Permit ARD CITY OF TIGL PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00489
'l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/27/2005
PARCEL: 2S111DB-05500
SITE ADDRESS: 15390 SW ALDERBROOK CT ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.7 LOT: 405 JURISDICTION: TIG
Project Description: Relocate water heater.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JACK SMITH Description Date Amount
15390 SW ALDERBROOK CT
TIGARD, OR 97224 [PLUMB] Permit Fee 9/27/2005 $72.50
[TAX] 8% State Surchan 9/27/2005 $5.80
Phone : 503- 620 -9519 Total $78.30
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97232
Phone : 249 - 5000
Reg #: LIC 36102
PLM 26 -621PB
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 • - • low rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -• :11-0010 thro oh OA' 95 - 0001 -0100. You may obtain copies of these r -s or direct questions to OUNC by
call g 503 - 246 -6699 o -:01 ' -2344.
Is-ued By: 1 Permittee Sig ��� ;�% / ,
Call 503 - 639 - 4175 by 7:00 a.m. for an inspectio . : 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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Plumbing Permit 1�pplic EIVED FOR OFFICE USE ONLY
Cl} of Ti and Received 4 el � I 49
`' g SEP 2 / Date /By: < / Permit No.: Vii I .+cdto
13125 SW Hall Blvd., Tigard, OR 97223 6 ( Plan Review
CITY
Phone: 503.639.4171 Fax: 503:598.1960 OF TIC//xx�irl:!q� i I i ;\ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 'A � � D ate Ready /By: t • RI See Page 2 for
Internet: www.ci.tigard.or.us BUILDING �" +, Notified/Method: • �a Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
dst Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Cl and 2- family dwelling ❑ CommerciaUindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
. Fire sprinkler ( sq. ft.) • Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: t 573 0 15 (...t . ' A ., a ,, , � - Catch basin or area drain 16.60
City/State /ZIP: iGot t'� � a � Drywell, leach line, or trench drain 16.60
n �
Suite/bldg. /apt. no.: J P roject name: 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
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 WO Backflow preventer Page 2
eaDc r i 4 . l.AOck.4-e .( Y� all-e- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
1 PROPERTY OWNER • " Drinking fountain 16.60
❑ TENANT
Ejectors /sump 16.60
Name: S K. 5 orl.`,AAN. Expansion tank 16.60
Address: 2 (A ) ` � 0 -ems Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
/ � . c , lq F ax: Garbage disposal 16.60
Phone: ( ) • l q l ( )
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
_ Interceptor /grease trap 16.60
Contact name: c) Ct- L 10 C.A.m, o c _ a . ( - Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof -drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory - - 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR •, : - ' - Water closet 16.60
Business name: - ?1 , on 49 ..... e4 - ( .cA,inaC.2 Water heater ': 16.60 i( CEO
Address: - 6C , 21. - $46 c�( - Oaf Other:
•
City/State /ZIP: ' c ;„,,,a 0 e..., 9� 3 Z Subtotal
� Minimum permit fee: $72.50 ' Z. $6
Phone: (53 )" 2_4 q _5 . Fax: (' JQ j) Z _ g 0 Residential backflow minimum permit fee: $36:25
State
CCB Lic.: c?�_ to o �''iI D -7 Plumbing Lic. no.: ", 4 .� 2t 1 F.) Plan review (25% of of permit fee)
surchar ( 8% pe rmit fee $ C7
Authorized signature: aJV‘ U.` Q Q 0 __ 7/i/0
TOTAL PERMIT FEE 7 $ 32-
Prin n �! u +M 00�l".lta`) nu " Date: � S - 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.
Plumbing Permit Application - City of Tigard
a
P ge 2'- `Supplemental Information . •
Fee Schedule: Residential Fire Suppression Systems: -
Site Utilities Qty• Fee (ea) , . Total Squar` e Footage: , , ' Permit Fee: • -
Footing drain - 1" 100' 55.00 0 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
Q . ' Fee.(ea) - Total additional $100.00 or fraction thereof, to and
Fixture or Item 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 - $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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, alterations or additions to food service
-Drive Thru • facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain .
❑ Any NFPA 13 -D multipurpose fire sprinkler system. •
Eye Wash
Floor Drain/sink - 2"
3 „ Submit 2 sets of plans with any of the above.
4
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
Water Extractor -
*Note: If the fixture. work under this permit results in an • -
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.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00489
i 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/17/2005 TIME: 7:04AM PAGE: 55
SITE ADDRESS: 16390 SW ALDERBROOK CT CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.7 LOT #: 406 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Relocate water heater.
OWNER: SMITH, JACK PHONE #: 503620 -9519
CONTRACTOR: PIONEER GAS FURNACE PHONE #: 249-5000
Inspection Request Scheduled For: Date: 10/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Plumbing final 018362 -01 503.249 -6000 Y
. Corrections /Comments /Instructions:
•
1 1,JDASS 1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: / Date: 0 (/ Phone #: (503) 718-