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Permit , • CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00234 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2009 Parcel: 2S103BB01400 Jurisdiction: Tigard Site address: 12476 SW BROOK CT Subdivision: BROOKWAY Lot: 14 Project: Zagorodney Project Description: Replace 50' water service. Owner: FEES ZAGORODNEY, WENDY Quantity Description Date Amount 12476 SW BROOK CT TIGARD, OR 97223 50 If Water Service 08/26/2009 $55.00 PHONE: 503-319-0805 1 12% State Surcharge - 08/26/2009 $8.70 Plumbing 18 ea Minimum Fee Adjustment - 08/26/2009 $17.50 Contractor: Plumbing WESTERN PLUMBING 9460 SW TIGARD, AVE STE 101 TIGARD, OR 97223 PHONE: 503 -639 -5296 FAX: 503 - 684 -9015 Type of Use: SF 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: r Permittee Signature: 19p/04/6w-770/N/ / 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. 7 08/26/2009 07:56 503E849015 WESTERN PLUMBING INC PAGE 01/03 Plumbin Permit Applicat i t C AVE FOR OFFICE USE ONLY ' City of Tigard Received (ja I� '��I 13225 SW Hall Blvd., Tigard, OR 97223 H G 2 6 ZOOB Date/Dv: O Pwm 11°, 4A1- , -6/ a 3 ' Rel ss iel Il h Phone: 503.639.4171 Fax: 503.598.196 Pi r� TIGARD InspectionLinc: 503.639.4175 CITY OFTIGARD Datc/ny: OtlarPcrmitNo.: latenlet: Date Rudy/By: !D www.tigard or.g'o a DING DI�I n y y Su, See Page 2 for l }" - i ISlO NotScdNetiod: A4', a,� , ,; .� � ,� ,� �t�,„, ���, ,� ""i � \ t r , ..� .,.� El Su Iemeutallnformation .. a.._ : ; 4,: ....ct-,,c4 Sg1; 7 M;;; , r, "� ( P Affi ...ir`.i , " kiP KP, , 7 ,. Y��-<.s� �"�' Cw" IK ,: "i"'" t a i ,1 ^ e s.? .. _ ; Ww '."1i, :. w c..: ;. � ,..3u...,c.° - -:- . u � u, 4 & u:..,..�a` , .,.m�la�'d,.,.- ,+�.,.�:i::� ..,�,,..., <u ""� ��. n,. ..,� � '� � ",Y, ' + � �, F)r�.. Ni° IHa A� r � � 1.. ^^,p xr wp ""rr� °�b'M�...,%l�;, 1� ,.Yy { Z �2(v f��;,(�f , r„4u.�'S��. � ✓,�k 3`i R ❑ New construction �^ .. 4 Y �. m ❑ Demolition For s p eclat information use eheckllsr. �c�1 Addition/alteration/replacement 0 Other: New 1- 2-family Descri.tion Ea. Total 7 � . raTam i?:,� q r 7; i-' t , :'r }iia'. "te e ns s.: :r ,- „Y , .,. dwellings - S t _ S t } e r(7tk t f tS r +� -s ; - . " "Y r t ' 1 4 +M S S t� 'i i ■ Xr “ .4,...,.;;;;,.„,., r " V 7 `` l " 4.'7,1.9 6 f """"'" Y IJngs (Includes 100 tt, for each utility connection) . ' ,,.. ,( ,. c l m ,. 2 1 r:l t j : F s {i „ SFR (I) bath . �.a,R,..::Ft_ . Y w;.kw,Ew.,n...a,�4 � -.a u...,.,, ,.c }..,.rc , -4„ lY 249.20 IV I - and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath -- 399.00 ID Master builder ❑ Other: Each additional bath/kitchen 45.00 r n " ". Y :'u �;- .;: °,., sa r .ii .,r. � wie:):'..,;r v. c „» Fire sprinkler u t hen Y! � 1' aw.. 1 t)C��)Vu � ri4; „ w g I 6 \ }k * qr,,, :9:,u�"'� r � f „x..1 ..1 t .,. ill p r ( - Sq. ft.) _ ,� f�I t S t } } r , r :..: Sit utilities r a i i0.0 �i1. Catch basin or area drain 16.60 City /State /ZIP • , 1:. Drywell, leach line, or trench drain 16.60 J illy:. Suite/bldg. /apt. no,: t Project natne: : •n .t . w ,� _ tyt� Footing drain (no- linear ft.: _,_) Page 2 : Cross street/directions to job ate: Manufactured home utilities 110.00 Mil - Manholes 16.60 Rain drain connector 16,60 Sanitary sewer (no- linear ft-: Storm sewer (no. linear ft.; ,.._J Subdivision: Lot no_' Water service (no- linear ft-. -fiumnwron `i Tax map /parcel no.: Fixture or item d "Q' . ` 'ti i S u i ""wM� , 6 '^�'""u,��? Oh`15., 6'mr ,T a ('�Wa ""'(`"'" �'.urp °r"fr i l -ri yr ^^ t Absotption valve 16.60 I R 1i1:3n r F . -a , I;:1.3ti- f ._.,. ;, ' ," ,,. . ,.„.4. , , , ,,,Backflow preventer p age 2 A Et> r' 'Yl y qII!' .�, � 17gili, tt77:; ::;;;;te T,7 r w Drinkin NOM ,1 '24':5 +.:4 .. °_ xl.)" ,"',a(S3_. :47.7, 4 t t i ;,. `S fr" !I� k s, u, , iS : • �' fountain .r. fr. . t. ' ,1 >, ,� w,.,..,,r; i , i 13 Nst i .t f tt r� , l , ] 6.60 Na1 =EMMIff OVA ' .. 4- u._ .< - i Its., :? ujtictorsl5urnp 16.60 Adflress: c 16.60 �� "' `�._ . Fixture/sewer cap 16.60 City/State/ZIP; Floor drain/floor sink/hub J/ 16.60 phone- ( 3� el / s ,Fax: ( Garbage disposal t � w..,.ry -. c� /,w.� ' rat. �.: ' , 5 +. ;,+ . k :r'. "s : ,.h�,: ,, :"e, y �:,F , . y. <;, :;C,. � ' .::.t1- =�.."�' ° ''�,. :te ls.: qA1 . - _Aa l _�., . t 2'.. :i �,� �>•...4 t4 ^t _ y , J y�c 1 7 TJ 4a` 'S"f�yk -.q.�, 16.60 Business name: 16.60 Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Address: Primer 11111 16.60 City /State/ZIP: Roof drain (commercial) NMI 16.60 ELI Phone: ( ) Fax: : ( ) Sink/basin/lavatoty 16.60 E-mail: Tub(showcr /s how er pan 16.60 .,. 1'.` �_ c,. r" �" �. zrF � „�_�y,A.....,�,. •••^ r; � r.-:. ::"'.: ..,.,rc .- ^ .�;Y: ,:- :,,....m:�. 7 . � ha 4 r w b a 1 \ a w �G t lYy . Urinal 16,60 >~,�r Bali ct Ai.7h4.,7 �y nX';;P• 3 metal r(.," 7 '17A , " "nk ly . "/;,;; ti;: ;.d+�...': �. k,� t•� r mi `^ i 4 ..sW. G Water cloact 16.60 Business name: Western Plumbing, Inc. _ 1660 Address; 9460 SW Tigard Avenue, Suite 10i. Othtr: III. City /State /ZIP: Tigard, Oregon 97223 Subtotal � Phone: (503) 639 -5296 Fax: (503) 684 -9015 Minimum permit fee: $72.50 Illan Residential backflow minimum permit fee: $36.25 Plumbing Lie. no.: 3429PB Plan review (25% of permit fee) NMI Authorized signature 1) State surcharge (12% of permit fee) a _ o f "� - i/ , TOTAL PERMIT FE ORM 1 Print name: Dana Jensen Date; i rJ This permit application expires if a permit is not obta 180 days after it has been accepted as complete. "Fes methodology set by Tri- County Building Industry Service Board, r: \B,fd:nyV`c .1.* 1 - 6 4- Pan..uADV.AOC vohaoe 4 0- R616T(]a/Q,2/CoM'waa •.18/26/2009 07:56 5036849015 WESTERN PLUMBING INC PAGE 02/03 Plumbin Permit Application - City. of Tigard • Page 2 - Supplemental Information c Fee Schedule: te :. Fee S. h .... tt + .. � :.. , � , :... ;�.= : ��:�* ,.�y ;�:.:,,:. , >.j:,�- :.::::- :r a�,:�.�f; u: -:; ,,,.....,M �. -._. al Residential Fire Su • • xessiou S stems: a to 1t li , ii : , a tx :.r jF< , r ( „ a - n *f < ( , y ': k - 4q: p . :, , : y 30n 4,*� .4& _.,.._$i t�w,..,,.re ,kr. Fr r Y, ( c s ; w : % t : 'l.. yy :"1T / r f 4 , - . t: r c;, e A . rr ra. . "A..7; ,�_.�� ;.,.�, nr:` �ti �.�L� ✓�•i2�..i>:G! ' P.ri4� , �2 §P I,N ( �. ��, �� Jppll 1� I � YLj ,s E hs' t� �. .., S $ . 15. ta r..._.... { ,. (� ... c,P . � s.: r ..., R- s a, Footing drain -1 100 5 5.00 0 to 2.000 $115.Op Footing drain - each additional 100' 46.40 M 2.001 to 3.600 $160.00 Sewer - 1st 100' 55.00 3 601 to 7 00 $220.00 Sewer - each additional 100' 7,201 and :seater $309.00 96.40 Min Water Service - 1st 100' -al 55.00 - �" Water Service - each additional 100' '� Medical Gas S Stems 46.40 tat '"x +2 7 -. StStorm & Rain Drain - lst 100' a 6G+ L Btt, i .' >l ,4 a w^ z "PIX .* a >Wl l t,Mi 55.00 - � �.� Storm Rain brain each additional 100' 46.40 $1'00 to $5.000.00 Minimum fee $72.50 i S tor m -. ai to $10,000.00 .te�rr ` n . x •....:... _ .,,.,.,.. 0 $72.50 - foible first 55,000.00 and thereof, t for each i'.:: «fAtfl: r.. _:a. ;.. a,:= f::>:r`�,�PfrG.' 'a r "" ;!fi� tp. "k5: :„ajY additional a D. a..x „«, ..,_.. r ,1 „craw r ...a...� <.._.,�,:. ; - ?a;�f },._ �..":;...�, n I $10 00 or tract,on thereof, to and Commercial Back Flow Prevention Device NM 46.40 includin • $10 000.00. first $ $10,001.00 to 525,000.00 $148.50 for the first $10,000.00 and $154 for Residential Backflow Prevention Device 111101111111 each additional $100.00 or fraction thereof to minimum . emut fee $36.25 and includin, $25 004.00. Rain Drain, single family dwelling 65.25 525,001,00 to $50,000.00 $379.50 for the first $25,000.00 and 51.45 for Inspection of existing plumbing or 111111,1111111 each additional $100.00 or fraction thereof, to a recial! • re. nested ins>actions - >er hour and including $50,000.00, Subtotal: NM_ $50,001,00 and up $742,00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. I • Fixture Work • ::.: .,,.. a�i�:t�Wlrl t. :... g cs'i 1 , 1 `r ;„ � t.1h , i` 1 , t P l'�' �t,s & F �� - im il Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of he following. } - :,'_.r.._ %,;t rai t; please indicate work performed by fixture. Failure to Please check all that apply. accurately re, ort fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and c� il., *�.` :::ati# , . d :!.;.., ,,.p „„; „., i "a ' ',( 1, .. :. _,. : -,,.. greater, except systems d • �1'4 l rtr ; '� it+ '��`�' f � �i'I i s ' 4 � -,, �tl,��i w��xs+:�,•uFts� � P Y designed and stamped by licensed 'ei?5. ;, "w .. % 11 i,S- µ er . a i f f cltiot' LW r : k' t i i •(l w Pt y,}t w � t w ' i0 1 a engineer. tibl i " "' atil.11 g a llti �.' ^a :ry'"'�gillit ,. fft cif011 ❑ Any new exterior plumbing site utilities. B+ tistr /Font Bath -Tub /Shower ���- ❑ ❑ Any mu ltitips and vacuum i n k ers for health care facilities. - lacuzzi/Whir1 � oo! Any mu purpose fire sprinkler system. Car Wash -Each Stall © Any complex structure as defined in OAR9I8 780 Op4p. -Drive Thru Cus•idor/Water • orator IMII M Mil 5ubmit2 sets of plans with any of the above. � Dishwasher -Commercial 111M� -Domestic 111.111111.1=1 MEN Y t ms s "'x ;. ir7 , y pp :,aL -_ 4 `�t ��,.,. (� hn ra Pf S F i z ,,,,, Ta.y� P l /. �' 1 i. N � ( Drinkin: Fountain ���� r..,. al, aw..,ar, ,.re *srrr- �-9. �^.... �- '�L� �".".: (kt ���� ❑ isometric or riser diagram is required for new buildings Floor Drain/sink . 2" 1.11.11111M that meet the I ualifications above. • - 4 " A MEN C regarding fixture work: Car Wash Drain��� g Garbage - Domestic Disposal commercial IIIIMIEIIIIMIIIMIN - industrial MU Ice Mach.IlZefri • . Drains 11.11/1. Oil Se arator Gas Station Rec. Vehicle Dum. Station ~� - Shower -Gang - stall MUM WWI "Note: If the fixture work under this permit results in an Sink - Bar/Lavatory MONIMIMME of sewer EDUs, a sewer permit will be issued and - Bradley MIIMEIIIM fees assessed for the sewer increase must be paid before the - SC ervice o vice `ai ��� plumbing permit can be issued. -S Swintmin_ Pool Filter Washer - Clothes M`� Water Extractor water Closet - Toilet �� �� Other Fixtures: � . i : \a..iidine.p„nit.Wr ,- Ra•,nit.lpp.4. 09/22Po0