Permit .' _ �- CITY OF TIGARD PLUMBING PERMIT
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` : COMMUNITY DEVELOPMENT Permit #: PLM2011 -00372
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2011
Parcel: 1 S136AD06800
Jurisdiction: Tigard
Site address: 7001 SW PINE ST
Project: Bridges Subdivision: 1992 -059 PARTITION PLAT Lot: 1
Project Description: Replacement of 70' of sanitary sewer service.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: BRIDGES, JON P
P.O. BOX 2830 13065 SW FALCON RUE DR
CLACKAMAS, OR 97015 TIGARD, OR 97223
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PHONE: 503 - 747 -2621
PHONE: 503 - 235 -8784
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
70 If Sewer Service 12/13/2011 $62.54
Specifics: 1 12% State Surcharge - 12/13/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 12/13/2011 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification_ Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct estions to • NC b calling 503.232.1987 or 1,800.3322344.
Issu d By: / / r Permittee Si; t. ,
Call 503.639.4175 by 7:00 a.m. for the next availa • • • • section date.
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.
DEC- 12- 2011(NON) 17:12 RRS /JackHouk /RescueRooter (FRX)503 491 2932 P.001 /003
Plumbing Permit Application_
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Building Fixtures FOR OFFICE USE ONLY
City of Tigard A 1 3 Z011 )nte/llva /.2 ,,J �/ �, Pen N o.: # G I�a �O // ,3
t� = a 13125 SW Hall Blvd . , Tigard, OR 972 _
,.• Plaorie: 503.639.4171 Pax: 503.598.1960 Phm Review •
TIGARD InspeotionLine; 503,639,4175 CITY OFTIGARD
I]ate /lty; Other Permit No.:
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N + o i ` fie d /Metl supplc Information
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[] New construction ❑ Demolition For speeial in brmation use checklist
Description - Oty. I H I 'total
461
�Ap��dgqditi (o NSH � Addition/alteration/replacement i ,y ❑ Other: �¢ (� � { New t- 2- fluidly dwellings (includes 100 fl. for each utility connection)
MUM 1 ' it l i' i if NIN x LMOI ° jIE 0 ' ' cd't l . to 11 11111M 1 ,, , 1 SFR (l) bath 312.70
x l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building 0 Multi - family
SFR (3) bath 500.32
Each additional bath /kitchen 25.02
❑ Muster builder 0 Other:
Fire sprinkler ( sq. 11,1 Page 2
l !sh 11R -L•16 �!1 „ti ,,r 1 , a• 1 046,125212M
a�dl Illutl��i��r�13tl1o111t311911i�! 4111 i, , 1. " RI Site utilities:
Job site address: -740 sl ri " Catch basin or area drain 18.76
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City/Slate/ZIP: 0 3 Drywell, leach line, or trench drain 18,76
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: 1 Project name: CLET Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear fl.:_) t T " Page 2
Storm sewer (no. linear ft.; _ ) Page 2
-__
Water service (no. linear ft: ) Page 2
Subdivision: Lot no.: Fixture nr item:
Tax map /parcel nu.: Bac;kfluw preventer 31,27
11'';C1"!1111 l i Ni :° Ili;4111 +;'1i! 11` 9 "n�i r u! " ...! ,.1,,',',, ` r ,A . ,,, ? ! a t i�Id i 4t11� 9d N tti t wisI lIt 1n i ��S j , Backwater valve 12.51
� (�--�
Clothes washer
� 25.02
� /f Dishwasher 25.02
OA F fl, Drinking fountain 25.02
Hjcctors /stup 25.02
th4_, 1 i3 1�3� 11�" ! !k',.a�c� u ' :;'3i111111i11/ 111i1 .3?11313E ri 1 l . „� �{ Expansion tank
, i � , , , P , ;a������r11Sl��it�� 12.51
Name: / AP7 / r' E l ixture/sewer cup 25.02
Address: ,5 {/1/ i Vim'
�- / � fi /y - Floor drain /floor sink/hub 25.02
Garbage disposal 25,02
City/State/Z1P: ii; r. 4T
Nose bib 25.02
Phone: ( .. 7 ++ r • x: ( ) ice maker 12.51
�Ml i i i1 ic#p w ,;,.d „T;.,� t. ii1SI1� 44 i a{ t 4r ( 4 P E: P
I 1 �� �>r tl� I lsl 111 1 Ip�� u {I'� � 01 �� jN Interco tnr /'reau trim 25.02
�- � g.. �w�M #tt11�,c � �
Business name: ARS dim JACK TROWK/RESCUE ROOTER Medical gas (value: $ _ ) Page 2
Contact. name: JOYCE DENNIS
Primer 12.51
Roof drain (commercial) 12.51
Address: P.O. BOX 283()
Sink/basin/lavatory 25.02
City /State /ZiP: CLACKAMAS, OR 97015 Solar units (potable water) 62,54
Phone: (503) 850 -3100 tax: : (503) 491 -2932 Tub /shower /shower pan 12.51
E- mail; JUN NNISt ,tRS,COM Urinal 25.02
S h 11111 t 1 1 j � .l 1 a r a P1 , , , Water disci 25.02
:1.1:!.11! 111 it l 11i� OI\lit,l,;lllfll#ll. 1, � SENI i( 1 N`1 1 1 t 1C Water healer 37,52
Busitiesti nutne: ARS dba JACK iTOWK/RESCITE ROOTER water piping/ „WV 56.29
Address: P.O. BOX 2830 Other: 25.02
City /Stale/ZIP: CLACKAMAS, OR 97015 Subtotal l .1 �i
('hone: (503) 850-3190 Fax: (503) 491 -2932 Minimum permit Ice: $72.50 V. 41
Platt review (25% of permit fee)
CCB Lie.: 127325 ` Plumbing T.ic. no.: 34.168143 �i S r ` State surcharge (12 %, ot'permit 1cc) �� �p
Authorized signature: \T1' / TOTAL PERMIT FF a
Print name; JOYCE BENNIS r Date: L ' / This permit application expires It a permit is riot ubtuinrd
after it has been accepted as complete,
1 r "fee methodololry set by Tri- Coucty Building Industry Service Itnarrl,
I l Build inglParrnirnll 'Ltr1U- P enuilA�10 UI/ 7717• 54(1-041G11 1U / 0 pM //f R)
DEC- 12 2011(MON) 17:12 RR5 /JackHouk /RescueRooter (FRX)503 t191 2932 P. 002/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information .
Fee Schedule: Residential Fire Su ression S stems:
T ABM ru • • F '1, tr' rR { Z 91 1�tAp °' )t ' va {"liF"! t ■17 � ° q° i tf s ... ° - pr'. °' ,r. rw y
,wwdl 6, l W .trli f�,j�' f +� , �} R I.1t �P1 i1�Y -{+ h � I dr } f,1. v�t i�i I' vY � - .1 1 2 � ' 'J�. v, Y { " Al'� o� { (�1� 1 , 111( 1 � 111.1 IM ES
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+ �� , �i -� Ma i' {} iV a� i �r� tai 1 21 r �x a ;t Y .. I, R??4'�;i� l a(!, V .., ., i t104 " \fit 4,1 wu uf�
Footing drain - I" 100' 11111 50.03 0 to 2,000 $121.90 lin Poplins drain -each additional 100' 37 - 52 u001 to 3,600 $169.69 MIN 3,601 to 7,200 $233.20 '
Sewer - 1st 100' :j =r 1 ,__ 201 and greater $327.54
Sewer - each additional 100' INEMIIMIll
Water Service - 1st 100' MIIIIIIIIIIM Medical Gas S stems:
Water Service - each additional 100' 1111111 37.52 n � i
O ,t � :,1° ' f ! ' l l ? 1 r f ;r 4 I "� � r 4,41r, . , f dl "' "NNIcl a!313k"� f t i d „ , !�( i : ), ; I:
Storm & Ruin 13rajn - Ist I00' UM 62.54 MI
$1.00 to 55,000.00 Minimum tee $72.50
Storm 4. Rain Drain - each additional 100' 37.52 111= $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
�+•v^`i ' ''� `'�` t` , n f + �} �" ;t ° t `' t i ts {{" ( i �f' r (r Atliy + i each additional $100.00 or fraction thereof, to
t . �.l ,lr. � r C �M `= a � 19 ii �lsw „ � 4` C1,r; , l ,l ?� 1 1lri' l i1 and including $10.000,00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148,50 for the first $10,000.00 and $1,54 for
which no fee is specifically indicated 90.00 /hr each additional $100.00 or fraction thereof, to
(minimum char re -1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00 /hr $25,001.00 10 $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum char .e - 2 hours) each additional $100.00 or fraction thereof, to
Reinspcction Fccs 90.00 /hr and including $511,000.00.
Additional plan review for revisions IIII 90.00/hr $50,001.00 and up $742.00 for the trst 550,000.00 and $1.20 for
(minimum char_e - 1/2 hour) each additional $100.00 or fraction thereof
Subtotal: _=11I
Commercial Fixture Work:
ArC ou capping, ► addin or replacing fixtures? If es" } ^r + {' " '}r�E {"} Cr p „ ti , t c�'rr,r E t
tt "il ffi
Y 1?P f„ t± P S Y r, 111?+Il r . 1 )1A. a 1:'I ,,, 1 " ° ?�'' `�d ' ^ a. A g 1 p k 'i
please indicate work performed by fixture. Failure to Plan review is required for any of the following,
accurately report fixtures could result in increased sewer fees Please check till that apply.
1 �.1�n, IA 1n'm M1 4 1' � ' .� y :
1 "r g f i � �i(r + t 9 ipl lYrril (� 1:i 0 Any new commercial building with writer service 2" and
¢ ,t # !l l t � . ( 'i 1 }y { ° , {` I { i�; +,11$ 1 ' t rt r �C } kl �;1
greater, except systems designed and stamped by licensed
Ba.tist /Font engineer.
Both =rub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Jacuzzi/Whirlpool as defined in OAR918- 780 -0040.
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care Iheililies.
-Drive 'Oyu -- ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator - ❑ Any complex structure as defined in OAR9I8- 780 -0040.
Dishwasher - Commercial
-Domestic Submit 2 sets of plans with any of the above.
Drinking, Fountain
E e Wash • f11'EtVr{1ts\pju��1'1'w f nw an . , rt1 *1 r �'r , + b 1�:rrlr' t': ar'a ^tiPC °� R'-" iC
�lf :1 IIIw"r} u' .li,{,i:rlWl� d6Mni, r,1w. l di:T. U �i f � , {Iima� , i .Lr �4 }i1� 1+
Flour Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 ~ that meet the qualifications above.
Car Wash Drain - 1
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach./Refri_. Drains -
Oil Separator (Gas Station) --
Rec. Vehicle Dump Station
Shower -Gang - _
-Stall
Sink - Bar/Lavatory --
- 13radlcy
-Commercial *Note: If the fixture work under this permit results in an
Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter p
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water 1:xtractor . . , plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
http: / /www.tigard or.gov/ city_ ha 11/ cicpttrtmcnts /cd /docdpl,MF- PermitApp2doe '