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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00055 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/16/2011 Parcel: 1 S135AA02500 Jurisdiction: Tigard Site address: 10440 SW 87TH AVE Project: Lyon Subdivision: METZGER ACRE TRACTS Lot: 38 Project Description: Replace 15' of kitchen drain line. Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: LYON, DONALD J HAZEL J P.O. BOX 2830 10440 SW 87TH AVE CLACKAMAS, OR 97015 PORTLAND, OR 97223 PHONE: 503 - 244 -1563 HONE: 503 - 235 -8784 FAX: 503 - 491 -2932 FEES Quantity Description Date Amount 1 ea Water Piping /DWV 02/16/2011 $56.29 Specifics: 1 12% State Surcharge - 02/16/2011 $8.70 Plumbing Type of Use: SF 16 ea Minimum Fee Adjustment - 02/16/2011 $16.21 Plumbing Class of Work: ALT 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 Notif ion Cen - 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 estions to OUN .y . 'ng 503.232.1987 or 1.800.332.2344. Issue By: / ` Permittee Sig . re: ,,'�'! -� s ( • 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. FEB- I5- 2011(TUE) 16:54 RRS /JackHouk /Rescu Rooter (FRX)503 491 2932 P. 001 /003 Plumbing Permit Application 1-0-5CA , Building Fixtures • Q- � ",,, v FOR OIrItICF. USE ONLY 1 City of Tigard 0 V O cl ' Reccit,r,l ,t 9 Dalc/B Permit No.: de/Ct// S W Hall Blvd., Tigard, OR t12 ��./ de/Ct // - 0005' a.. Phone; 503.639.4171 Fax; 503.59`8.I96� :a �� ti Plan ttewicw rrkro Qilier Permit No.: inspection Line: 503 639.4175 G �e \� iZDntc/B y: TIGARD lnlernek www.tigard-or.gov ,1 Notified/Method: � . D Date Jude: {� Sec Pa i for a rw' >r' ! aI ^' 4 A er ! t, a. a+ , ,. fied/Method: Supplemental Information .f ��.1� � �'y }, 41 I4Fdtj1,Y,'�. n,1 '.�'�t'a0'!3 a )t <IS( p t "�" ., {v.,.�,ir Mr�.,. n 1 n r, e,a�.,,. r. ,,i,. et�I iTit 1; ,. l0�h p.7 d�l °{..,.,.. y 11 ... e', tl tp�V ' te i•. �'�. {;It ,.Y�,.t ^1 ,,i�?l. ii 4 .l�� i�"; .. lib 1 i1 �5 a 4r 14'.. � , �. t ' l' .} �ut F 1W,i. :..i.; ' 1� 1Anold ?nut A , � A.S a'r � V ., 4„rr „ St � 0 ,. s Ail ,,ai s `e " �t'11 Am 4 ,i . ". id ,4 � x 1 � c;e ` r � ,,i,4 i i, , 4, z qo [3 New construction 111 Demolition For�ccial information use checklist Description 1 Qt FA. Total A lacement Y' 1 .� ddition/alteration/re �,- p ❑ Other: New 1- Z- family dwellings (includes 100 ft. for each utili connection) ,, r M��� � 4 ` µ� x IMENiwra. t It4, `�'G� ; t 6 f '�� i� SFR I bath N,c, #.',u! f,, tiZ;1��� r , o f „��t�td "� Get .e��i�ax>,l�tl�!ltw;�lr� +��l� > llj,�t:��kyr� () 312.70 Z 1- and 2- family dwelling ❑ Commercial/ndustrial SFR (2) bath 437.78 O Accessory building ❑ Multi - family SFR (3) bath 500.32 - Each additional bath/kitchen 25,02 ❑ Master builder y ❑ Other ut Fire sprinkler ( sq. tt) Page 2 lu ' u' �tt3 �e*�5u� � 4 t ' i 'n l'� ' }, ' w t M ° a t :i1"il` +l t!, t t 1,,1IS:} Slte utilities: Job site address: , '` / Catch basin Or aTCA drain = 18.76 i M Y City /State/ZiP : a r � / Drywcil, leach line, or trench drain 18.76 Ar Lair. r J Footing drain (nn, linear ft.: ) Page 2 , L , -x SuitcJbldg./apt_no -: Project name: _ Manufactured home utilities 50,03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear R.; _) [t - Storm sewer (no. linear ft.: ,__J fSST'�.T,. Water service (no. linear fl: 1 Page 2 Subdivision; Lot no.: Fixture or Rein: Tax map /parcel no.: Backflow preventcr 31.27 y {�" (4 i F t, ,n asr v +, . t � , } i Jt� 1' err;" t B '° Backwater valve tii�'1 + "' �5 �� w }9`1GV G 1 O l+t 1 4411 5 t, "" t t� }�r � 1; i $� "1 } /�4yytA 12.51 1aii,7 1 1 1 ). t 1 ' i n in u f 71 '' , �' a nt M ,,, A el � a 2w ,w e a mat 1c!, , t'� ld$Ay,U .,�, _�If j T ,,�% Clothes washer 25.02 ""; _____ "!i1 - Dishwasher _ . 1 /7/7"Vir"r 25.02 • Drinking fountain El 25,02 Ejectors/sump 25.02 r � r w+ yt.,..,y, aa: , t ,,. 1 yyy ( � .+1'Id'M f�' �' � ���yy t �li ,iZSdGRi'"4 S w �l�lb 1'I` I!J i 1 i�l T�'1 ` ^w" +�tFlf'�i`Er I } �" ,� �a tI'f �>~��. 'IarM»'�.�w t ' nnk.� "'' w1��,�9t �r41.� �'� x. � F?�....., t ' t..«�..��T,,t Expansio tank 1251 r _Fixture/sewer cap 25,02 Address: '�S /!/1 , a i Floor d 25.02 !/ 7 (� J' GoreagbdiSpasul 25.02 Ci[y /Stutel7,TP: x �/ ('hone: ( /j ( l, . ax: ( ) Icesoa maker 25.02 �! ��..��ww>�•rr + Ice maker I2.51 t V EJ t R �111 ' �"S F�! t ' . n ! Nu �� P i * r ° !� a i Mp*�� a fl r,� ,.,u;.w ti , lezati lr '!1 Ans f 4A2 A% � $ . 1 { r i115,br �1).,,a �y�ro4.Ai =dreg 44; Y ;bah Interceptor/grease tra a,, ��' � Yom„ � � }} �Y, l .sta�v� � } l� k{ � �'� _ P 25.02 Business name: ARS dba .TACK HOWK/RESCUE ROOTER Medical gas (value: $ _ . ) Contact name: JOYCE DENNIS Primer 12.51 Address: P.O. BOX 2830 Roof drain (commercial) )2.$) Sink/basin /lavatory 25.02 City/State/ZIP: CLACKAMAS, OR 97015 Solar units (potable water) 62.54 Phone: (503) 850 -3100 Fax: : (503) 491 -2932 Tub /shower /shower pan 12.51 - E -mail: JDENMS@a ARS,COM Urinal 25,02 - �� (1'�'1�`� y � �' t,� ��,. � t } 1 V {j, u �. (c ,��{ , , t t � � , � �}, 1 ", ('� � F lo CYiltilYf(V�S tA�1�3ti1kk�11�iXiTPIt'31':!i �v4V� 1U P A i r 1` `'i'S �� t'i tl M r +V r >aY��" , t r 'i IN E1 25.02 ■ i 4 Ta,,, gs tr..t. IA .,�k ara,s t, ,, t •:A ,(40 t,tlil'.d,,; Water cset Watc,. heater 37.52 Business name: ARS dim JACK HOWK/RESCUE ROOTER iilat pp'^g /DWG' / 56.29 Address: P.O. BOX 2830 Other: 25.02 City /State /ZIP: CLACKAMAS, OR 97015 Subtotal Phone; (503) 850 -3100 Fax: (503) 491 -2932 Minimum permit fee: $72.50 IMO CCB Lie.: 127325 Plumbing Lip. no.: 34 -168PII Plan review (25% of pcnnit fee) State surcharge (12% a of permit fee, � Authorized signature: , , _ TOTAL PERMIT FEE r �J��!! L Print name: JOYCE DENNIS Date; r / 1 'r hos permit application e:pires If a permit is not obtal ' G� L l after it hos been accepted us complete. (� " "1 a 471 15 7 196 - pf 7�j� 'Fee methodology set by Tri- County Building Imlusiry Service Bnard, 1:uilduloermitiAmMU- ParmilA� p�p.da -t Ul V l "- - 44D -0616T(10/U Utrtr� 0) FEB- 15- 2011(TUE) 16:54 RRS /JackHouk /RescueRooter (FRX)503 491 2932 P. 002/003 Plumbinft Permit Application - City of Tigard Page 2 - Supplemental information Fee Schedule: Residential Fire Su 1 r ression S stems: minsintsranammurP, i :a rottimum# ,,,,,,,,,..,;,, .. ammi , „.. Footing drain - I'100' 11111 50.03 11111 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 Sower - I st 100' ��/ 62 54 �� 3,601 to 7200 $23120 22 �l 7,201 and greater $32734 Sewer - each additional 100' 37,52 Water Service - 1st 100' 62.54 IMI Medical Gas S stems: Water Service - each additional IOC)' 37.52 1 � e1 l + fv�tr C r � a�, , � • ruin 1I y t� re e , r , 9tnrm Rain Drain - 1st low 62.54 '1 k + ` � �� 9 1 ' � 9 " " ; ; $1.00 to $5,000,00 Minimum fee $72,511 Storm di Rain Drain -each additional 100' 37.52 $5,001.110 to $10,000.00 $72,50 for the first $5,000.00 and $1,52 for fly".. �: rr r �. � R p # ,. � v I n „ , t r I ° t 1 , �� ' ' � l �ti 4 i` ...i ,11 ' , > each additional $100.00 or fraction thereof, to inspection of existing sting plumbing or for and including $10,000.00. which no fee is catty indicated 90.OQ/hr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.51 for (minimum charge — 1/2 hour) each additional $100.00 or fraction thereof, to Inspections outside of nom business 90.00 /hr and including $25, 0 00. rrn hours (minimum charge —2 hours) $25,001 -00 to $50,000,00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum Feca each additional $100.00 or fraction thereof, to 90.00/hr and including $50,000.00. Additional plan review for revisions 90,00 /hr $50,00 1.00 and up $742.00 for the first $50,000.00 and $ 120 for minimum char -1/2 hour _, each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes", k?��'rtt'n'1'y y M r' { p b' p l; yeS " 1 ' y�� Z�ii ' � l n { � � � I 1,1 � ++ xt<I,'r „ r �' ' 4' . r e l '' t rr ,,�� � a yye . ' C { r,, 1 ��ti' "1 � 1�d���a,4i�n� , „� I r O y 1 r t �, � � ' Wu � +d�},It please indicate work performed by fixture. Failure to Plan review is required for any of the following. accuratel re' ort fixtures could result in increased sewer fees Please check all that apply. 1 ` ;,1 )' Fr 1 it "'; 4 L2 ;y ” 1, ❑ Any new commercial building with water service 2" and � . , a1 ; , r�° 1t " " +' `'' greater, except systems designed and stamped b •' 1 titi4 e, ' . r 1.' " . , 1 # K p Y g p by licensed dairy /Pont engineer. Bath - Tub/Shower ❑ New exterior plumbing site utilities for any complex structure -Jucuni/Whirlpool as defined in OAR918- 780 -0040. Car Wioh - Each Stall rive Medical gas and vacuum systems for health care facilities. - rive Th l — ❑ Any multipurpose fire sprinkler system. Cuspidor /Water Aspirator 0 Any complex structure as defined in OA1t918 -7$0 -0040. Dishwasher - Commercial _ Domestic — Submit 2 sets of plans with any of the Above. Drin� kid, Fountain Eye Wash 1r v ,' ' „ik h !t�,1 t ' k +r r a+ r"�r r r , ,( rZr l r r 1 i +} S l i 1 Floor Drain /sink -2" , 'k,, Ati� tai 1. `a i , " `�^` ' r 4„n gat 4;i�� LYi. © isometric or riser diagram is required for new buildings — - 4" that meet the qualifications above. • Car Wash Drain , — Garbage - Domestic Disposal - Commercial - industrial - Comments regarding fixture work: Ice MachJltefri , Drains Oil Separator (Gas Station Rec. Vehicle Dump Station Shower -Gang ' -Stall Sink - Bar /Lavatory - Bradley '- -Commercial *Note: lithe fixture work under this permit results in an - Service Swimmin 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 Extractor _ pl permit can be issued. Water Closet - Toilet - Urinal Other Fixtures; - http:/h vww, tigard- or. gov/ city_ hall /depal tments /ed /docs/PLMF- PermitApp2doc