Permit `1
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00592
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2006
PARCEL: 25111 BA -12400
SITE ADDRESS: 09577 SW MOUNTAIN VIEW LN ZONING: R -4.5
SUBDIVISION: TEMPLETON HEIGHTS LOT: 004 JURISDICTION: TIG
Project Description: Repair sewer line.
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: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MATTHEW HARRELL
569 NW PACIFIC GROVE DR Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 12/18/200E $72.50
[TAX] 8% State Surcha 121181200E $5.80
Phone : 570 -4785 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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 f• low rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 00'1 -0 00. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
11 11/4,410 w
Issued By: ', 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.
r
Site Utilities
,r4 ' `Plumbing Permit Apblicati 1,ro ECE9vE® rO,z oI l ICE vS► (
• City of Tigard 8 R �� f J l R �� / � Permit Nei \ Da( c6f-1 r
IN v 13125 SW Hall Blvd., Tigard, OR 9720E C 1 v 2006 plan Review
• Phone: 503.639.4171 Fax: 503.598.1960
Date/By. Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By r la See Page 2 for
TIGARD
Internet: www.tigard -or.gov BUILDING CIvIsIOnI Notified/Method: Supplemental Informa
TYPE OF WORK FEE* SCHEDULE
• ❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 1214- 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 address: 9 5 "7 7 ILA) pi/Jr O LJJ Catch basin or area drain 16.60
City /State/ZIP: ' 4 f erg_ G/ 7 21. Drywell, leach line, or trench drain 16.60
• Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft: 8a ) Page 2 5
Storm sewer (no. linear ft.: ) Page 2
•
Subdivision: I Lot no.: Water service (no. linear ft.: _I Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
124Pfh (L- , 60 "ht 5 �4. 7&4 2 - L /NE_ Backwater valve 16.60
. — Clothes washer 16.60
Dishwasher 16.60
V I PROPERTY OWNER I ❑ TENANT Drinking fountain
k� H t
E � 1t,... . v f" /`J, _(__ E xpa ns ion tan . • I
Name: 4 -
Expansion tank 16.60
Address: L PI NW R iF,C. • 4,47v. >)(L, Fixture/sewer cap 16.60
• City / State/ZIP: 6golvikt,loyu_ 012 q 7 c ( Floor drain/floor sink/hub 16.60
(ch I ) 5 7 '47 e S / Garbage disposal 16.60
Phone: Fax: ( )
❑ APPLICANT ❑ CONTACT PERSON Hose bib • I
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: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 43 N fire______ Water heater 16.60
Address: Other:
City/ State/ZIP: Subtotal $S
Minimum permit fee: $72.50 —T S°
. . Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: ' lumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: ,41/41 State surcharge (8% of permit fee)
TOTAL PERMIT FEE 8 te-
Print name: At eGNokt.G 4.4 T1t,— I Date: /2//1/06 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\Pamits\PLMU- PamitApp.doc 06/26/06 40- 4616T(I0/02/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 - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 0 55.00 OS 3,601 to 7,200 $220.00
1 S 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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 Back flow 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 5'5 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 ❑ Any 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 Thru 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
•
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-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 *Note: If the fixture work under this permit results in an
Washer - Clothes •
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal o plumbing permit can be issued.
Other Fixtures: - - - -
iMuilding\Permits PLM- PamitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION - • PERMIT #: �a2 -- 000 G+
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: o(Jd/ Z
Phone: (503) 639 -4171 /
Inspection Requests (24 Hrs.): (503) 639 -4175 i. < Z i�
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ���� 1 , `v
A/ ad $ CLASS Va A S OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Sam 4--4 ,
Correc /Comment ructions:
C:%I- r/2/ ZA _ /, /DL414
i 7-Le2 Alhi - c3 L -ogle � r te •
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_..-./- -_____
PASS ❑ PA'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL 11 ' L F•R CTIO ❑ ADDITIONAL FEES ASSESSED
0 I--e
Inspector: Date: i i f 1 Phone #: (503) 718