Permit CITY OF TIGARD PLUMBING PERMIT
1 11- COMMUNITY DEVELOPMENT Permit #: PLM2009-00142
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/10/2009
Parcel: 2S114BD01100
Jurisdiction: Tigard
Site address: 9890 SW RIVERWOOD LN
Subdivision: Lot: 0
Project: Fenstermaker
Project Description: Install /replace (4) lays.
Owner: FEES
FENSTERMAKER, ROBERT K/LINDA A Quantity Description Date Amount
9890 SW RIVERWOOD LANE
TIGARD, OR 97223 4 ea Lavatories 06/10/2009 $66.40
PHONE: 1 12% State Surcharge - 06/10/2009 $8.70
Plumbing
6 ea Minimum Fee Adjustment - 06/10/2009 $6.10
Plumbing
Contractor:
TOP NOTCH PLUMBING
PO BOX 2676
WILSONVILLE, OR 97070
PHONE: 503 - 570 -7777
FAX: 503- 682 -0560
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
or direct questions toO UNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: rl ,r, ^ Permittee Signature: S O S( ^ 5 �\;/ 0
'Q 1�/V� BL '� 'TTT `JV 01
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.
Plumbing Permit Application"
Building Fixtures y -AJ " "° FOR OFFICE USE ONLY
- City of Tigard JUN I 0 2009 Received
DaDate/By: erm ►r 4 Z
t g Pit No.. p) �/yl a
n 13125 SW Hall Blvd., Tigard, OR 97223 � g ' (
Phone: 503.639 4171 Fax: 503.598.1 60 OF Plan Review
Inspection Line: 503.639.4175 q � � � ' p " !q � ���� Date/By. Other Permit No.
T I GARD F NG DIVISION Date Ready/By: y u j s: See Page 2 for
Internet: www.tigard- or.gov Notified/Method: I I Supplemental Information
,, .: -r� .., ";.r.. -. -, .,.. ,,.:�, - s x..+;.nx= :s =.�', 'a:: .':.:.:a rn:�;*:. , .��.� i ":,.:,sea "r:��:.a ^.cr,� , -..
-. . ✓ ^:.,r.: ..; k v � ...r . M` x .,;�.^�. ;'hc°. .: e,.. =K44`' "`:ti ..k. '�:'.`,<� h"4;�- x . ;s ".ah'i�
'.i.c , 5 ', 4 y k ; ...� -.'r =. 5 ' "Fay .. { es���,�; x ,. s , .„>r... <r� .;,�,'b Sd`� i. =...^ .; n,�r� . ,fir , r * a wrx ;, .
� ;. . E:'.„,rF I.., � i3O WORK - ,.:: ~ w -Pe4 .. l -F SC H EDULE .a .
�.._.�.. - ���. ..,�". ,.�..�. «.�.�xfiansa. -_...? rra;_- .� �P . �; „• , � � ^ � � "_ 4_K °s ^a?"�- .:,rS:ha .r'.� &f..�v.�^ < a rat ^,..�..,.� ^ � t�:^ ne„ �.. � �� v.;: n:-. �,.:,;~! �, ��. ��- r. =,r = +.� sA..-z; " ... >,
❑ New construction ❑ Demolition For special information use checklis
Description Qty. Ea I Total
dditio . teratio ' eplacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
�� r , 5 L C AT EG02 Y ry O �C t, ,U C T 1oNi ,, k , s "` ;; : w ' SFR (])bath 249.20
[∎1 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family
SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
_
:.e k,... s ,x - =:. 6w ❑ _, 0 her . V µ<, m. x _ Fire sprinkler ( sq. ft) Page 2
t
i iii . ' TO T VO i,-* LrOCA # ,- e.r �� Site utilities
Job site address: .,e390 sW g tO01a im.., Catch basin or area drain 16.60
City /State /ZIP: 116A i-P 1 04 9 7214- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: t`EN51 1"iA F. 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.: ) Page 2
Storm sewer (no. linear ft.. ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
;",- . ,. , k ORK"
r Absorption valve
A or 16.60
'� g i � t DESCRTPTId�V, _ O.I+ _W- ;, i .; ,,, i , .t . 'o* p reventer Page 2
.;,_.' � , , i -A'it .., ,.Qwt.> , „..,, . s ... p .; =� a ,_,, .:m- is l.. � c . _ a r Backflow
P 1-141 ) el Ili t RS'"I�CI $ pft" .S Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
g'r= � °� l r ��r.; Drinking fountain 16.60
: x ®PE'RTY OW1V 040 �, s' ; M , i ts ` „ :. fl T : °
Name: Ejectors /sump 16.60
�� L U 3DA ���� � � �' Expansion tank 16 60
Address: cf0 c 0 90 5v) R wig.,v j) ,j ( - Fixture /sewer cap 16.60
City /State /ZIP: ¶I 1I ' 14 � 97Z Z4 ' Floor drain/floor sink/hub 16.60
Phone: ( ,SQO ) 00 .� 9 1' Fax: ( ) Garbage disposal 16.60
t ,. ,. r ;s...or• ' ;a" . ° Y.,.... 4 „Al rr -t r.�'< ,era-: ;a°'l ' Hose bib 16.60
u , (- PLI t._CA; � w - ._ , NTACT� PFRSON _ .
s�, -. i � ,., -� lee maker 16.60
Business name: -'AM 1iakr - g urli O1-3 ems, 151704 Interceptor /grease trap • 16.60
Contact name: ' 'w 4 L L'( ?1 ?. oc Medical gas (value: $ ) Page 2
Address: 42769 Sp "P,pg cc" Primer 16.60
-
City /State /ZIP: to ` �sco v) uk ( De_ 2 70176, Roof drain (commercial) 16.60
Sink/basin /lavatory ¢ 16.60 r ( 14.()
Phone:
(,71 ) 645- o 7 9 Fax: � () ive Tub /shower /shower pan 16.60 P•
E -mail: . 4L` , 1�YCP� 3
'ti j 1 p`� � Tit?J? . 60 i
16.60
1 l a . P CONT :a9 ,P ,
� f"
, � . . s -.�_. , >< �`�.': < �s�: .q ..' � �u , Water closet 16.60
Business name: 117 1 ` � i'lkr,i 6 Water heater 16.60
Address: pa ie `
1( , Other.
� p Subtota
City /State /ZIP: U I LPU i l' f O F. 97070
Minimum permit fee: $72.50 72- O
Phone: (5b3 ) 3-70, 77/1 Fax: ( ) Residential backflow minimum permit fee: $36.25 J
CCB Lie.: , ,1 Z d 13 3 Plumbing Lic. no.' Plan review (25% of permit fee)
®� . � f ` State surcharge (12% of permit fee) g � j i I" Authorized signature: e / // �2rw // i 3 � I TOTAL PERMIT FEE ' • ,a6 Print name: •F _ IPA � C X1,4 roa2� Date: -/O- 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,
t.\Budding\Permits\PLMF- PermitApp doe 12/27/06 440- 4616T(10/02 /COM/WEB)
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
C "�` x . #;r ., ; �x,_� , v ., t >� . +.� � : ,t" � ." "2�
"".Site Uti'lfl e.4 ,'�7 ^a?�� .. �. p FCC e#
..', S guare Foot
Footing drain - U 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 '
Storm & Rain Drain - 1st 100' 55.00 Va1uatu n "r f i "Permij ee
$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
• additional $100.00 or fraction thereof, to and
rt J 1 ii., l>rC ,OI ] eTY1 =:' _s Qry ;i (ea) Tot1;7'. 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 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 including $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.
Commercial Fixture Work: ,; �P�a���Revewfor� ,Plumb><ng�Ia�stallaho>ns _�
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 * . ❑ Any new commercial building with water service 2" and
. i }; � ` ='x "''"ti. , nab ; r- i itnti "x °tiy. iztu"re 9,r,k�Periori greater, except systems designed and stamped by licensed
Fixttll'erTypC y
044 '. r r a r a -., ,'` -'� ', E . _ Rep1aCe"' =-: engineer.
t C ed Addeds ,n ._.Existin
�Prev,ons�,��,Ca ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ 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 C4,00" r:r; - ..: t1COI' :az RTSB IAgPai[l
47 `'"
Drinking Fountain .OII1
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4'
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
\Building\Permits\PLM- Permi1App doc 12/27/06
Al u CITY OF TIGARD .
° COMMUNITY DEVELOPMENT ;
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223- 593-6 RECEIVED
JUN 1 0 ?P09
Plumbing Signature Form CITYOFTIGARD 7.
BUILDING DIVISION
IMPORTANT PERMIT NOTICE m Li ,k ju i ufkruLGI
Rru_ t. - tc' q cdkion% Lit U ' lQY1,L■, .
Permit #: 0 I MZOCxi - QO l I 9 -
Date Issued: Co • 1 O • Gq
Parcel:
Site Address: ° i8 ° ( 0 3 u CZ .v CIF LLD OOd ' - r 1
Subdivision:
Lot:
Jurisdiction: I oJC■_rd
Zoning:
Project Name: FenSiCirpnQKe
Description: Z nacc..‘ 1 lr.e ptQC.e tf) \ & js .
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
Top AJ crkc n 1 u lm i : j li(J
Phone #: - Phone #: ,5 a 3 - S 70 )777
AN INK SIGNATURE IS REQUIRE n ON THIS FOR -
X ' -r. c.a. ` - G
Signatu - o °% thorized Plumber Name printed)