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Permit
CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009-00111 Date Issued: 05/06/2009 T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S111 DD16600 Jurisdiction: Tigard Site address: 8662 SW HAMLET CT Subdivision: Lot: 0 Project: Alexander Project Description: Replace 100 feet of water service. Owner: FEES ALEXANDER, JOANNE C Quantity Description Date Amount 8662 SW HAMLET CT TIGARD, OR 97223 100 If Water Service 05/06/2009 $55.00 1 12% State Surcharge - 05/06/2009 $8.70 PHONE: Plumbing 18 ea Minimum Fee Adjustment 05/06/2009 $17.50 Contractor: - Plumbing AMERICAN RESIDENTIAL SERVICES LLC P.O. BOX 2830 CLACKAMAS, OR 97015 PHONE: 503 - 235 -8784 FAX: 503- 491 -2932 Type of Use: SF 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 -0100. You may obtain a copy of the rules Issued By: GI t -A 1 ` ' l �� Permittee Signature: SR O c %pcp L1 c20, "`emu l 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. OCT -02 - 2004 22:15 P.001 lumbin Perm Appl Building Fixtures �) ,-- cc, \\E ; ) Y . Foil OFFICE use ONLY III City of Tigard ? o9 Rccci.ed G._ � . , Permit No = n 1 312 5 5W Hail B1\d,. Tigard, OR 472 3t A O e 20 DatwA+ `J y 1110 • _ � I I Ph one: 503.63 .4171 Fax; :03.598.19C,r1A� Plan Re�,eti. Da[aAc Other Permit NO T I G A It 17 Inspection Line: 503 639.4175 ARD Dale Re:u(y'C3. Internet: aww.tigard- vr.goc -�J T r n B! seePugc: for CAT/ 1 ut `� � Nritified;hlethod ie Su pplemental Information TYPE OF ��OR 1 Lp1 � u v � FEE- ScfIEDL LE ❑ New construction © Demolition For auxin( informnrlon use cheeAlir. Description ()I\ 1 Ka. 1 Total [ Addition/alteration/replacement ❑Other: Ncn I- 2- family dwellings (includes 1 11. for each otil+ty connectinnu CATEGORY OF CONSTRUCTION SFR Iii bath 249 20 h; I - and 2- family dwelling ❑ Commercial /industrial SFR (21 bath = 11 356 00 0 Accessory building 111 Multi-family SFR 131 lath EMI Each additional bath/kitchen -` 45.00 ❑ Master builder ❑ Other: Fire sprinkler (_ sq. Il. t Page 2 . JOB SITE INFORMATION ANt CICATION Site utilities Job site address: / // -'!? R jr- Catch basin or area drain 16 60 City /.State /ZIP: 4i 7 f Drywell. leach line. or trench drain MI 16 Suite /bldg. /apt. no.: Project name: 4d., '* Footing drain lao. linear R.: _1 Page 2 Cross street/directions to job site: Manufactured home utilities 110.00 - -- Manholes 16,60 Rain drain connector _ 16.60 j Sanitary sewer (no. linear R.: �) Page 2 Storm Sewer (no. linear ft.: —) Page 2 _ Subdiv'i ion• 1 Lot no.: Water service (no. linear ti.: dAC Page 2 olio Tax map /parcel nu.: Fixture or Item ... - - Absorption valve 16.60 DESCRIPTION OF WORK `� .rA ' I � _� / / Backflow preventer 1M Page 2 Backwater valve 16 60 EMI _ - I14 Clothes washer 16,60 Dishwasher I6 60 k PROPERTY OWNER 0 TENANT Drinking fountain -- 1660 • Name: - f � � / i Ejectors /sump �� 14 of - Expansion tank • Address: �, W Fixture/sewer cap 16 .60 City /State /Z.IP: ✓ i Floor drain /floorsink/hub 16.60 Phone: ( ) f r Ar ■I� ) Garbage disposal 16.60 T1 APPLICA„lv'T Q CONTACT PERSON Hose bib 16 60 Ice maker 16.60 Business name: ARS dba .JACK FIOWK /Rescue Rooter Interceptor /grease trap 16.60 Contact name: JOYCE DENNIS Medical gas (value: $) Page 2 Address: P.O. BOX 2830 Primer 16,60 City /StateJZ.IP: CLACKAmAS, OR 97015 Roof drain (commcrciall 16.60 Phone; (503) 235-8784 Sink/basin /laratory Fax: (503) 491 -2932 16.60 E -mail: JOYCEIFeJACKNOWK.COM • - - Tuh /shower /shower pan 16,60 - Urinal 16.60 CONTRACTOR Water closet _ 16.60 Rusincss name: ARS dba JACK FIOWK /Rescue Rt7oter Water heater 16.60 Address: P.O. BOX 2830 Other: City /State /ZIP: CLACKAMAS, OR 97015 — Subtotal W Minimum permit Ice: $72.50 Phone: (503) 235-8784 Fax: (503) 491 -2932 Residential hacktlow minimum ermit fee: $36.25 • it ` O 1t-- Plumbing I,ie, no.: 34 -168 P Plan review (25% of pernut fee) ME Aut}wriced signature: � � State surcharge (12% of permit fee) wara , TOTAL PERMIT F Amin lle # ,•• Date jjrigna This permit application expires if a permit is not o rl1i :it i'I" 1811 days after it has been accepted as comp ete. *Fee methodology set by Tri- County Building Industry Service Board, r 16ui]d,ns LMF -P, Please FAX BACK t • 503 -491 -2932, OCT -02 - 2004 22:16 P.002 ,x ' * plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Eire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: -1 Footing dram - I" 100' 55 00 0 to 2.000 $115.00 Footing drain • each additional 100' 46.40 ' 2,001 to 3.600 $1$0.0(1 3,601 to 72 00 $22 00 Sewer - 1st 100' 55.90 7.201 and greater S30 00 - - Sewer - each additional 100' 46.40 —` Water Service - Ist 100' tear 55.00 / .� Medical Gas Systems: Water Scry ice - each additional I (It)' 46.40 Valuation: Permit Fee: Storm & Rain Drain - i st I00 55.00 $ LOq to $5,0[)0,00 Minimum fee $72.50 Storm & Ram Drain - each additional 100" 46.40 $5,001,00 to $ 10.000. $72 50 for 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 5148.50 for the — first $10,0001)0 and $1,54 tar Residential Back f ow Preverttinn Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.251 27.55 and including $25,000.00 Rain Drain. single family dwelling - 65.25 $ 5.001.00 to S50.000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of (Pasting plumbing or each additional $100.00 or fraction thereof, to and includin $50.000 00 specia115 requested inspections •per hour 72.50 $50,001.00 and u $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*. 0 Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater- except systems designed and stamped by licensed Fixture Type: Ret,>ace engineer. Previous Capped Added Existing _ ❑ New exterior plumbing site utilities for any complex structure Baptistry /Font as defined in OAR918- 780 -0040, Bath - Tun/Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuezi /Whirl oat ❑ 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 Diagram - Drinking Fountain Isometric or Riser Eve Wash ❑ Isometric or riser diagram is required Tor new buildings Fluor Drain /sink -2" that meet the qualifications above. •3 „ - 4' Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial - _ Ice Mach. /Ref Drains _ Oil Separator (Gies Station) Rec. Vehicle Dump Station Shower -Mang . - Stall Sink -Bar /Lavatory - Bradley * Note: If the fixture work under this permit results in an - Commercial increase of sewer EUUs, a sewer permit will be issued and -Service - _ fees assessed for the sewer increase must be paid before the Swimming Pool Filter Washer - Clothes — plumbing permit can be issued. Water Extractor Water Closet - Toilet Urinal Other Fixtures' i kiilding‘Permitx \PLM•Permib\pp.dnc 12227/06