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Permit 4 r, CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00160 '�"�' At DEVELOPMENT SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/26/2005 PARCEL: 2S112CC - 03800 SITE ADDRESS: 08010 SW CHURCHILL CT ZONING: R - SUBDIVISION: BOND PARK NO. 3 LOT: 066 JURISDICTION: TIG Project Description: Replace 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 DECK, DENNIS D + VIRGINIA A 8010 SW CHURCHILL CT Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 4/26/2005 $72.50 [TAX] 8% State Surcha 4/26/2005 $5.80 Phone : Total $78.30 Contractor: RESCUE ROOTER • PO BOX 1728 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Phone : 503- 243 -1172 Reg #: LIC 127325 PLM 34 -168PB 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: -7, f Permittee Signature: A��, �L�/ ,J 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 proj • . Approved plans are required on the job site at the time of each inspection. • Plumbing P Permit t ermit Application ' ' , ` FOR OFFICE USE 'ONLY ' City of Tigard Received, / 5' PermtNo.. t �( 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: y y 0 �✓ \\\,.,0,47".. O (� f V Plan Review Other Permit No.: Phone: 503.639.4171 Fax: 503.598.1960 DH ;dI � Date/By: Hour Inspection Line: 503.639.4175` ill I�, Date ReadyBy: Jun See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: T e: B1 I(7 Supplemental Information TYPE OF WORK FEE* SCHEDULE For special information use checklist. ❑ New construction ❑Demolition Description J Qty. Ea. Total ❑ Addition/alteration/replacement ❑ 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 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: 5 0 10 $ GCS d /W ir lf) )1 + 1 6Th Catch basin or area drain 16.60 City/State /ZIP: " � t yayd ©, 9722 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 ll f / J , / Manufactured home utilities 110.00 16.60 Cross street/directions to job site: 7 (� G. e 7"f O""�! /(iYC/j�� (l Manholes C + QOM i` /V4l f ro/0 / 1) ✓r ha i ie D 1 o 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 R P )a C'- NIGr, / m//1- S Y e r✓1 C Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 [PROPERTY OWNER El PROPERTY Drinking fountain 16.60 Ejectors /sump 16.60 Name: v/'ll J 1 S Dec )� /- Expansion tank 16.60 Address: 8'o / D SG() C�' /I/i- e� i//l�l C7% Fixture /sewer cap 16.60 City/State /ZIP: - 7 - 7/.1d /.1d ©4 9 7 224 Floor drain/floor sink/hub 16.60 Phone: ( j 0g) 639 - g / /LF Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT El PERSON Hose bib 16.60 J �, Ice maker 16.60 Business name: ..es Oe co l-er" Interceptor /grease trap 16.60 Contact name: f7,Y / 'CW eiv Medical gas (value: $ ) Page 2 /� Address: 20 066 Sal gar /ties rr sey Primer 16.60 City/State /ZIP: A ' ' tq/ 1 / - 0 97© 70 - J 72 Roof drain (commercial) 16 Phone: (5:)5 ) 211 - 72 Fax:: ( ) Sink/basin / lavatory 16.60 ' t E-mail: pan 16.60 E -mail: Urinal 16.60 4. CONTRACTOR Water closet 16.60 1 Business name: .,e � C � / u e -)--€ V Water heater 16.60 Other: Address: ae 6,6 5 �iW Bc ' es j y7/ /7 � J�, Subtotal 1- `�� 5 City/State /ZIP: o/v1/i e 64 t /D�O� 7 1 Minimum permit fee: $72.50 4 Phone: ( 503) Z 3 // 7 'Z Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: /- 7325 P imbing Lic. no.: bZ ?(up Plan review (25% of permit fee) Al° _G( State surcharge (8% of permit fee) Authorized signature: 7 _ i ..,.." TOTAL PERMIT FEE 7 6 Print name: X-- al 4/7) ' Date: CM. j 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. i:\Building\Permits\PLM- PermitApp.doc 12/03 440- 4616T(i0 /02 /COM/WEB) .. 4 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 • 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: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to • accurately report fixtures could result in increased sewer fees * . Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved Existing Capped Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" -4 „ Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial increase.of sewer EDUs, a sewer permit will be issued and Ice Mach./Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total -Bradley Isometric or riser diagram is required if fixture quantity - Commercial - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. • Urinal Other Fixtures: • • i:\Building\Permits\PLM- PermitApp.doc 3/03 CITY OF TIGARD . , BUILDING DIVISION _. PERMIT #: PL.M2005.00M0 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/26/2005 Phone: (503) 639 -4171 /o �� 47/ /%/IfIjp@I� i Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/2/2005 TIME: 7:10AM • PAGE: 90 SITE ADDRESS: 08010 SW CHURCHILL CT CLASS OF WORK: SUBDIVISION: BOND PARK NO. 3 LOT #: 066 TYPE OF USE: PROJECT NAME: DECK DESCRIPTION: Replace water service. OWNER: DECK, DENNIS D + VIRGINIA A, PHONE #: CONTRACTOR: RESCUE ROOTER PHONE #: 503.243 -1172 Inspection Request Scheduled For: Date: 5/2/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 005587 -01 503-243 -1172 N Corrections /Comments /Instructions: • .■si% 'AWL" X) 4J PiC (-- ...- . ,....- 4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: i- irk Date:-- 02 Phone #: (503) 718-