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Permit
C ITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00506 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/15/2007 PARCEL: 25111 CC -07500 SITE ADDRESS: 15845 SW GREENS WAY ZONING: R -12 SUBDIVISION: SUMMERFIELD NO.2 LOT: 102 JURISDICTION: TIG PROJECT: STABENOW Project Description: Relocate water heater. 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: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES HERB STABENOW 15845 SW GREENS WAY Description Date Amount TIGARD, OR 97223 [TAX] 8% State Surcha 11/15/2007 $5.80 [PLUMB] Permit Fee 11/15/2007 $72.50 Phone : 503- 624 -9020 Total $78.30 Contractor: TEE TO GREEN, INC. 9730 SW 168TH PL. BEAVERTON, OR 97007 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 740 -2549 Reg #: LIC 156762 PLM 34 -428PB 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. ou may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: 4L Permittee Signature: _1014 / • �� 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 Application 1 \ , * Building Fixtures FOR OFFICE USE ONLY , City of Tigard CE /J Pen it N [gyp II I � FCEIVED Date/By: i I 17 / 3,B " p'�7 - O� ✓ 6 n 13125 SW Hall Blvd., Tigard, OR 97 Plan Re view Phone: 503.639.4171 Fax: 503.598N ' 1 5 2007 Date/By: Other Permit No.: Inspection Line: 503.639.4175 T I G A R D T , f Date Ready /By: Jtya Page www.tieard-or.gov Cl I T OF EIGAR® I Supplemental Se Pat 2 for g Notified/Method: Supplemental Information 'TYPE OF WBA LDINCADIIVISION FEE* SCHEDULE . ID New construction ID Demolition For special information use checklist Description I Qty. I Ea. I Total Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION . SFR (I) bath 249.20 ,WI- and 2- family dwelling ❑ CommerciaUindustrial 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: As d 9 92 s tv 4 r g • Oa iii basin or area drain 16.60 City /State /ZIP: ' TO q n ©R Drywell, leach line, or trench drain ft.: 16.60 Suite/bldg. /apt. no.: u' Project name: Footing drain (no. linear .: ) Page 2 Manufactured home utilities 110.00 • Cross street/directions to job site: / Manholes 16.60 '>✓ ICq ir ! Q � - 4 ' e- e lcc Sc.' r► d 9, e-r 1C-71 e id )) 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.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer - Page 2 . * e ! o , a . L. 6 er., . Backwater valve 16.60 . Clothes washer 16.60 Dishwasher 16 60 1:1 PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 _ Ejectors /sump 16.60 Name: .e.� -..C.(<4 f -6 'Q b ei1,1-09A-...3 Expansion tank 16.60 Address: c s Q 6 0 v -.e Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: (15 - (To ao Fax: ( ) Garbage disposal 16.60 . ❑ APPLICANT ❑ 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 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: fee 4,0 !n R e h 1 h G Water heater .1 16.60 Address: itrVpi q73 S k) i 6 p/ • Other: City /State /ZIP: B ie. q Subtotal q Minimum permit fee: $72.50 y 24 60 Phone: (S03) 7 c/0 `,2. ( Fax: ( ) Residential backflow minimum permit fee: $36.25 f 7 � Plan review (25% of permit fee) CCB Lic.: � � (� L „ 71 Plumbing Lic. no.: '3, � -! e J�6 State surcharge (8% of permit fee) Y j , g b t) Authorized signature: N TOTAL PERMIT FEE '? 9.,.6:17 Print name: c 5 T61/6 � 5,-,76 Date: r( -7q-02 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\PLMF- PermitApp.doc 12/27/06 440- 4616T(I0/02 /COM/WEB) 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' 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 Valuations ` - 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 Subtotal: $50 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 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. -3" 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: is\ Building \Permits\PLM- PermitApp.doc 12/27/06 CITY.OF TIGARD BUILDING DIVISION PERMIT #: PLM2007-00506 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11f1t�12007 Phone: (503) 639 -4171 4 Inspection Requests (24 Hrs.): (503) 639 -4175 i 6 1 I1 .. INSPECTION WORKSHEET FOR DATE: 11/16/3007 TIME: 7:01AM PAGE: 56 SITE ADDRESS: 158466 SW GREENS WAY CLASS OF WORK: SUBDIVISION: SUMMEI ?FIELD NO.2 LOT #: 102 TYPE OF USE: PROJECT NAME: STABENOW DESCRIPTION: Relocate water heater. OWNER: STABENOW, HERB PHONE #: 503-624-9020 CONTRACTOR: TEE TO GREEN, INC. PHONE #: 503- -740 -2549 Inspection Request Scheduled For: Date: 11/16/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Piurnbing final 059771 -01 503-.624 -9020 dr, Corrections/Comments/Instructions: • era_ PA •' -TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL IM CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED - Inspector: ■ _ Date: // / l, 7 Phone #: (503) 718-