Permit U CITY OF TIGARD PLUMBING PERMIT
iii
' ' COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00371
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/15/2008
PARCEL: 1 S134DC -00500
SITE ADDRESS: 11476 SW TWIN PARK PL ZONING: R - 4.5
SUBDIVISION: TIGARD PARK LOT: JURISDICTION: TIG
PROJECT: ALATTAR
Project Description: Installation of approximately 200' of storm drain.
CLASS OF WORK: ALT 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: 200 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ADNAN ALATTAR
11476 SW TWIN PARK PL Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 9/15/2008 $101.40
[TAX] 12% State Surch 9/15/2008 $12.17
Phone : 503 -521 -1320 Total $113.57
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
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 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 r - or direc = estions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
A
Iss ed By: / / / Permittee Signature: /' /
Call 503.639.4175 by 7:00 a.m. for an inspection that business d . .
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 Perm Auplicat
Building Fixtures FOR OFFICE USE ONLY
City of and Received Ti q -�z
Tigard Date/By / /5 pg Permit No.: p a�g J7/
Date/By
V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone. 503 639 4171 Fax. 503 598 1960 Date/By Other Permit No •
T I G A R D Inspection Line: 503.639 Date Ready/By: �m El See Page 2 for
Internet. www tigard -or gov Notified/Method ! /4„., 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 (1) bath 249 20
❑ 1- 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: ,l % ( 5L*) )t,✓tv. pal-k.,, jo ap( OR 132.t..1 . Catch basin or area drain 16.60
City /State/ZIP: 1 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: I Project name: ID r ox∎ vLe-ti 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 liiiear ft • ) Page 2
Storm sewer (no linear ft.. ?d o ). Page 2 / '/. g0
Subdivision: I Lot no.: Water service (no linear ft • ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
S'to ^-
gC Sa_c t� k { p�k z �: � Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16 60
Name: Ad a j\ k tkkac ,.✓ Expansion tank 16 60
Address: t tL.k ?.{ 5 ■"i`w%\A ? jiy) Fixture/sewer cap 1660
City/ State/ZIP: - "-Z 5 IJ 97 2 2-3 Floor drain/floor sink/hub 16.60
Phone: ( 5 8U3 e, 5" i 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: ( ) 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: OCc) ` /p`-/► /J Water heater - 16.60
Address: / Other.
• City/State /ZIP:
• Subtotal
Minimum permit fee $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee $36.25 fob LA
CCB Lic.: Plumbing Lic. no.:
Plan review (25% of permit fee) 6
State surcharge (12% of permit fee) 2.1
Authorized signature: 5 /
n
/ TOTAL PERMIT FEE
Print name: 4t7 r`AG` A `� -ls Date: 1/(510 8 This permit application expires if a permit is not obtaine
within
180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
i \Building\Permits\PLMF- PermiApp 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:
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 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
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
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
Subtotal: $50 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: Plan Review for Plumbing Installations
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ 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 Isometric or Riser Diagram
Drinking Fountain
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
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 •
is \Buiiding\Permits\PLM- PermitApp doc 12/27/06
CITY OF TIGARD . ,. A
BUILDING DIVISION PERMIT #: P w 9,4eg - .oc737/
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 IL
INSPECTION WORKSHEET FOR DATE: 9//s/e8 TIME: r 1— 1 2- PAGE:
SITE ADDRESS: //q76 bco / 40 Ask A- CLASS OF WORK: /9L-
SUBDIVISION: LOT #: TYPE OF USE: �--
PROJECT NAME: - 17 -- rn�
DESCRIPTION:
OWNER: 11- ' E113 4 L ITi X42 PHONE #: 5b3- i'o3 - 975/
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 f >ti A \.
Corrections/Comments/Instructions:
C -t i t. c i ti✓ J4 ! )1,)
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i LuU 11 \1 Date: q 1 \< fl s c� Phone #: (503) 718-