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Permit
n CITY OF TIGARD PLUMBING PERMIT Is • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00175 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2012 Parcel: 1 S136DCO2701 Jurisdiction: Tigard Slte address: 7040 SW BAYLOR ST Project: Ledridge Subdivision: ELNOLA HEIGHTS Lot: 2 Project Description: Connect existing house to sewer service, less than 100'. • Contractor: RAZ CONSTRUCTION CO Owner: LEDRIDGE, JAMES A 20800 NW KRIEGER RD 1141 SW ENGLEWOOD DR RIDGEFIELD, WA 98642 LAKE OSWEGO, OR 97034 PHONE: 503 - 244 -0011 HONE: 360 - 518 -2665 FAX: 360 - 887 -8580 FEES Quantity Description Date Amount 100 If Sewer Service 06/25/2012 $62.54 Specifics: 1 12% State Surcharge - 06/25/2012 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment - 06/25/2012 $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 issuan •- • " ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utili Notification • - nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or • rect questions to O • NC • a 'ng 503.232.1987 or 1.800.332.2344. r Iss ed By: I �/j Permittee Signature: r/ / y�J Call 503.639.4175 by 7:00 a.m. for the next available inspection 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. Plumbing Permit Application RECE WED FOR OFFICI•: 1151: ON,., �t City of Tigard Received Date/By: . Ac / A k • / Permit No.: 1 No /A ...ap 175 a 13125 SW Hall Blvd., Tigard,OR 9721 5 20 12 Plan Review D ,j . Phone: 503.718.2439 Fax: 503.598 Date/By: Other Permit No t 5fo2Ae( jt -OO T I G A It D Inspection Line: 503.639 t i Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard or.gov CITY OF TIC ARD Notified/Method: Supplemental Information TYPE OF FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total 'ddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 1- and 2- family dwelling ❑ Commercia]lmdustrial ❑ Multi- family SFR (2) bath 437.78 Accesso ry building buildin SFR (3) bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (__ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: _ Job site address: 2D yo S ) 64 )/� -� Catch basin or area drain 18.76 City/State /ZIP: Drywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.1:0) Page 2 6a, sy Storm sewer (no. linear ft.: _) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 P ROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: ../ 9- /yES Lt -b2 /.d 6- -&---- Fixture /sewer cap 25.02 /19 s4 � '6 /OGo4 r Floor ge disposal sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: G�,Ljt- Os 4 , L ) O. 9 26 y Hose bib 25.02 Phone:3), 9 - ©o // Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR 11 Water heater 37.52 ( Business name: 4l. J,t.4trli� Co Water piping/DWV 56.29 Address: go E) h! 6 0 x J� Other: I 25.02 City/State /ZIP: A e I1 � 98-c, (, Z G Subtotal Phone: ( 314) 5/1 _ .24,6,5 Fax: (3b5) a 7- t511 U Minimum permit fee: $72.50 U fa, 50 CCB Lic.: 1 51, S 7 S 9/ (i 3 _ Plumbing Lic. no.: P C3 a , Plan review (25% of permit fee) / State surcharge (12% of permit fee) (1 0, 7 a Authorized signature: �� it r �Y TOTAL PERMIT FEE f/ . Print name: /�1 e 9 t Date: lei _ I a This permit application expires if a permit is not obtained within 180 days /' �/ 1 ` after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. l:\ Building \Permits\PLMU - PermitApp.doc 10 /01/09 440- 4616T(10 /02ICOM/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 - I" 100' 50.03 0 to 2,000. $121.90 Footing drain - each additional 100' 37.52 2,001 -to 3,600 $169.69 , - 3,601 to 7,200 - $233.20 " . Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50:for the first$5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to p 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 charge - 1/2 hour) „- , and including $25;000.00: . Inspections outside of normal business . 90.00/hr $25,001.00 to $50,000.00 $37930 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Rein Fees 90.00/hr and including $50,000.00.. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. • accuratelyy report fixtures could result in increased sewer fees * . Please check'all that apply. ' Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Tub /Shower ❑ New exterior plumbing site utilities for any complex structure Bath - -Jacuzzi/Whirlpool Tub/S Tub/Shower as defined in OAR918- 780 - 0040.'- .' Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive Thru ❑ Any multipurpose fire sprinkler system. - Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 -780 -0040. Dishwasher - Commercial Submit 2 sets of plans with any of the above. - Domestic Drinking Fountain Eye Wash Isometric or Riser Diagram . Floor Drain/sink • - 2" ❑ ' Isometric or riser diagram is required for new buildings 3,. that meet the qualifications above. Car Wash Drain - • Garbage - Domestic • . Disposal . - Commercial . . -Industrial Comments regarding fixture work: Ice MachiRefrig. Drains - , Oil Separator (Gas Station) ' Rec. Vehicle Dump Station . Shower -Gang • -Stall Sink - Bar/Lavatory - Bradley . - Commercial *Note: If the fixture work under this permit results in an - Service , increase o sewer EDUs, a sewer will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. • Water Closet - Toilet u� 00 Urinal . m / 3 7 7 (f Other Fixtures: - !X ter, I: \Building\Permits\PLM- PermitApp.doc 2 Po I . „ , WEST HILLSBOROOR 97123 = .....„. , • IF 4(-7/,. a 1 c:,./ e NvoicE# 02435 , .503;522-2727 .... . - .:1) TE, _ 1 , 7 Z- /2 II II ' • -SIDE 503-359-4930 FAX JOB# • , T CHNICIAN)z/G-et94 # 4 qz , o / Xte;a> i ,_ • (503) II , . CUSTOMER e c, 7 (6,-,5/ c ii-,..,—, /1 /1.- ; 1.--- Z 1 - . ADDRESS 70 S& -DRAI ,...) g'>/..,-./0, . . ' CITY -7 ;-,.--a ' STATE OR ZIP 9 2 ? 7 5 2 522 - -2727 , .,,.! N 4--.- . .. . ' ,, ., HOME PHONE# ( ...G2 ) s / 8 - 1 , j II ,I. - r - COW ._ (-- ...- ) , ' Y • TIME IN /0 V 5 CA ,- • 1% • t , TIME OUT /1 / S 601m • . - Fr=c7Es DANI ,_____ . , GuAm _..., : ____ mrEE ,_____ 1\77E1 • . 1 ri DRAIN CLEANING i NED FLAT/ - WORK PERFORME DRAIN E $ AUTH. 1 SURV. HOURLY i •, r R p MAIN LINE HOURLY , .,. . , • . I: .` . DIAGNOSIS FEE , KITCHEN SINK FLAT ': if?-• :-- CP er.% 11 / SEPTIC PUMP , . 41 . ....,, LAUNDRY LINE FLAT ; ir-1,- e ; ' - -,e ' c52 r .4 V 0,-. i ,, IWATER JETTING f- BATH SINK .- 5! -FLAT -• ..- z-•;!.. -':-E ,,,.) , A.....` ., r, .%:' / et- - . 6 , s.. . ..„. - '7: • IVIDEO INSPECTION . . BATH TUB FLAT / -s . .-_-•., -..,. _..C 1LINE LOCATE ., . . ' -• 6 - SHOWER FLAT ; - , !EXCAVATION - ':-.;'• .;.. URINAL FLAT : _....- LABOR TOILET.. _ FLAT ' ROOF/2ND FLOOR .... FLOOR DRAIN : . FLAT . PLUMBING AREA DRAIN . HOURLY : . ' PRODUCTS ,- RAIN DRAIN H 7-' t 0 4" ".!.>(1.7 9, 3 , - .. PARTS , • SEPTIC /000 GAL. r/..?9:5 -:,--' ,..-,', ,./. 9 . . „ ' CO/CHEDK# _ • . ' EXP. CODE, ,. • ' . . . PARTS ' - "'" RECOMMENDATIONS . • 1 QTY. PART# DESCRIPTION PRICE CI- ENZYME TREATMENT El VIDEO INSPECTION , i . 0 ROOT KILLER 0 PIPE REPAIR/REPLACEMENT- !A C.C. FEE 7 , I 7 — lit Abk PAYMENT RECEIVED //? 1 JAL MAINTENANCE • 0 CLEANOUT/INSTALLATION .,.... I - . LI , : I] WATE JETTING : ! 1 ' . BALANCE DUE .,,.. . • ADDITIONAL TERMS AND CONDITIONS CONTAINED ON • . - • - THE REVERSE SIDE OF THIS SHEET . --, 4: , • .-...'"'•= '. ,,..•'-` .1 -.-- --------- I = . ----- , .... • , • - . WWW. WE_ STS I DEDRAIN..com : . .__ ACCEPTANCE OF ESTIMATE AND TERMS AND CONDITIONS ACKNOWL4)GEMEI■IT OF COMPLETION