Permit t . V
CITY OF TIGARD PERMIT
E l A DEVELOPMENT SERVICES PERMIT #: PLM2006 -00029
, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 6394171 DATE ISSUED: 1/25/2006
PARCEL: 2S103BD -00301
SITE ADDRESS: 11770 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Repipe interior plumbing.
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WILLIAMS, LENA MARIE Description Date Amount
11770 SW WALNUT ST
TIGARD, OR 97223 [PLUMB] Permit Fee 1/25/2006 $72.50
[TAX] 8% State Surcharl 1/25/2006 $5.80
Phone : 503 - 590 - 3610 Total $78.30
Contractor:
TIGARD PLUMBING & HEATING
20205 SW CELEBRITY REQUIRED ITEMS AND REPORTS
ALOHA, OR 97007
Contact # : PRI 642 - 7917
FAX 503 -648 -7917
Reg #: LIC 00037443
PLM 34 -116PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 -246 -6 9 or 1- 800 - 332 -234
Issued By :� Permittee Signatures
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• /
Building Fixtures sue. E
Plumbing Permit App Ica ion - FOR . OFFICE USE ONLY .
City of Ti JAN 2 5 2006 Received '
Date/By: /- 5 -V _ • A Permit No u - / / , - pp Z
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59: I .r //a „ht , ( i;1 Date/By. Other Permit No .
24- Hour Inspection Line: 503.639. Y OF , g 1G " f • - I
Internet: www.ci.ti d.or.us H41I$ -�' -- I Date Ready/By $ El See Page 2 for
® DING niv . Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE • . ,
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
X Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF - SFR (I) bath 249.20
al- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
CI 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: 1 ' 770 g...,..1 LJIALYVL,t r Catch basin or area drain 16.60
City /State /ZIP: ft G fir 12-c) 0 2 972_2_3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: /�eJ i
M=► U! 1 1 1 01.4 C Footing drain (no. linear ft: ) Page 2
Cross street/directions to job site: ) Manufactured home utilities 110.00
�' S k f l v•JUT Manholes 16.60
NJ(4 de 1 2,15t- ST . Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
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
R t i p-e_ ) (j Le Wi4t-ce ` �7 5. k.QJYI Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: L-6J•► I t \ i Aro S Expansion tank 16.60
Address: 11770 (LJ L .. i 1,�.k,��- r] r Fixture /sewer cap 16.60
City /State/ZIP: 1 (S to t 2 \) 0 2_ G1 . 2-Z - 5 Floor drain/floor sink/hub 16.60
Phone: (503) 590 3 (p 10 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: - 1 b. /,a1Z 7 I' . ( c k r k G Water heater 16.60
Address: 7.K) z 7 5 S rr.J Ce 1 e (,Lit (` -1- Other:
City / State/ZIP: Atoll o l , t A 0 2 , el (� "
Subtotal
I 1 / Minimum permit fee: $72.50
Phone: (S03) 0 Li Z _ ' j) f 7 Fax: ( 5' 3 lc , LA Z -1 ei t' Residential backflow minimum permit fee: $36.25 'Z S ()
CCB Lic.: ' 7 1 7 Plan review (25% fee)
7 4 9
Plumbing Lic. no.: '3 t) -� b 7�7 . - G
S tate surcharge (8% of permit fee) L
Authorized signature: tX `V�� TOTAL PERMIT FEE -7g. BO
Print name: (l '.v� e_ 9_ L T per( S Date: , .- ZS - OCR This permit application expires if a permit is not obtained within
J 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I \Buddmg\Perrnils\PLMF- PermutApp doe 06/05 440-4616T(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 ValuatlOn • 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
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
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 l ' . ' ' , , ' ,
Swimming Pool Filter
Washer - 'Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet - Toilet 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.
1 .
i, \Buddmg\Permus\PLM- PennitApp doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S.O0029
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/261200(
Phone: (503) 639- 4171y t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION'WORKSHEET FOR DATE: 1/30/2005 TIME: 7 :01AM PAGE: 16
SITE ADDRESS: 11770 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WILLIAMS
DESCRIPTION: Repipe interior plumbing, •
OWNER: WILLIAMS, LENA MARIE, PHONE #: F;03-
CONTRACTOR: TIGARD PLUMBING & HEATING PHONE #: 642 -7011
Inspection Request Scheduled For: Date: 1/30/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3a ;0 Plumbing final 025:58 - 01 503 313 - 56£33 N
Corrections /Comments /Instructions:
WI P I I Ade
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SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: Iii `I Date: I • Phone #: (503) 718 -