Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00398
�II DEVELOPMENT H BMEN9 Tigard, -639 -4171 DATE ISSUED: 8/17/2005
PARCEL: 2S 111 AB -02400
SITE ADDRESS: 09340 SW MOUNTAIN VIEW LN ZONING: R -4.5
SUBDIVISION: ELROSE TERRACE LOT: 020 JURISDICTION: TIG
Project Description: Replace water service.
CLASS OF WORK: OTR 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: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KENNETH & M HERN Description Date Amount
9340 SW MOUNTAIN VIEW
TIGARD, OR 97224 [PLUMB] Permit Fee 8/17/2005 $72.50
[TAX] 8% State Surchari 8/17/2005 $5.80
Phone : 503 - 598 - 9603 Total $78.30
Contractor:
RESCUE ROOTER
PO BOX 1728 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070
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Phone : 503 243 - 1172
Reg #: LIC 127325
• PLM 34 -168PB
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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 By: Z6,2>2 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.
Building Fixtures
Plumbine Permit Appl a li"�tr - V 7' roli OFFICE IBSE °NE.i
City of Tigard ( o�� d"
Da2� ` - , Permi N o.� )\.,,,...2165
13125 SW Hall Blvd., Tigard, OR 97223 ,- 7 200- Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 its.,...,.,..,11.1` Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 01 T �' 0 ?'1G�'- --- j,. j Date Ready/By. Juris: Pi See Page 2 for
Internet: www.ci.tigard.or.us BOO rum Drv!SfcN Notified/Method: /�� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
A Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 249.20
g I- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site addressZ540 motim.rotim view kF Catch basin or area drain 16.60
City /State/ZIP: 7/4) DR q7u Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
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Cross street/directions to job site: 93= Manholes 16.60
Rain drain connector 16.60
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Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft: )10) Page 2
Future or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK
Back flow prevents Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
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Name: K EN Il.3 ETN HERty Expansion tank 16.60
Address 1f1UNTAIK1 u iSIAJ 04 Fixture/sewercap 16.60
City /State/ZIP: - ri&ARp 'j Floor drain/floor sink/hub 16.60
Phone: (553) ."p 3 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
lee maker 16.60
• Business name: Fescue Rocerelt. Interceptor /grease trap 16.60
Contact name: e KIV VFP Medical gas (value: $ ) Page 2
Address: p0 17 z8 Primer 16.60
City /State/ZIP: w l ( V i i(e, t aR �OZa
Roof (commercial) 16.60 -
(503) `505 ?SO I ( ) 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: SA 146, A, S A P'PL (G tr Water heater 16.60
Other:
Address:
City / State/ZIP:
Subtotal
Minimum permit fee: $72.50 on
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: j Z'? 32.5 Plumbing Lic. no.: 314 - 14.yre Plan review (25% of permit fee) tt,^,
State surcharge (8% of permit fee) 5 dO
Authorized signature: TOTAL PERMIT FEE -7 .ffl6
Print name: &:71 fe- �NV p^,e I Date:B �... . J This permit application expires if a permit is not obtained within
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/� 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permits\PLMF - PennitApp.doc 06/05 4104616T(IO/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
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
Commercial Back Flow Prevention Device 46.40
including
148. i0g for the first $10,000.00 to $25,000.0 $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
specially requested inspections - per hour 72.50 and inclitdr t $50,000.00.
Subtotal: $50,001.00 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 Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ My new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Tim, facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ My NFPA 13 - D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
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-3
-4 ,,
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains •
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory •
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this ermit results in an
Water Extractor p
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ BuildingWermits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION \ PERMIT #: PLM2005 -00398
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/17/2005
Phone: (503) 639 -4171 X0 1 / ° 'll ,1'
Inspection Requests (24 Hrs.): (503) 639 -4175 . °`'f �I
INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7 :06AM PAGE: 93
SITE ADDRESS: 09340 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: ELROSE'TERRACE LOT #: 020 TYPE OF USE:
PROJECT NAME: HERN
DESCRIPTION: Replace water service.
OWNER: HERN, KENNETH & MICHIKO PHONE #: 503.598 -9603
CONTRACTOR: RESCUE ROOTER PHONE #: 503-243-1172
Inspection Request Scheduled For: Date: 8/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 013782-01 503-790-8922 N
Corrections /Comments /Instructions:
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'PASS ❑ PARTIAL APPROVAL ❑ CANCEL' ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 2M Date. Phone #: (503) 718-