Permit CITY TIGARD PLUMBING PERMIT
'T' I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00455
' lll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 --- DATE ISSUED: 9/12/2005
PARCEL: 25111 DC -01700
SITE ADDRESS: 15945 SW ALDERBROOK CIR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.8 LOT: 464 JURISDICTION: TIG
Project Description: Raindrains.
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: ft
DISHWASHERS: RAIN DRAIN: 100 ft
Owner: FEES
WYNNE, ELAINE
1.5945 SW ALDERBROOK CIR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 9/12/2005 $72.50
[TAX] 8% State Surcharl 9/12/2005 $5.80
Phone : 503 - 598 - 0181 Total $78.30
Contractor:
CHAMPION WINDOW CO OF PORTLAND, LLC
13009 NE DAVID CIR REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97230
Phone : 503- 624 -2678
Reg #: LIC 158326
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: - 72, /A 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 Ap f d ,Is El FOR OFFICE USE ONLY
City of Tigard SEP 2 2005 RDeatceeliBveyd f � �� ��
�± Permit No.. 1 \\\,, %y/ yi
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 5 V
Phone: 503.639.4171 Fax: 503.598.1960 / s f/ ,; . rIN, . a' Other Pemut No.:
• I Date /By:
24- Hour Inspection Line: 503.639.417101TV OF TIGARD `1J-� Date Ready/By: Jul': 0 See Page 2 for
Internet: www.ci.tigard.or.us R oI! ®��► DIVISION Notified/Method: 1ki-' Supplemental Information
TYPE OF WORK . FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. i Total
❑ Addition /alteration /replacement 0 Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
- ' ' - CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial 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: /5 5(9'_5' 1,2 ?/ 'r b rr,,,,,k c , f Catch basin or area drain 16.60
• City /State /ZIP: --r, • a v , f / v E., 1 7 , , L/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: LJ v1 il Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
• Rain drain connector ,.2 _m 16.60 - /00 /
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 Back flow preventer Page 2
` h ev r
-� y(J '- SG' /-Ce t' vi <(.a.a lo - ieoc- Backwater valve 16.60
1 ., �fi. 'G7 "-co te c-cij�•� o� 10 t ' t y tb Clothes washer 16.60
f Dishwasher 16.60
`Pxrsfi't'1 5
La PROPERTY OWNER ` ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: k /-'C h!1/ N N C Expansion tank 16.60
Address: Su v e e,- S 6..../0 m ci'e• Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
- APPLICANT ®`CONTACT 'PERSON
' Ice maker 16.60
Business name: ? / C v,,,t ,o, , t t,J ,, //t cf 4/S Interceptor /grease trap 16.60
Contact name: '�c,,, 0 v.,J S C'-/ 1 .1 Medical gas (value: $ ) Page 2
Address: / 3 04, t F; ,Or; ✓` C / ` o.- Primer - 16.60
City/State /ZIP: - / it ± 4 vii / OA. r a .16 Roof drain (commercial) I 16.60
Sink /basin/lavatory 16.60
Phone: (S 0) 6a7 y _ a ‘ 77 Fax: : ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
, .. CONTRACTOR . Water closet 16.60
Business name: .SG- t,•/I-C �t s 4 .b 0 4^i; Water heater 16.60
Address: Other:
City /State /ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: /5" S' Plumbing Lic. no.: Plan review (25 % of permit fee)
Authorized signature: �- State surcharge (8% of permit fee) ,
�� TOTAL PERMIT FEE ? '-.- 3 d
Print name: � try 5 ,- f t Date: 0;0,s This permit application expires if a permit is not obtained w ithin
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 06/05 440-4616T(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 • , . Qty Fee (ea) Total additional $100.00 or fraction thereof, to and
Commercial Back Flow Prevention Device 46.40 including for the first $
$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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
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 Complex Stru -,
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.
Q uantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Typed 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
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
- 3"
.
Car Wash Drain Isometric or Riser D .
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 ermit 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 \Permits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION '- PERMIT #: F :
PLM2005-00455
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/12/2(305
Phone: (503).639 -4171 /� �uua9pu�ii V4
Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' '_
INSPECTION WORKSHEET FOR DATE: 9/14/2005 TIME: 7:09AM PAGE: 100
SITE ADDRESS: 15945 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO .8 LOT #: 464 TYPE OF USE:
PROJECT NAME: WYNNE
DESCRIPTION: Raindrains.
OWNER: WYNNE ELAINE PHONE #: 503- 598 -0181
CONTRACTOR: CHAMPION WINDOW CO OF PORTLAND, LLC PHONE #: 503 -624 -2678
Inspection Request Scheduled For: Date: 9/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
336 Rain drain 015554 -01 503- 572 -3242 N
Corrections /Comments/ Instructions:
/
•
F -ASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL ❑ Cr 1 FOR INSP z n ADDITIONAL SSESSED
//%Phone Inspector: #: (503) 718-