Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00206
.TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/12/2008
PARCEL: 2S102CB - 03500
SITE ADDRESS: 10050 SW GARRETT ST ZONING: R -
SUBDIVISION: SUNNYWOODS APARTMENTS LOT: 010 JURISDICTION: TIG
PROJECT: SANDSTROM
Project Description: Repairing 10 ft. of sewer line.
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: 10 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GLENN & MA SANDSTROM
22775 SW 108TH AVE Description Date Amount
TUALATIN, OR 97062 [PLUMB] Permit Fee 5/12/2008 $72.50
[TAX] 12% State Surch 5/12/2008 $8.70
Phone : Total $81.20
Contractor:
RAYMOND CUSHMAN
12428 NE HASSALO
PORTLAND, OR 97230 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 254 -9134
PRI 503 -522 -4129 (cell)
Reg #: LIC 118079
PLM 26 -653PB
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 _ t/ / ��� 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.
Qrm it Applicat
r
r l� - FOR OFFICE USE ONLY
City of Tigard c` � ^C f I 'R ece i ved film
�` • t 4 r. Date/By. /�it No.: �^ � ■ 13125 SW Hall Blvd., Tigard, OR 9722 0 t
Phone: 503.639.4171 Fax: 503.598. Plan Review
1 d 'l it
B �� � Date/13y: Other Permit No.:
Inspection Line: 503.639.4175 Ap Icy ® See Pa e 2 for
Internet: www.ti
T I G A R D ard -or. ov \`11~ , Rea /By: luris: g
g g __ .g t,�'°, &u_figd/Method: Supplemental Information
TYPE OF WORK c' Or Ira,9 %O FEE* SCHEDULE
❑ New construction CI DemAkAr" For special information use checklist.
Description I Qty. I Ea. I Total
I 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 El Multi- family PL,-p) 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: / 00,50 s w 66 Pre. f - Catch basin or area drain 16.60
City/State /ZIP: l I) Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Q Manufactured home utilities 110.00
Cross street/directions to job site: Uu G f (G /t q f t o
y �) j �rry Manholes 16.60
00 / 0 S0l141 - Q# WtJ ( /(/L / Q `f 6�Crre / Rain drain connector 16.60
Sanitary sewer (no. linear ft.: / 0 ) Page 2 js t oo
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
S b+ lair- d o- .(`adei l) i Q� 1 d R Remo v� ROSS Backwater valve 16.60
( * A f En t , f e 7 4 1 , f - 5 41,1-e, Clothes washer 16.60
1'T /" v"` ` J Dishwasher 16.60
ROPERTY OWNER I ❑TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: l(, /vAl ��f7/-yeify-N, Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
5SYAPPLICANT '' CONTACT PERSON Hose bib 16.60
I Ice maker 16.60
Business name: "/M J6 �DAIL1/ Ct11HMA ,
Interceptor /grease trap 16.60
Contact name: Rt91/1 0 C /�M / Medical gas (value: $ ) Page 2
)_2 �
Address: � N ' t $ !'.,(i Primer 16.60
City /State /ZIP: ofc t 977 3 0 Roof drain (commercial) 16.60
Phone: (Y33 ) 2Z, ti f q / (S13) `t/ 9r Sink /basin lavator 16.60
/ Fax:
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: (J ` S ANIm pD nt f
�� C Water heater 16.60
Address: i Z,O Other:
City /State /ZIP: P e f,,-/ � �� � OR 97a30 Subtotal
Minimum permit fee: $72.50
(�b.) ) &/ 9 J13 )21--q/� p ermit fee: $36.25
Phone: �- Fax: ( ) y Residential backflow minimum �� CC
CCB Lic.: 0 Authorized signature: 11017 aiii- Plumbing Lic. no. b -6S-3 PA Plan review (25% of permit fee)
State surcharge (12% of permit fee) 55:70 ,
TOTAL PERMIT FEE
Print name: ply pto it CUJ O 1411141 Date:. '- J -113 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 12/27/06 440.4616T(10/02 /COM/WEB)
I
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 - I" 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
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
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Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of, the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ''❑ Any new commercial building with water service 2" and
Fixture.Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
• Eye Wash - Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
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 *Note: If the fixture work under this permit results in an
- Bradley
- 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 #: PLM2008 -00206
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/12/2008
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 I
INSPECTION WORKSHEET FOR DATE: 5/13/2008 TIME: 7:02AM PAGE: 16
SITE ADDRESS: 10050 SW GARRETT ST CLASS OF WORK:
SUBDIVISION: SUNNYWOODS APARTMENTS LOT #: 010 TYPE OF USE:
PROJECT NAME: SANDSTROM
DESCRIPTION: Repairinc; 10 ft. of sever line.
OWNER: SANDSTROM, GLENN & MARGERY PHONE #:
CONTRACTOR: CUSHMAN, RAYMOND PHONE #: 503 - 5214123 (cell)
Inspection Request Scheduled For: Date: 5113/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 069804 -01 503-522-4129 Y
Corrections /Comments /Instructions:
it,)
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[ PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: V V "vhn..- ►1\lr4,t, Date: (c1 J23, $) Phone #: (503) 718
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