Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00171
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/03/2011
Parcel: 2S110AA00300
Jurisdiction: Tigard
Site address: 14145 SW 105TH AVE
Project: Pacific Health & Rehabilitation Center Subdivision: ANTERBURY TERRACE APARTMENT Lot:
Project Description: Replacing 60 ft. of kitchen waste line.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: TIGARD INVESTMENT GROUP LLC
P.O. BOX 2830 BY EYRING REALTY INC
CLACKAMAS, OR 97015 1777 N CALIFORNIA BLVD #300
WALNUT CREEK, CA 94596
PHONE: 503 - 235 -8784 PHONE:
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
60 If Sewer Service 06/03/2011 $62.54
Specifics: 1 12% State Surcharge - 06/03/2011 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment - 06/03/2011 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct stions to NC calling 503.232.1987 or 1.800.332.2344.
Issued y: A0k Permittee Sig :ture:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JUN 02 2011(THU) 08:42 AR5 /JackHouk /RescueRooter (FAX)503 491 2932 P. 001 /002
r
P lu 1 Per_ Per A lication Ell ED ,
Building Fixtures JUN 2 2011 FOR OFFICE USE ONLY
City of Tigard Received IMEMINEll
1
u 13125 SW Hall Dlyd., Tigard, OR 9722 1 � ry Date/p : -X� u �L�
° : Phone: 5113,639.4171 Fax: 503.59$ r ®F TIGARD Plan Review
TIGARD IltspectionLine; 503.639,4175 uuILUING DIVISION Date/lty; _ Other Permit No,;
Datc
Internet: www tigurckr gov itendylBy: r��t ; See Page : rah
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] New construction 0 Dem Demolition FOPS eclaIlh nrmllClurr use checklist
lt�i,”
ddttton /ultcrauon /rc lacemcnt ❑ Other:
Descri lion
� i 1Q "R t f,l, it 1'^?,1 i' .n r t t New 1 - 2-family dwelti • > Total
,� �irl l y ” �f.ti1 ):10 "`1 ;�d`�1;1 ii Y ' j � ` V y S t, iyr,V;�! , ; 1 M m 5 tfi,;p y n a (includes 100 It. for each utility connection)
ut : 4,„ a�1' t ,�,; 1 t !',� r ' ..i' d`1o11' it it tlo S FR ( 1) b ads 31170
IIM
And 2- family dwelling Fj 11 Contnwciul /industria SFR (2) bath
437.78 =
q Accessory building 0 Multi - family 500,32
Muster builder Each additional bath/kitchen 25.02
❑ Other
�) + i °>1r Ih ^1 f'S +' q IY 1W !r° P ? r ri Fire sprinkler ( ��
} / �'� � p�1 t� y1 , ' 1 , t r �'� Mm . rt "f+^rmi r, r sq. Pagc2
i(r , d ,1, IArf i �im, ∎ P.ai, A 'l � ii. in ,,s t l t i f Mh t ;,!. ' 1i tit^ �tr AI IiI+ ' lrlf,u, +.ki , f. , MittOMINIMMEMMillmommimin
Job site address, _ I � j�a Catch basin or area drain
' 4� 'Ai,r —.ri1J Drywell, (each line, or trench drain �� 14..r
Suite/bldg./apt. no.: Project name: �j a► , Footing drain (no. linear R.: �) PVC 2
Cross strcet/directions■to job site:
+� /rd e ta_dLi' Manufactured' home utilities 50.03
Manholes 18.76 0
Ruin drain connector 18,76
Sanitary sewer (no. linear tt.: AF fiA /A
Pa • 2 '
_
Storm sewer (no, linear ft.: J � )/"� „�r�r
Subdivision: Water service (no. linear 11,; ) Page 2
Lot no.: fixture or item:
Tax leap /parcel no.: Sacldlow MEI
U,+�, r q, I''y� p y �y preventer
�,Fl fil4�i iti.' 1fUp2 lii'1;,� 1��]>11'jC t u,� 1 d , Y � �i�,f I , YJ'i°' t rlilti n
j 7 , ya q ((pp �� j ( +1�r k A � t7� 1 }r (1 e v py fiat kwaier valve
�
�. at - �1Y?i, t1E111�. tiG �,tt� ,.tlW�lGi�1f'G �;d:�.:dV�1 ?e!� ,��f P�t�ir�lVit„' i Yklia����.;±
�, rr ;� . „} Clothes washer 25.02
i ,,�ri� „ ./ � Dishwasher 11.0 25.02
1 Drinking fountain 25.02 '
}} i° "W r +rt i Iu tl " ���1t tE' rail 1 r l ra ^v r ,, q Ejectors /sump
X ' ttdtiSf +. 1y t .r n t , PI ggI' IIS ilil ttt 1{ �v ' ri*,;,� r 25.02
l I, 7latiiikb ldiiivllif' aJsS titititika r,t a,r, �shi r(`11'1 � �qI /,i1 r' ,i Ex ansion n
'" ,araeg". 4 m, t v r' pP Y : P ta 12 "51
Nome: f� 1 I R / /� r F ixture/sewer cap p 25.02
Address: + ' 1 Floor drain/floor sink/hub IIM min City /Slate/ZI ! /
Garbage disposal 25,02
Phone: ( 00 % , /mot Ice ma e
V 0 r! y ��1 1 .. 4 ` 1 ,nSd, r.rr r
25.02
u11i� (tly 1 } � ° I 1 �f t r Icemukcr 12 -51
1'1 ,t t' 1 �sn°�;.a ,„ °.tf',rl„b °,t' +af 1 q� f` k t { F � ° " �'�� "t Interco tor/ rcasetrap 2
�r� 1�» fiw: ll�.. �W,), :man, �i,�.3'rwZ,o!,tr$Y�Q i tt @ p � 5A2
Business name: ARS dba JACK IIQWK/RESCUE ROOTER II W
Contact name: JOYCE DENNIS Primer mum
Address: P.Q. BOX 2830 Roofdrtirl (commercial)
City /State/ZIP: CLACKAMAS, OR 97015 — SInk/busin /lavatory ,. J — ` r
Phone: (503) 8$0 -3100 Solar units (potable water)
II 6z 54 t w/
Tub/shower/shower pan 12.51 /
E-mail: JDENNIS@ARS,COM
Urinal
a ��� 41 rlr , 1'��7 r m i �, r�' 25.02
'�ti "SA iY4 Caykl3: aft '! 3 � Sal r ki 'tdt'u r u;R?l�w, �i!° a? w"r�i " t l ! I, (15 p1 r IRlfi� {�,t�tijF. �4( I l tyi31 �a7 i '`"C, i it�� ;u Water eraser Emu
..V..,,4,1W.I4 till, AL H ,,, ,.M1,rwr i rill f l 25 -02
�} .. )! "Ito �Ssf.t 1Yt(
Business name: ARS dba JACK 1'I0WK/RESCUF ROOTER Water heater 37.52
1111 56.29
Address: P.O, BOX 2830 Water piping{DWV 25.02
City/State/DP: CLACKAMAS, OR 97015 Other: 25.02
Subtotal 4 . / '!
Phone; (503) 850 -3100 Fax: (503) 491-2932 Minimum permit fee: $72, _.
CCB Lie.: 127325 50 1.
Plumbing Lie, no.: 34- 168Pi3 Plan review (25 % of permit fee)
Authorized signature: / State surcharge (l2 %ofpermit fec) ._� i • - W ,A - 44 A i ma .4.,,_,P"" /'
"
TOTAL, PERMIT FE i � - y■ i t l 71%
Print name; JOYCE DENNIS 6 D R This permit pL Me 0 , >
ADate: �, p mite >Uwtiou a ■pires It permit is not obtained �
after It has been nccepled na complete. t.
1 f "Fee methodology set by Tri- Caualy Building Industry S. i , Board
P. HUpdinglPemchalPLM !!- ParmilApp Oa.- IO aUf 440- 4at(T F�'4G
(10lu OMlWF,'
JUN- 02- 2O11(THU) 08{42 RRS /JackHouk /RescueRooter IFRX)503 4 91 2932 P. 002/002
Plumbing' Permit A lication - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
~a ` ale :t � r" y �„ tr ;,; r � Residential Fire Su r ression S stems:
�� 1d �A t�itS,taiar , • r Ir 1 t li� t, f +
k.�.Jr'(i�t` tCt , }�" V ;�'1i�yry , yyi N, �"'iti7. , r ,� r•
Footing drain - . 100'
r ,,,m „ • T wn Traw , k , ( t iitliiAi i,4" �� o"' C a' 9 'zr ° �I , i ' , w !
MI
50.03 $« 1 ' �A ! li 1� !•, ttw�l } l i ' 1 1 .' 4 "I,1,, " "'t'1{1'
0 to 2 000 1 <� t + 1C lw at1 h!ii
Footing drain - each additional 100' � $121.90
�
Sewer - 1st 100' 2,001 to 3 660 $169,64
*27-111;12 � e w 7 ,6D 1 to 7 200
Sewer - each additional 100' 7201 and , aler
Water Sccvicc - ht 100' � " r ! /'� <
Water Service - each additional 100' �� Medical Gas S steins
Storm S Rain -eac ,_ 1st ion 1 �U ,i. In "� S ' tl i�' t'r U, �r 1' C " y(1 ' ' 'M r tiw
i, r rrrr' ^ 5,0 1 Ff 1 � ' ^l"rN'i', Yl � - 7+ . �r(A 4 1 yM n
Storm & Rain t PPP w ,w,1 .1 ' � #.. Y ,WYII,r«' , M r `�!'tV 4Y t •
�� i 6a t�F. lb t�1V� m' ^, 1 �s t tl 1 �iC 1 r
Drain - each additional 100' $1.00 to $5,000,00 ":eaµ !' , „ }.` �,�
tq 3 0l "'�y " ` t M , y ., � $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
' rS1 4i ,�lc , viiia t iir ? i l a t l l t g( ri' ; It each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or for
which no ice is isting specifically indicated and ineludin: $10 000.00,
(mfuim no
char t l2 hour 90.00/hr
$10,001 -00 to $ 25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Inspections outside of normal business
each additional $100.00 or fraction thereof, to
hours (minimum chi • a 2 hours) 90.00/hr and includin_ $25 000.00.
$25,001.00 to $ $ 379,50 for the first 00.00 and $1,45 for
Reinspectiort Fees each additional $100.00 .00 or fraction thereof, to
90.00!1
Additional plan review for revisions 90.00/hr $50,601.OD and u and including $50,000.00.
minimum chore –12 hour D $742.00 for the test $50,000.00 and $1.20 for
Subtotal: 0 each additional $100.00 or fraction thereof.
•
Commercial Fixture Work: _ -
• Are you capp adding or replacing fixtures? .
g res? If "yeS " 1 rppr > . err , r� q m 1 '�
please indicate work performed by fixture. Failure to `,{10� 1' ` w „ ills � M yy , �� G "� t ` q1 , P' • rt'
hC Phi r i v ' ro .E4 a t f d 1 n ' 1' i ii.: -1 JAM win LAti t ( y = td 1 4 L
report fixtures could result in increased sewer fees *. Plim r eview is required for any of the following.
accurate! repo
�� � �� �� �t ��� 1( � ^ , 1 �' "V� t " >''. ilttti" t ''b Jt7 u , '�� kW �� ,Please check all that apply.
tl C Y n a a . , + w r IM Q Any new commercial
1: 5�1:�d ^ , a`d s i {{;, , A ; „1 t r p1 r al building with water service 2" and
]la� tistry /Pent `t " greater, except systems designed and stamped by licensed
Bath = rnb/sho r engineer.
���
as defined rred i exterior plumbing site utilities for any complex structure
Jaeu�zf/Wh 1 aol fined in OAR918 - 780 - 0040.
Car Wash -Each Si ���
'Drive 1 hr D Medical gas and vacuum systems for health care facilities.
C us • idor /WulerAs.irator V 0 Any multipurpose fire sprinkler nc4 system.
❑ Any complex structure as defined
Dishwasher Commcrciul ~ ned in OAR918-780-0040-
--
_Domestic ■4111.0.1
Submit2
Drinkin: Fountain k
y sets of plans with any of the above.
Floor Drain sink . . 2^ �� { it t11 1�t 4" t ti' �G',r'.5 �}° �'" nS",,,� e a n n tm
{ t i e + , S ° 1 It y4d+ • Li �1pW' w d 1 L" V NIC Y Y mr
3" �� ill?'dw;E 4, " 1 , ' '� �w'ia,v,fie14,: ''" +a`,> A1'' Vii' R<! 4�N�tit e + u4
- 4 „ Tsornetric or riser diagram is required for new buildings
t
Car Wash Drain ��� that meet the qualifications above.
Garbage - Domestic
Disposal - Commercial i
- Industrial wrAt' .
Ice Mach. /Refri , Drains Co ' In = ts regarding fixture work:
Oil Sc orator (Gas Station) �� 1 I - – , ' —
Rec. Vehicle Dump Station A � •,4�! ��
Shower -Gant; �_� ~�� � [ t 0l�tr. w
-Stull –
Sink - Bst/La •tory IIM E nummim
umm
Brad ��� - __
-Co mercial � �
E IMMOMIMIMMII
-s` vise * Note: If the fixture work under this permit results in an
Wi> her- Cio �� ~ � ~ increase of sewer EDUs, a sewer permit will be issued and
for ��►�� fees assessed for the sewer increase must be paid before the
Water Closet Toilet ���� plumbing permit Can be issued- —
Other Fixtures: INIMINIMMIIIMUMENIM
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littp://www.tigurd hall/departments/cd/doCs/FINI F- permitApaloc