Permit r C
CITY O I *TIGARD PLUMBING PERMIT
` " COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00422
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/3/2008
PARCEL: 2S 104DD -06400
SITE ADDRESS: 12658 SW GAARDE ST ZONING: R -4.5
SUBDIVISION: EAGLE POINTE LOT: 060 JURISDICTION: TIG
PROJECT: HURRLE
Project Description: Replace 30' of water service.
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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 30 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
JOHN & EVE HURRLE
12658 SW GAARDE ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/3/2008 $72.50
[TAX] 12% State Surch 11/3/2008 $8.70
Phone : Total $81.20
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 r or s -. suestions to OUNC by calling 503.246 6699 or 1.800.332.2344.
Is ued By: 1 0/` !/ ✓ 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.
e'Ph ilbing Permit Appl
Building Fixtures . FOR OFFI USE ONi Y'_
City of Tigard d DateBy I/ d 0. Dlf P No . , 7,a ' .'' 2
I
V 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503 639 4171 Fax 503 598 1960 Date /By Other Permit No
Inspection Line 503 639 4175
TIGARD Date Ready /By 1 ® See Page 2 for
Internet www tigard - gov Notified/Method / lc Supplemental Information
� TYPE'OF WORK , > ;,FEE *.'SCHEDULE s• ,
❑ New construction ❑ Demolition For special information use checklist
Description Qty Ea Total
&Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
. _ - , - , , t°. CATEGORY OF CONSTRUCTION r' _` ; ,,,,, - : SFR (1) bath 249 20
,j4,1- 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
b , ' = icili SITE INFORMATION: AND_,,LOCATION° ",` Site utilities
Job site address: ( Z( a S L.(.) , c -A e___ St- Catch basin or area drain 16 60
City /State /ZIP: --� � , 0,g, Q• 7 22_9; Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: v l Project name: , tfc j K-'/,'-'(.32.....___ Footing drain (no linear ft _ ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site: �t f \ , ` C^ jc L , e ,___
l Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft ) Page 2
Storm sewer (no linear ft ) Page 2
Subdivision: Lot no.: Water service (no. linear ft 3 3 c Page 2 G1
Fixture or item
Tax map /parcel no.: Absorption valve 16 60
g° - R ' :. :' ° `fi DESCRIPTION' OF ,WORK . ,
'• '" ` Backflow preventer Page 2
V (..,+-'&\. Le/I/� Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16 60
- _ .. Drinking fountain 16.60
El P ROPERTY 'OWNER —, • , I ' ❑ TENANT
` Ejectors/sump 16 60
Name: Expansion tank 16 60
Address: Fixture /sewer cap 16 60
City /State /Z1P: Floor drain /floor sink/hub 16 60
Phone: ( ) Fax: ( ) Garbage disposal 16 60
,,, - - Hose bib 16 60
,„
, ❑ ,APPLICANT . , _ . , ❑ CONTACT. PERSON' - ', CON TA 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: ( ) Fax:: ( )
Tub /shower /shower pan 16 60
E -mail: Urinal 16 60
CONTRACTOR- .
, Water closet 16 60
Business name: E , ,...).,...).,\ .� e ,- 1/ p( v-,,, 1 ! „ // Water heater 16 60
Address: 1P `� t r
r v C).., C).., S �� 2 � �l � S -.1 Other
City /State /ZIP: / z3�" Subtotal
/ ���/ Minimum permit fee $72 50 -72. , S—t',
Phone: G off) b Z_ y y z V Fax: 6,52) ,k/Z`( ,, j 7 3 Residential backflow minimum permit fee. $36 25
CCB Lie.: j O j _7
O Plumbing Lic. no.: 2 -4 / ( 7 l .0 i/ , j Plan review (25% of permit fee)
State surcharge (12% of permit fee) '= 7 '�'
Authorized signature: TOTAL PERMIT FEE V . Z
Print name: ifL/a /,it, Z. ?J/W�— Date: u
t'/ 3 /` 5' This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
i \Bu ldmg\Permos\PLMF- Perm5App doc 12/27/06 440- 4616T(I0/02 /COM/WEB)
Plumbing Permit Application - City of Tigard t,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ` , , Qty: Fee (ea) Square; Footage: : Permit; Fee:i
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
Total additional $100 00 or fraction thereof, to and
�1Xt11rC Item' : Qty' Fee ( ea ) ' 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
Commercial 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 *. ❑Y 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 6 >A■ded . 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 Rigel; Diagram,' , "
Eye Wash ❑ Isometric or riser diagram is required for new. buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-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 \Buildmg\Permtts\PLM- PermttAPP doc 12/27/06
. _- - .
CITY OF TIGARa -- '.^
BUILDING DIVISION '
PERMIT ��o��on��m �:�n�o��n� PLM2008-00422
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/30008
Phone: (503) 639-4171 * 1
Inspection Requests (24 Hrs.): (503) 639-4175 �B�N■ «1.1.
INSPECTION WORKSHEET FOR DATE: 11/5/2008 TIME: 7:01AKX PAGE: 14
SITE ADDRESS CLASS DFVVORK
� 12�8�S ��GA�RQ��T WORK:
,SUBDIVISION: EAGUEpO}NTE LOT #: 860 TYPE OF USE:
PROJECT NAME: HUPRLE
DESCRIPTION: R ep l ace 30 o f wa service
OWNER: MURRLE. JOHN & EVELYN PHONE #:
CONTRACTOR: BRUNBRpLUk8E8NE; PHONE #: 503-624-4800
Inspection Request Scheduled For: Date: 11/5/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 077680-01 503-624-4880 Y
Corrections/Comments/Instructions:
«�
~ � -� �
y_���"�c �- �-«^�~�
,
x PASS I I PARTIAL APPROVAL El CANCEL NO ACCESS
FAIL fl CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED