Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00020
Ai l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 006
PARCEL: 2511 2S 114BB -07200
SITE ADDRESS: 16219 SW 104TH AVE ZONING: R -12
SUBDIVISION: SWANSONS GLEN LOT: 013 JURISDICTION: TIG
Project Description: Replace water service.
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: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BILL WILLEMS Description Date Amount
16219 SW 104TH AVE
TIGARD, OR 97223 [PLUMB] Permit Fee 1/12/2006 $72.50
[TAX] 8% State Surcharl 1/12/2006 $5.80
Phone : 503 - 860 - 2846 Total $78.30
Contractor:
RESCUE ROOTER
28655 SW BOONES FERRY RD REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
Contact # : PRI 503- 869 -2260
FAX 503- 685 -9185
Reg #: LIC 127325
PLM 34 -168PB
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: •---,ze4 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.
• Building Fixtures ('
Plumbing Permit Apply o ,V D FOR OFFICE USE ONLY •
p, N 1 7 2006 Received Permit No.:'t i
City o f Ti H Dec �J //�� y1 A / rFt /n /--`)
-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 I OF TIGAR' / / � ?' `ii Daze/By Other Permit No.:
24- Hour Inspection Line: 503.639.417 �<<, �,. '• Date Ready/By: ' Juris: RI See Page 2 for
Internet: www.ci.tigard.or.us kUILDING DIVI = .. Notified/Method: Supplemental Information
TYPE OF WORK r FEE* SCHEDULE
El New construction El Demolition For special information use checklist.
Description I Qty. I Ea. I Total
K1 Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION
SFR (I) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
1:1 Accessory building El 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: ' L,Z j g 5W 10 4TH AV E Catch basin or area drain 16.60
City /State /ZIP: ') GAR p , OR 9 -1 Z Z 4 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: -Du RHAI`'1 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 Backflow preventer Page 2
Backwater valve s 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ❑ TENANT
- Ejectors/sump 16.60
Name: LL VO (L LE.M S Expansion tank 16.60
Address: I L Ai q sw 10 4T (4 AU E Fixture /sewer cap 16.60
City /State /ZIP: T, .ARt, , c ).R a772„*'f Floor drain/floor sink/hub 16.60
( . Garbage disposal 16.60
Phone: D3 ) O�d iv-1( Fax: ( )
$r APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ESC U E doR Interceptor /grease trap 16.60
Contact name: c_,..IV E. Kis V Medical gas (value: $ ) Page 2
Address: 7
( 0;) Bol"Z Primer 16.60
City /State /ZIP: W tLSoNV +LL C / D R 976 0 Roof drain (commercial) 16.60
Phone: (503 --/e33 g7Z Z Fax :: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: -t.SC U 6. I, o o Water heater 16.60
Address: po Sox 1-21S Other:
Subtotal
City /State /ZIP: W 11_30 u U ( u...-c- o g, ern)-74) / Minimum permit fee: $72.50
Phone: (045 z,o$5 9.05t Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: /Z 73Z S Plumbing Lie. no.:344--/dpe Plan review (25% of permit fee)
Authorized signature' State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: ewe Ai , y�/J Date: /.17.--e74.. 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 \Permits\PLMF- PermitApp.doc 06/05 440-46t6T(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 - 1 100' 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 Valuation• Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $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 Qtr ` 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 $50,000.006 ` $379.50'fof the first $25,000.00 and $1.45 for
each additional $190.00 or fraction thereof, to
Inspection of existing plumbing or ? ' ., t `$'56:006:061.
specially requested inspections - per hour 72.50 and 00foing t $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 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. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
- "Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alteratioiis.gr additions to food service
-Drive Thru facilities where new plumbing f xt including interceptors,
Cuspidor/Water Aspirator are being installed fdr t}iefood 'Service area
Dishwasher - Commercial ❑ Any residential new•r eside tal buildin g contain n . three' 3 or more
- Domestic '• - g (' )
dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose'fire sprinkler` "system.
•
Floor Drain /sink 2" Submit 2•sets of plans with apy of the above.
% F -
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram' is required for new buildings
Disposal - Commercial .three (3) or more stories in height. •
- Industrial -
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 ,. • p
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 \Pe`mits\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: I i_It 200S.I f11 t
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/17121)06
Phone: (503) 639 -4171 � ' itii`'
. Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1119/2006 TIME: 7 :03AM PAGE:
SITE ADDRESS: 16219 SW 104TH AVE CLASS OF WORK:
SUBDIVISION: SWANSONS GLEN LOT #: 013 TYPE OF USE:
PROJECT NAME: WILLEMS
DESCRIPTION: Replace water service.
OWNER: W11L,LEMS BILL PHONE #: 603,.860- 603O60216
CONTRACTOR: RESCUE ROOTER PHONE #: 603 - 669.2260
Inspection Request Scheduled For: Date: 1/12006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water ser vice 026294-01 603 - 793 N
Corrections /Comments/ Instructions:
Etfzq(Cc --
Aiat,
wspryv '7/
•
'!PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
4 c � �
Inspector: Date: Phone #: (503) 718-