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Permit
.t„ I4- 1 C ITY OF TIGARD PLUMBING PERMIT 41, DEVELOPMENT SERVICES PERMIT #: PLM2006 -00537 --- 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 . - DATE ISSUED: 11/3/2006 PARCEL: 2S104CD -03700 SITE ADDRESS: 13641 SW BENCHVIEW TERR ZONING: R - SUBDIVISION: HILLSHIRE ESTATES LOT: 037 JURISDICTION: TIG Project Description: Installation of 50' of 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: 50 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES LINDA BAKER 13641 SW BENCHVIEW TERRACE Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 11/3/2006 $72.50 [TAX] 8% State Surcha 11/3/2006 $5.80 Phone : Total $78.30 Contractor: UNITED PLUMBING 40333 SE MEADOWSONG RD SANDY, OR 97055 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 752 -8446 Reg #: LIC 165115 PLM PB54 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 o irect questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Iss d By: M L � Permittee Signature: Call 503 - 639 -4175 by 7:00 a.m. for an inspection that b siness 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. Plumbing Permit Application - - • Building Fixtures FOR OEE10E USE ONLY ' City of Tigard Received 4 Q C /_ Permit No.: '1 „5 DazeBy. d (f/ II q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review '.: o , Phone: 503.639.4171 Fax: 503.598.1960 Daze/BY Other Permit No.: Inspection Line: 503.639.4175 Date Read B lu ®See Pa e 2 for TIGXRD Ready /By: � h .. Internet: www.tigard- or.gov Notified/Method: t"/ I8.. Supplemental Information TYPE OF WORK ,, ' F EE * SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I 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 (I) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 11 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: ) 3 64/ I 5 k l 13e,, c.,k t/ i Pw T&j. v. Catch basin or area drain 16.60 ' City /State /ZIP: T f a J 4 ©f 9 7 , a 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 7 I Project 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.: ij Page 2 Fixture or item Tax map /parcel no.: • . Absorption valve 16.60 ' DESCRIPTION OF WORK Backflow preventer Page 2 CA...) ( "I e-4-1 S. 42' v t r C P Backwater valve 16.60 • Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER 0 TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: 1 .4 0/ 5 5 a ltd Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 . ❑ APPLICANT, . . . ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: 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: () 6,1 r r t;A` R p) k P-si 41,...... Water heater 16.60 Address: Li 0 3 3 .3 g l 4I'1 a d p I t, So.-el /Z' Other: City/State/ZIP: a ( Subtotal y `� d Q r b 7 c S s Minimum permit fee: $72.50 7� j Phone: ( 93 3 .4 7 S a., i try ye Fax: ( ) Residential backflow minimum permit fee: $36.25 _/ CCB Lic.: t 6 S , i S " 4,(,,d, 7 Plumbing Lic. no.: /3 S Plan review (25% of permit fee) • l�' g State surcharge (8 %ofpermit fee) G� ,, g0 Authorized signature: �dY'1 ,71/ TOTAL PERMIT FEE 76 , Print name: a S O ✓1 `G...4.--I �~ `j Date: / ( - 3 - Q 6, This permit application expires if a permit is not obtained within i 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 04 /06/06 440 -4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard ' "' . „r • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ,Site Utilities • Qtr. Fee (ea) Total Square. Foota ge: 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 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: $50,001.00 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 Plumbing,Ins 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 ❑ Any new exterior plumbing site utilities. Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities. Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system. - Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040. Car Wash -Each Stall -Drive Thru Submit 2 sets of plans with any of the above. Cuspidor/Water Aspirator Dishwasher - Commercial Domestic Isometric or Riser Diagram • Drinking Fountain ❑ Isometric or riser diagram is required for new buildings Eye Wash that meet the qualifications above. . Floor Drain /sink - 2" • -3" -4 ', Car Wash Drain Comments regarding fixture work: Garbage - Domestic Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station • Shower -Gang -Stall Sink - Bar/Lavatory - *Note: If the fixture work under this permit results in an • - Bradley increase of sewer EDUs, a sewer permit will be issued and - Commercial fees assessed for the sewer increase must be paid before the - Service plumbing permit can be issued. Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 09/22/06 CITY OF TIGARD X 0-4 v C oo c-3°), BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 !iuN�u�iil'� Inspection Requests (24 Hrs.): (503) 639 -4175 Ar INSPECTION WORKSHEET FOR DATE: t (At) /6 ( TIME: PAGE: X36 I � SITE ADDRESS: ' CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspecti n Description Confirm # Contact # Message o '1/42v � u `7 2 4 JJJ. Corrections /Comments /Instructions: SS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS • FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: M I IR" Date: . Phone #: (503) 718- �t�,�