Permit , o^
CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00588
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/13/2006
PARCEL: 1S135BD-00200
SITE ADDRESS: 09785 SW SHADY LN ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace 150ft. water service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 150 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
•
STAN NORD
Description Date Amount
[PLUMB] Permit Fee 12/13/200E $101.40
[TAX] 8% State Surcha 12/13/200E $8.11
Phone : Total $109.51
Contractor: -
BRUCE STEELE PLUMBING
17368 SW WASHINGTON CT.
ALOHA, OR 97007 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 259 -2920
FAX same as above
Reg #: LIC 86514
PLM PB1
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.
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Issued By: Permittee Signature: A f1/' , . .,��
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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.
, , a
Building Fixtures
Plumbing Permit App `I
Received
VV
City of Tigard Date/By. to 1 D& IS 6 Permit N
u 13125 SW Hall Blvd., Tigard, OR 97W- r 1 3 2006 Plan Review
C Phone: 503.639.4171 Fax: 503.59 Wg Date/By. Other Permit No.:
T 1 G n It p Inspection Line: 503.639.4175 Page 2 for
Internet: www.tigard- or.gov BUi DING DIVAS nN Notified/Method lu' Supplemental Information
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 ft. for each utility connection)
CATEGORY OF CONSTRUCTION : ,.SFR (I) bath 249.20
❑ 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: w S . ria Catch basin or area drain 16.60
City / State/Z1P: Drywell, leach line, or trench drain 16.60
Suite bldg. /apt. no.: Project name: ► Footing drain (no. linear ft.: ) Page 2
L `� . 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.: /raft 2 /D�, LV()
Fixture or item
Tax map /parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
4 A • , I _ , / t• “
1 I " * Backwater valve 16.60
_
Clothes washer 16.60
. Dishwasher • 16.60
0 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60.
Ejectors/sump 16.60
�Y .
Name: r .. - t - - r i I . . . . i A .. , K.),y'wf Expansion ion tank tank 16.60
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
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: ( ) Fax:: ( ) Sink/basin/lavatory • 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60 '
CONTRACTOR Water closet 16.60
Business name: j f � 44; c 6,1,-- ( . , r� Water heater 16.60
Address: f ./ 7 ' g rs' to 1,1911.4 1,1911.4 i•4 ff y 7x9d f Other: I
Subtotal
City /State/ZIP:
$),I' 041 T °2 Minimum permit fee: $72.50
Phone: (I ; 7 _Rai, Fax: ( ) $/C /StC/ Residential backflow minimum permit fee: $36.25
CCB Lic.: d b 18- p Plumbing Lic. no.:. - • / Plan review (25% of permit fee)
�
Authorized signature: - ' --- D - State surcharge (8% of permit fee) D- I
Lit _ . / 4 • TOTAL PERMIT FEE 4 (� Q 7 51
Print name: e^ r e ¶ S1 3' e ( G Date:, ..g.- �/ This permit application expires if a permit is not obtained witgin
f 180 days after it has been accepted as complete. •
*Fee methodology set by Tri-County Building Industry Service Board. •
I:\ Building \PermitsWLMF- PermitApp.doc 04/06/06 440.4616T(I0/02/COM/WEB)
a
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
• Fee Schedule: 'r ` Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l 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 5 ' Medical Gas Systems:
Water Service - each additional 100' / 46.40 Tor. 0 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
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 $25,006.00 and $1.45 for
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or
specially requested inspections - per hour 72.50 and including $50,000.00.
/0 NO '$50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
• Subtotal: /v • ' ` r each additional $100.00 or fraction thereof
'Fix 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"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic 0 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
Water Extractor ' *Note: If the fixture work under this permit results in an
Water Closet - Toilet S . 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.
is\Building\Permits\PLM- PermitApp.doc 07/06/05
F
CITY OF TIGARD
l i BUILDING DIVISION PERMIT #: PLM200 &00588
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/2006
Phone: (503) 639- 4171 , ; ���
A. - .
Inspection Requests (24 Hrs.): (503) 639 -4175 :_:
INSPECTION WORKSHEET FOR DATE: 12114/200€; TIME: 7:02AM PAGE: 10
SITE ADDRESS: 09785 SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: � PARK
DESCRIPTION: eplace 150ft. water service.
OWNER: NORD, STAN PHONE #:
CONTRACTOR: STEELE PLUMBING, BRUCE PHONE #: 503- 23.2920
Inspection Request Scheduled For: Date: 12/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
339 Plumbing final 041113-01 503-997-0993 N
Corrections /Comments /Instructions:
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/3 - 0 i .(p, ,77
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7
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11 Date: , • i (Phone #: (503) 718 -