F O i l IC E - USI ,ONEY , •
City of Tigard j am} �� - � I " ED
� � D E 'ew Permit No.: ) . ip 13125 SW Hall Bvd., Tigard, OR 972 � - 1 �
6 ° Phone: 503.639.4171 Fax: 503.598.1960 C Date/By. Other Permit No.:
T G A R D Inspection Line: 503.639 OCT 2006 Date Ready/By: furs: RI See Page 2 for
, Internet: www.tigard- or.gov _ _ Notified/Method Supplemental Information
TYPE OF WORK C" I i'r ''' ''}' r!' - FEE* SCHEDULE .
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. j Ea. I Total
. tir Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION ., SFR (1) bath 249.20
IA 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: / / 67 5 s,‘ 9/.52 S / r Catch basin or area drain 16.60
City /State /ZIP: / /6 A n N r
Q IQ q 7 22 3 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: /\/a k /t/s CoaNi.�C�. O p q/ sr
Manholes . .1
N, 6ncrN(3UR6- iQ r.), Rain drain connector 61
Storm Sanitary sevver (no. linear ft.: ) Page 2
1
Subdivision: I Lot no.: 1
Fixture or item
' Tax map /parcel no.:
Absorption valve 16.60
• . DESCRIPTION OF. WORK
Backwater valve 16.60
Ai6 6 (4.11 r,4 i-/ /vF� r F-20 r 77, 1 ■ 16.60
Dishwasher 16.60
fountain . Drinking . .1
❑ PROPERTY OWNER ❑ TENANT
Ejectors/sump .1
Name: TO tilt' \At bri ir-mvA /✓ Expansion tank 16.60
Address: / / 17 -25 s, W cf / 577 ST 1 16.60
City /State /ZIP: T / f U/ OR t q 7 Lz3 Floor 1 11 661
(To3 63 l- 57 q disposal 6.1
Phone: Fax:( )
❑ APPLICANT - ❑ CONTACT PERSON • 1 1 11 Ice maker - 11
Business name:
cut/ , /d� Interceptor /grease trap ■ ..1
Contact name: TN m .'J O pr/VNAN Medical gas (value: $ ) Page 2
. Address: /l 6 75 S q/ 61- 57; Primer 16.60
City /State /ZIP: T / o a ' J f on , q .7 2-2-3 Roof drain (commercial) 16.60
( ) 6 3q — S� 1 Z Fa x: ( ) Sink/basin/lavatory 16.60
J 3
Phone: 0
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR . Water closet 16.60
• Business name: Water heater / 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.:
Plan review (25% of permit fee)
Authorized signature: / / . J J State s (8% of permit fee)
t/� �' �"""G TOTAL PERMIT FEE - 7, , ,
Print name: C'� I l . � ,, I t:..A7A//a / Date: /p .....-2.0 —!J c 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.
t\ Building \Pennits\PLMF- PennitApp.doc 04 /06/06 440 -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 - 1 S ' 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 additional 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 (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 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
each additional $100.00 or fraction thereof.
- 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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by, licensed
Fixture Type: Replace engineer.
Previous Capped - Added Existing. ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash -Each Stall
-Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher - Commercial
•
Domestic 'Isometric or Riser. Diagram -
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink -2"
-3
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
. Shower -Gang
-Stall
•
Sink - Bar /Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
. Washer - Clothes
• Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
• I: \Building\ Permits \PLM- PermitApp.doc 09/22/06
1
CITY OF TIGARD .. 4
BUILDING DIVISION PERMIT #: PLM2006.00492 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2006
Phone: (503) 639 -4171 Av Otj�l'�
Inspection Requests (24 Hrs.): (503) 639 -4175 t_ ..
INSPECTION WORKSHEET FOR DATE: 10/24/2006 TIME: 7 :02AM PAGE: 3
SITE ADDRESS: 11675 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: CHARBEN LOT #: 8-9 TYPE OF USE:
PROJECT NAME: DRENNAN
DESCRIPTION: Water heater.
OWNER: DRENNAN, JOHN PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
e ",
320 Plumbing rough -in 038770 -01 503- 639-5792 N
Corrections /Comments /Instructions:
1
v1 '�
/ #
N r
►, PASS n PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
I I FAIL I I CALL FOR INSPECTION [ I ADDITIONAL FEES ASSESSED
Inspector: 1, ' CV Date: II
P hone #: (503) 718 - •