Permit •
pp CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00554
TIGARD DATE ISSUED: 12/14/2007
13 125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103DD 00403
SITE ADDRESS: 10645 SW FAIRHAVEN ST ZONING: R -3.5
SUBDIVISION: FAIRHAVEN COURT LOT: 003 JURISDICTION: TIG
PROJECT: SCHMIERER
Project Description: Replace 50ft. water service.
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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: 55 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SCHMIERER, MICHAEL J AND
BARBARA L Description Date Amount
10645 SW FAIRHAVEN ST [PLUMB] Permit Fee 12/14/2007 $72.50
TIGARD, OR 97223
[TAX] 8% State Surcha 12/14/2007 $5.80
Phone : 503- 639 -8797 Total $78.30
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 624 -4880
FAX 503- 624 -2173
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: ) Permittee Signatures
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.
Plumbing Permit A4 ' � ' �� ,� •
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Litt,' 14 2001 Received ^ Permit N
4 13125 SW Hall Blvd., Tigard, OR 917 I Y p y�� Review Other Permit Date /By: Lp` 1 1 1 (ol '?.2.0 �tIvi2 , 17_c 9 5 - 5 - h "
1 s �� 1 Au p R
C' Phone: 503.639.4171 Fax: 50 6� Ur 1 ` Perm N Inspection Line: 503.639.417 By
Ins
P ►. d / By: lu ® See Page 2 for
T 1 G A li D Internet: www.tigard-or.gov V 1�jJ�J �� 1, S ;;' Method. Supplemental Information
TYPE OF WORK . FEE* SCHEDULE .
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. Ea. Total
.'Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
C ATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Z`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: /(24,9 5, w , Fa / r4a Vt , i S f- Catch basin or area drain 16.60
City /State /ZIP: T9w,."( C, : '17Z-2-3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: 6'c,/,...1 ✓1--%� Footing drain (no. linear ft.: ) Page 2
� 7 Manufactured home utilities 110.00
Cross street/directions to job site: ct f o1 co (,' - A-- i v7 c- Manholes 16.60
J / 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.:5 0) 6 J ' Page 2 SS, `'°
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
- DESCRIPTION OF WORK • Backflow preventer Page 2
rep C49 eitfr -�t/ f 4:;>t/' y Backwater valve 16.60 .
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER ❑ TENANT
� j - ' Ejectors /sump 16.60
n
Name: nit t (k, S1 vl - 1,,,,, ._ Expansion tank 16.60
Address: S f`M Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
S
Phone: ( 53) u J 7 p _ {J 71 '7 " F ax: ( ) Garbage disposal 16.60
❑ APPLICANT El 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
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( )
' Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR . Water closet 16.60
Business name: g r.„ MFi- PL( fr / „ C 1 . , Water heater 16.60
Address: e 3'> 2_101 ' S
J Other:
City /State /ZIP: l l 9 l 0 re _ ' 7 2_8 / - 3cl ' _ Subtotal
Minimum permit fee: $72.50
Phone: (503) 6" Zcf _ f f'ae c , Fax: (r) 53 ) 62<( 2_17 3 Residential backflow minimum permit fee: $36.25
Plan review (25% of permit fee)
CCB Lic.: � . -7 Plumbing Lic. no.: LG y j P� State surcharge (8% of permit fee) .4, +O
Authorized signature: TOTAL PERMIT FEE sq. t( J
Print name: (,�Gy,_a( fgyL,�a„ Date: 1 I y 0 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete. �f 27)
*Fee methodology set by Tri -County Building Industry Service Board.
I: \Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard >R
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities 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: Plan Review for Plumbing Installations
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 ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
•
- Industrial •
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar /Lavatory •
- Bradley *Note: If the fixture work under this permit - results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i' \Building\Permits\PLM- PermitApp doc 12/27/06
CITY OF TIGARD . .
.,_ •_
BUILDING DIVISION PERMIT #: PLM2007-005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1412007
Phone: (503) 639-4171 koppplitil\
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12118/2007 TIME: 7:01AM PAGE: 60
SITE ADDRESS: 10646 SW FAIRHAVEN ST CLASS OF WORK:
SUBDIVISION: FAIRHAVEN COURT LOT #: 003 TYPE OF USE:
PROJECT NAME: SCHMIERER
DESCRIPTION: R 5011 wa serv
OWNER: SCHMIERER, MICHAEL J AND, PHONE #: 503-639.0797
CONTRACTOR: BRUNER PLUMBING PHONE #: 50.7624-4880
Inspection Request Scheduled For: Date: 1 211912007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service _ 061710-01 503-624-4880 N
t met I.
Corrections/Comments/Instructions:
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0 44 - r ,, PI i . .1•••"" _ . * 0 le, to t—...i 41i ' Ar ., , tc4 ibr4 V-e. ' •
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- PV0 ±e--(7k
c olgt G1 i.
\ PASS El PARTIAL APPROVAL E CANCEL I I NO ACCESS
n FAIL El CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Date: 1 I ( tI07 Phone #: (503) 718-