Permit MI CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00012
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/18/2007
PARCEL: 2S 111 AB -03100
SITE ADDRESS: 14135 SW 93RD AVE ZONING: R -4.5
SUBDIVISION: ELROSE TERRACE LOT: 027 JURISDICTION: TIG
Project Description: Replaceing (3) fixtures.
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: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SCHWARTZ
14135 SW 93RD AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/18/2007 $72.50
[TAX] 8% State Surcha 1/18/2007 $5.80
Phone : Total $78.30
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 624 -4880
FAX 503- 624 -2173
Reg #: LIC 81 837
PLM 26 -445PB
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: "'" 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.
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13125 SW Hall Blvd, Tigard OR 97223 II nn ^I'
Plan
8 2007 an Review A L/ -1 1 �sX
m : Phone: 503.639.4171 Fax: 503.598.1960`+ Date/By Other Perrot No.:
Inspection Line: 503.639.4175 '
• T 1 G A K _ l Date ReadyBy: , ® See Page 2 for
Internet: www.tigard- or.gov ® �,���® Notified/Method: ) Supplemental! Information
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❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
fp ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
a a§ }�. 1?�`'f" "' er:�.a. .,,.. �M::rt..«.:.�a �. .x.;�a,wFO.n.;a .. .n,:�a• .- n
:ski" , 'F` ";' C' lqe V - , Y ' . , ( )
;. ,. :,T , . • ` GAT•EG( ,)RY OF CONSI RU .. ..* ° � . 4.47 , SFR 1 bath 249.20
= :�:� ��. j Pew' �.*_��
Om 1 - and 2- famtiy 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:
JOB SITE INFORMAT AND LOCA '` ` 4 , Fire sprinkler ( sq. ft.) Page 2
m a �°^ +"',_ �snu _" li > sx+ ..��e.,'saet,,,r:,.�vw. 1 ,x.�,.� _. ,� . ._. Site uttllti„
Job site address: 1Z-1-1 j y "''`
T 3 S SIJV ° l� (,j.A/�-A-- Catch basin or area drain 16.60
City /State/ZIP: t f ) ` �� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: t l Project name: ... s - c. .,.., 4,,..-{-z..- Footing drain (no. linear ft: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: fill e 6 cS -,....„ ...-e-eC S (--'• Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: _) Page 2
Tax map /parcel no.:
Fixture or item
s, : _a • .:- . .._. .,s� Absorption valve 16.60
• r m y " r 4� ,., ,�`. ,. ` a,'tw` D E3CRI E!T ION' OF ,, , :4 ,1 :
r� °'h X *° .•<a' =� Back flow preventer Paget
leQ`T of +rn C3 .^1 ��i�rr o -4 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
: e .: R , iiii . , .;. - ", g. � -; - �.. ,. :w,. '• r ; Drinking fountain 16.60
� ~k ®• PRUPEBTY OWNER =`':': •� g� r �~ ® � •" "�'
t�..�3�+� �; �� F.��x'�"�`�:��.x,� ^�TENAN ?, `?��,",`���"
` Ejectors/sump 16.60
Name:
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
, �,. •y -a- °*4. , u�,.; L'•. 3 " !r. . 2,6 . °5•":' °.>.- �;.•r..i • : y , ... +'�m•n;c.: s' wr...
w ® SAPPi, 7 1 ; * ', >r . r . " " x = a- ` t ' Hose b 16.60
..: .a,°..' a.t. -41 . .. tirox.i ,,, 1 WPAT. ;,, a �j „- P ERSON " -
„" ° ._. .:�'`• vK. 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 Ai , (.90 E -mall: Tub /shower /shower pan 1 16.60 (( ( ( o U
w. , 'l, #. v .e µ .. , : c Urinal 16.60 (
y ' . h` �, i.5; ", ,a ' -* CONTRAd'I'UR f. .-' ` , `.- e 1 ` '' - t ,"` '4 l b
.r+ �" ' . Water closet 1 (,
Business name: 1�YV 4 W- 7 l 0,1-1 "') i Water heater 16.60
Address: P , `7 2._.-2-'1 g S Other:
City/State/ZIP: Subtotal at' .. v
Minimum permit fee: $72.50 -.�
Phone: (53i,') ( - cf ge O Fax: ( 5 , 3) !aZ Z � ( 7 3 Residential backflow minimum permit fee: $36.25 7Z. s
CCB Lic.: ei K 7 Plumbing Lic. no.: 2_,6,- 5 VS: PR Plan review (25% of permit fee)
State surcharge (8% of permit fee) ..S 0
Authorized signature: ., K 3 >
��� TOTAL PERMIT FEE
Print name: /4)z,....,. 3;-...,,, Date: f� 1�D 7 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 \Pwmits\PLM- PamitApp.doc 06/26/06 440-4616T(l0V02/COM/WEB)
Plumbing Permit Application - City of Tigard 9.
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
� * � a Q t y ' Fee (ea)` •TOta1, C .
."� :,��. �,� „•.. ,.-� hif :��� ��S,quareF�ootage .���`� �Peran ><t�,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 valu ation a,
„ j er mi t 'ee w : ;:.P
Storm & Rain Drain - 1st 100' 55.00 ,. f
$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
,i
r �� � x additional 100.00 or fraction thereof, to and
Qty. n, ?Eee i (cal g, 4 %,'Toot',;'•
, $
.Tutu re, or IteII ' � _ ::ves. A- ,. ;ae tE. v,`.a: • a `
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
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the e first first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: �, .•,..,, „* 4;.,
'';; Pt anRev ><e wf orPlum6ingInstallations e
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
� �`�µ ; �`- •� <�' t "' uanti b` Fiztore Work.eeiforoied�w' greater, except systems designed and stamped by licensed
:Fiitt eT x u „ � s ;w g
ype: 1 . �" ....
engineer.
t , k3 s ?. ?P.rebious I.i �`• e d . E istii
nPee m :Added: a� ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher -Commercial
- Domestic
Drinking Fountain „ xa S,O Metl'1Cor: Ri ser Di agram ;q
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink -2" that meet the qualifications above.
-3"
- 4"
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 *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor ��
Water Closet - Toilet /,
Urinal
Other er Fixtures:
1 /11
is Build ing\Pennits \PLM- PamitApp.doc 09/22/06