Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00409
c� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 -- DATE ISSUED: 8/25/2005
PARCEL: 1S134CA-05200
SITE ADDRESS: 11775 SW BURLCREST DR ZONING: R -4.5
SUBDIVISION: BURLWOOD NO.2 LOT: 024 • JURISDICTION: TIG
Project Description: To obtain Final Inspection for work already done.
CLASS OF WORK: ALT 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: 0 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: 0 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
HOF, DANIEL L + MARY F TRS Description Date Amount
11775 SW BURLCREST DR
TIGARD, OR 97223 [PLUMB] Permit Fee 8/25/2005 $72.50
[TAX] 8% State Surchari 8/25/2005 $5.80
Phone : 503 - 590 - 8311 Total $78.30
Contractor:
BRUNER PLUMBING
PO BOX 23985 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97281
Phone : 503- 624 -4880
Reg #: LIC 81837
PLM 26 -445PB
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: , nL , c, Permittee Signature k' l! „y� ; ; L�
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.
$u • cl ng Fixtui ECE V L D .
Plumbing Permit Application FOR OFFICE USE ONLY
NAY 4 0 tuna
City of Tigard R eceived Y, c 26 D5 036 Permit No.. �/ .. oOIiD9
13125 SW Hall Blvd., Tigard, OR 97223 T Plan Revi� vY
Phone: 503.639.4171 Fax: 501?598n §60 IGARD / jy . n , ; Ntw , ,.: l Other Pennit No.:
24 -Hour Inspection Line: 5D,1i,§'. _9E4p17153 DIVISION W ' � Date/By. ": _., Date Ready/By: Judi ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /9 Supplemental Informat
TYPE OF WORK • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
• Ifnd 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ 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: 7/77c E- � / eg o r/.. 1.....g / 6r - Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 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.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
// DESCRIPTION OF WORK Backflow preventer Page 2
. 477)0 o /Or ..,c4 1.4i v ,A / , V , `j Backwater valve 16.60
U� a1 0/ i - ( / . y y - - /4s &, 0 Clothes washer 16.60
�L - G
/Y [ Dishwasher 16.60
[.i/
Drinking fountain 16.60
,(PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: A >Q - / C f"Yn. Expansion tank 16.60
Address: //77A S" 41 A 6: 3 6 , 4 7 , s -' • d Fixture /sewer cap 16.60
City /State /ZIP: f Y a 0/ 97,2> .2 -3 Floor drain/floor sink/hub 16.60
Phone: (s"o3) S PO " "3 /1 Fax: ( . ) Garbage disposal 16.60
ID 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
ub/srtower /shower pan 1 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: --3 / ..,..., y,, 2 y ® Water he ater 1)Attov 16.60
Address: ' ..C) �v� 0�3 9 gas O ther: � 1 � i Kit •
City /State /ZIP: r. , r .� / 0 ...
Subtotal
Minimum permit fee: $72.50 -�
Phone: (c ) r/ y 9Fe b Fax ` ( ) Residential backflow minimum permit fee: $36.25 7a, S
4 /S "2.1-, �'Q -y� Plan review (25% of permit fee)
CCB Lic.: 1 t > l � u7nb ic. no.: ll J
- , - - State surcharge (8% of permit fee) 5, III
Signature of Owner /Agent Dat
�Z TOTAL PERMIT FEE ?g .
- --
This permit application expires if a permit is not obtained within
. Contact Person Name h one 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
.0/02/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 - I 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' V 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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 ty. 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
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 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
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" • 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 *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.
-
is \Building \Permits \PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005„00409
r 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/25/20055
Phone: (503) 639 -4171
A /1
Inspection Requests (24 Hrs.): (503) 639 -4175 _.'
INSPECTION WORKSHEET FOR DATE: 9/&2005 TIME: 7 :06AM PAGE: 5U
SITE ADDRESS: 11775 SW BURLCREST DR CLASS OF WORK:
SUBDIVISION: BURLWOO NO.2 LOT #: 024 TYPE OF USE:
I PROJECT NAME: HOF
DESCRIPTION: To obtain Final Inspection for work already done.
OWNER: HOF, DANIEL L + MARY F TRS, PHONE #: 503 - 590 -8311
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 - 624.4880
Inspection Request Scheduled For: Date: 9/612005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 01492401 503-590 -8311 Y
Corrections /Comments/ Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED .
Inspector: Date: h Phone #: (503) 718-
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CITY OF TIGARD ,. •
BUILDING DIVISION PERMIT #: P M200rr00409
13125 SW Hall BIkd.,'Tigard, OR 97223 DATE ISSUED: 8/2612005
Phone: (503) 639 -4171 A'l''y1y
Inspection Requests (24 Hrs.): (503) 639 -4175 �':� "'f -l..
INSPECTION WORKSHEET FOR DATE: 8/26/2005 TIME: 7 :06AM PAGE: 88
SITE ADDRESS: 1 1775 SW BURLCREST DR • CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.2 LOT #: 024 TYPE OF USE:
PROJECT NAME: HOF
DESCRIPTION: To obtain Final Inspection for work already done.
OWNER: HOF, DANIEL L + MARY F TRS, PHONE #: 503 - 590 -8311
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 - 624 -4880
Inspection Request Scheduled For: Date: 8/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 014330 -01 603-590-8311 id
Corrections /Comments/ Instructions:
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