Permit hek CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00491
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED. 9/28/2005
PARCEL: 2S 103AD -00400
SITE ADDRESS 10980 SW ERROL ST ZONING: R -4 5
SUBDIVISION: LOT: 012 JURISDICTION. TIG
Project Description. Sewer connection existing residence
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: 55 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CHUKE, STEVEN C + Description Date Amount
CHRISTOPHERSON, BARBARA J
10980 SW ERROL ST [PLUMB] Permit Fee 9/28/2005 $72 50
TIGARD, OR 97223 [TAX] 8% State Surchari 9/28/2005 $5 80
Phone: 503 - 598 -4587 Total $78.30
Contractor.
IVAN MCBEE EXCAVATING
28104 S REDDING LN REQUIRED ITEMS AND REPORTS
MULINO, OR 97042 - 9708
Phone: 503 -239 -2620
Reg #: LIC 1944
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 503-246-66" • or 1- 800 -332 -2
Issued By: , _ e Permittee Signature ��
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.
it wilding FhixturRECEIVED
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard SEP 28 2005 Dae/By m
Plan Re Permit N % .12 � ebS — Y�J
13125 SW Ilall Blvd, Tigard, OR 97223 y
� �
Phone 503 639 4171 Fax I �
I l iGARD tr,,, vip p ,k Date/By Other Penult No
24- Hour Inspection Line i 1 j �- { 9 � , 6/ � + +• Date Ready/By `� E81 See Page 2 for
Internet vrvrn el tigard .i DIVISIO �'�� Notified/Method y Supplemental Information
TYPE OF WORK FEE* SCHEDULE _
❑ New construction ❑ Demolition For special information use checklist
Description I Qty I Ea 1 Total
❑ Addition/alteration/replacement 0 Other C n,� Spa Y New 1 -2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
igr I- and 2 -family dwelling ❑Commercial /mdustrial SFR (2) bath 35000
❑ 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 V • • 0 S- t - L`• _ Catch basin or area drain 16 60 -
City /State /ZIP 4 > , , • e Z Drywell, leach line, or trench drain 16 60
Suite / bldg /apt no Project name Footing drain (no linear ft ) Page 2
Manufactured home utilities 110 00
Cross street /directions to job site Manholes 16 60
a ,) M Pit I IAI A L N IA-'- Rain drain connector 16 60
Sanitary sewer (no linear ft Sr 5 Page 2
Storm sewer (no linear ft ) Page 2
Subdivision Lot no Water service (no linear ft ) Page 2
Fixture or item
fax map /parcel no
Absorption valve 16 60
DESCRIPTION OF WORK
Back flow preventer Page 2
- -. • 17' C S: - L Backwater valve 1660
Clothes washer 16 60
Dishwasher 16 60
1../
p51 PROPERTY OWNER I 0 TENANT Drinking fountain 16 60
f � Ejectors/sump 16 60
Name : - _: t_ , ..L_. a ` ttnb Cbt.) * Stens C4444YC P
Ex ansion tank 16 60
Address p• (t E_ • ',, Fixture /sewer cap 1660
• , r , , • Floor drain/floor sink /hub 16 60
Phone (go 3) ...5-9 8 „ 45 cs Fax ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON (lose bib 660
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
CONTRACT OR Water closet 16 60
Business name . • I C • E& ii.t A t T s Water heater 16 60
Address - 1 VIN Sr / CT Other •
City/State /'LIP • R.Cco e.3 C I I , • 0 Subtotal
Minimum permit fee $72 50
Phone ( , eZ % Fax ( 3) ), - Q Residential backflow minimum permit fee $36 25
CCB Lic • q Plumbing Lc no Plan review (25% of permit fee)
s / ' //�� / //� Stale surcharge (8% of permit fee) 5 ger
Authorized signature
.. g et„. ' Q 46°� J ! !/ TOTAL PERMIT FEE 7g,
Print name I VA N fy\ r 1 EE Da - 9 _ 2 _ rs This permit application expires if a permit is not obtained within
ISO days after it has been accepted as complete.
*Fee methodology set by Trl- County Building Industry Service Board
I \auddingWennus\PLMF- PemutApp doe 06/OS 440-46i6T(I0/02/COM/WEa)
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' 5500 0 to 2,000 $11500
Footing drain - each additional 100' 4640 2,001 to 3,600 $16000
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' 5500 Medical Gas Systems:
Water Service r 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
: i r • i ; .. i mg or replacing fixtures? If "yes ", A "complex structure is defined as an installation of a plumbing
please in icate 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 extenor plumbing site utilities
Primus 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 ❑ Any NFPA I 3-D multipurpose fire sprinkler system
Eye Wash
Floor Drain /sink -2"
3 „ 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.
\ Building \Pennds\PLM- PenmNpp doe 07/06/05
CITY OF TIGARD, ,
BUILDING DIVISION PERMIT# pi.14,2p06
13125 SW Hall Blvd , Tigard, OR 97223 DATE ISSUED
Phone: (503) 639 -4171
Inspection Requests (24 Hrs) (503) 639 -4175 1±4
INSPECTION WORKSHEET FOR DATE /0 — 01./ —05 TIME AM PAGE
SITE ADDRESS I O9 SO SW RRDL &E P-- CLASS OF WORK:
SUBDIVISION. LOT # TYPE OF USE
PROJECT NAME
DESCRIPTION
OWNER n 0G _ PHONE # ( Sv 3)767,— 44-6/ CONTRACTOR K PHONE #•
Inspection Request Scheduled For Date: Pour Time
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions. 377
c g _-_ ,..... „... _..
7 r-tr 4.-71"-lex-V-7 -
PASS n PARTIAL APPROVAL _ CANCEL I I NO ACCESS
I I FAIL // CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
`i Inspector. /, Date: " ( 1t j/4 ) Phone #. (503) 718-