Permit Ili! CITY. OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00324
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/23/2007
PARCEL: 2 S 104 B D -00500
SITE ADDRESS: 12615 SW 136TH CT ZONING: R -7
SUBDIVISION: HUSKE PARTITION LOT: 003 JURISDICTION: TIG
PROJECT: HUSKE PARTITION
Project Description: Relocate sewer connection for existing house. Approximate 100' of service.
CLASS OF WORK: ALT 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PATRICK HUSKE
12615 SW 136TH CT Description Date Amount
TIGARD, OR 97223 [TAX] 8% State Surcha 7/23/2007 $5.80
[PLUMB] Permit Fee 7/23/2007 $72.50
Phone : 503- 625 -4391 Total $78.30
Contractor:
ENDICOTT -WOODS ENTERPRISES
PO BOX 1537
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 625 -3525
Reg #: LIC 94954
PLM PB236
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.:. cialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if ork I. not started withi 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires yo - to folliw rules adopted , the Oregon
Utility Notific..• i enter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -00'∎ 1 -0101. Y. may obta i opies of
these . es or direct qu- ions o 0 NC by calling 503.246.6699 or 1.800.332.2344.
I ued By: L - Permittee Signature: A :AA
Call 503.639.4175 by 7:00 a.m. for an inspection that bu;. iness day.
This permit card shall be kept in a conspicuous place on the job site un it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures , 1 - FOR OFFICE U ONLY ' '
lig City of Tigard Date/By: �� 07 Permit No : P a-a(57-603,9
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: ® s See Page 2 for
Internet: www.tigard- or.gov Notified/Method: ( co Supplemental Information
TYPE OF WORK 'FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 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
III - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ 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: 6 Catch basin or area drain 16.60
City /State /ZIP: Ti G r^ /Qp�, Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I I Project n`a-m`e:`, Footing drain (no. linear ft.: _ ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
ie Sanitary sewer (no. linear ft.:6) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Subdivision: 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
V g _ \OC,c+'k _ fi r- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
ROPE OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: 17 _ j ti _ ■ _ P Expansion tank 16.60
Address: a _ Fixture /sewer cap 16.60
City /State /ZIP: _ • __ L = = -� n Floor drain/floor sink/hub 16.60
( 6 '- (. ' t7/ Fax:
Phone: ) 6 � ! ( �- Garbage disposal 16.60 ._ _.
5APPLICANT . ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Q.A. :r.m - ∎■ ., ,.l - . I C i Interceptor /grease trap 16.60
Contact name: 1r S Medical gas (value: $ ) Page 2
Address: O 40 9'81' Primer 1 6.60
City /State /ZIP: Roof drain (commercial) 16.60
A. Cstrae . S409 f Af
S ink/basin/lavatory 16.60
Phone: ( 624 7 �1 3r/ Fax: : (Z'b?) g
Tub /shower /shower pan 16.60
� -
I J
E -mail: [1,1_00 tn rho - t ,.5. 7 Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: F'n,4i,*( -0 -.� , / ^ r Water heater 16.60
Address: PD f. ` ((5 3 7 li�.�/ IJ 02 sr 70 c 0�. Other:
I 11 • Subtotal
City /State /ZIP: / . o � �
-
Minimum permit fee: $72.50
Phone: (6b3) (, i S- 3: Al ` Fax: ( ) Residential backflow minimum permit fee: $36.25
U
CCB Lic.: /YS _ O��/ il P j _ Lic. no.: ,A3,0 Plan review (25% of permit fee)
Authorized signature: , State surcharge (8% of permit fee)
���5 , 7 O� TOTAL PERMIT FEE
Print name:. A f it , Date: • p 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 doe 12/27/06 440- 46I6T( I0 /02 /COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information ti
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` 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 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 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 ❑ 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 Isometric' or Riser Diagram:
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial . increase of sewer EDUs, a sewer permit will,be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor .
•
Water Closet - Toilet •
Urinal -
Other Fixtures:
i. \Building \Permits \PLM- PermitApp doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION . PERMIT #: PLM2007 -00324
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/23/2007
Phone: (503) 639 -4171 a�lp,�oi�ltk
Inspection Requests (24 Hrs.): (503) 639 -4175 :.:! -_
INSPECTION WORKSHEET FOR DATE: 7/24/2007 TIME: 7:00AM PAGE: 50
SITE ADDRESS: 12615 SW 136TH CT CLASS OF WORK:
SUBDIVISION: HUSKE PARTITION LOT #: 003 TYPE OF USE:
PROJECT NAME: HUSKE PARTITION
DESCRIPTION: Relocate sewer connection for existing house. Approximate 100' of service.
OWNER: HUSKE, PATRICK PHONE #: 503-625-4391
CONTRACTOR: ENDIGOTT -WOODS ENTERPRISES PHONE #: 503 - 625 -3525
Inspection Request Scheduled For: Date: 7/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Mess -.ge
395 Misc. inspection 052578 -01 503.939 -5545 Y
( 5.'
Corrections /Comments /Instructions:
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PASS PARTIAL APPROVAL n CANCEL El NO ACCESS
FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
y() ciki
Inspector: Date: / n Phone #: (503) 718 -