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Permit CITY T l GARD PLUMBING PERMIT 'AiT`„ I& DEVELOPMENT SERVICES PERMIT #: PLM2005 -00464 ,� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/16/2005 PARCEL: 2 S 10 3 DA -05100 SITE ADDRESS: 10635 SW COOK LN ZONING: R -3.5 SUBDIVISION: FANTASY HILL LOT: 008 JURISDICTION: TIG Project Description: Sewer connection. 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: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES IRENE MAWHIRTER Description Date Amount 13960 SW 100TH AVE TIGARD, OR 97223 [PLUMB] Permit Fee 9/16/2005 $72.50 [TAX] 8% State Surcharl 9/16/2005 $5.80 Phone : 503 639 - 6645 Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone : Reg #: 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 the.- les or direct que • •.ais to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. h., Issued By : Permittee Signatur• I� d Call 503 - 639 -4175 by 7:00 a.m. for an inspection at 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 „ r.q . . FOR OFFICE USE ONLY Ci of Tigard Received _ _ • `r g Date/By 9 1 0 / 1 ) $ Permit No.T ` ad) C 5/G y 13125 SW Hall Blvd., Tigard, OR 972 3 ® 1 c �oo Plan Review / Phone: 503.639.4171 Fax: 503.598.1111! I 1 v / /aita;A t�" j y Other Permit No.: a 24- Hour Inspection Line: 503.639.4175 J �' Al I ' Date /B . 1uris: Internet: www.ci.tigard.or.us TSC.1��® Date ed/Met y: // Supplemental Seepage l for CITY OF Notified/Method: � � V Supplemental Information - , .,tL l$I ® FEE* SCHEllULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total AA ddition /alteration /replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 X and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 'El 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' SIT INFORMATION AND ,LOCATION Site utilities Job site address: / / (, 3 5 L(1 e,0 O /: 4) Catch basin or area drain 16.60 • City /State /ZIP: / ' 20 ©e_ U 7 7 ` �� Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: `; /V ! Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 (AM (AM /x-/ Al 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 Back flow preventer Page 2 /D 0 (Z it t $ g_trlJ _ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 2- ) Drinking fountain 16.60 E I PROPERTY OWNER ❑ TENANT . 7 t rJ/� 1 �� Ejectors/sump 16.60 Name: / /d Expansion tank 16.60 Address: / , 4� 0 5 G:ut / 7"4 ✓��, - Fixture /sewer cap 16.60 City /State /ZIP: 77(,--A2,47(.4 ) g Floor drain/floor sink /hub 16.60 Phone: ( ..- �3 .r ( Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON ' - Hose bib 16.60 �-� Ice maker 16.60 Business name: Cam' 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: ( ) I Fax::( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: O ____ Water heater 16.60 Address: Other: Subtotal City /StatelZIP: • Minimum permit fee: $72.50 Phone: ( ) ` Fax. ) Residential backflow minimum permit fee: $36.25 CCB Lic.: I Plumb g Lic. no.: Plan review (25% of permit fee) Authorized signaC� _. ' �` J / State surcharge (8% of permit fee) �_ TOTAL PERMIT FEE V • Print name: /) .6 (( � Date: I p J Th is 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. is \Building\ Permits\ PLMF- PennitApp.doc 06/05 440-4616T(10 /01KOM/WEB) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Fee Schedule: Residential Fire Suppression Systems: •Site Utilities ,_ Qty Fee (ea) Total Square Footage:_ P F eei „ ., 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 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: $50,001.00 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 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 Perfortried ❑ 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. -3" -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 permit results in an Water Extractor er 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. • 1 i:\ Building \Penniu\PLM- PermitApp.doc 07/06/05 CITY. OF TIGARD • BUILDING DIVISION PERMIT #: PLM2005 00464 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 911612006 Phone: (503) 639 -4171 IIiityl ill Inspection Requests (24 Hrs.): (503) 639 -4175 ..:' ■ ....... INSPECTION WORKSHEET FOR DATE: TIME: TIME: 7:08AM PAGE: 83 • SITE ADDRESS: 10635 SW COOK LN CLASS OF WORK: SUBDIVISION: r= ANTASY HILL 008 #: 008 TYPE OF USE: PROJECT NAME: MAWHIRTER DESCRIPTION: S erer connection. OWNER: MA•IIRTER, IRENE PHONE #: 503 - 635 - 6645 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 91280005 Pour Time: • Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 016782 -01 503-4107-6009 N Corrections /Comments /Instructions: ' -- 7 ' i i i If fa 'ASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector:fri Date: / ` Phone #: (503) 718-