Permit , N.,
. CITY OF TIGARD
PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00001
TIGARD DATE ISSUED: 1/2/2009
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S133CD -11200
SITE ADDRESS: 11689 SW WILTON AVE ZONING: R -25
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT: 144 JURISDICTION: TIG
PROJECT: WITTMAN
Project Description: Replace 50 feet of water service.
CLASS OF WORK: OTR 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: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
JULIE WITTMANN Description Date Amount
11689 SW WILTON•AVE
TIGARD, OR 97223 [PLUMB] Permit Fee 1/2/2009 $72.50
[TAX] 12% State Surcha 1/2/2009 $8.70
Phone : 503 -590 -4997 Total $81.20
Contractor:
ARS RESCUE ROOTER
PO BOX 2830
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 235 -8784
FAX 503- 491 -2932
Reg #: LIC 127325
PLM 34 -168PB
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 OU NC by calling 503 246.6699 or 1.800.332.2344.
6:n11446...tak_i_ , - .
Issued B P ermittee Signat AO& %. �1 A r a," ••
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.
`- JUN -05 - 2004 18:19 P.001
Plumbing Permit Applic %gp CEI'ED
Building Fixtures FOR OFFlt.:r. USE O,`L>
City of Tigard J AN 0 2 2 009 Doe i ft 0 9 "41-y PermitNo.• /��4_
= Plan Re�,
Y 13125 SW Hall Bh'd. T igard, OR 97223 a%
Phone: 503 639.4171 Fax 5 Datc,9y Other Penult No
Inspection Line' 503 639 4175 TIGARD
I i C:A R ID N
3 Uii niN nIVISION o te Ready
'M By. . upp m e l Inf
Intemct: w•ux•,tigard-oGgOV Notified/method �� � S upphmentallnformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For s eclat it ormation use checklist.
Descn non Qty. En. Tout
Fr Addition/alteration /replacement ❑ Other New 1. 2•famlly dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR I I 1 bath
249.20
I i I- and 2- family dwelling ❑ Commercial /industrial SFR 121 bath 350.00
❑ Accessory building ❑ Multi - family SFR 131 bath 399.00
0 Master builder ❑ Other Each additional bath/kitchen 45.00
- Fire sprinkler I sq. ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address:
V. S' 1,7 Catch basin or area drain 16.60 —
City /State/ZIP; /1:j :°.� I . . Drywell, leach line, or trench drain , 16 60 -
Suite/bldg./apt. no.. Project name: r �� Footing drain (no. linear ft : ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Ram drain connector 16 iiii
Sanitary sewer (no linear ft. _) Page 2
Storm sewer (no, linear ft.: , ) Page 2
Subdivision: Lot no.. Water service (no linear fl,; T/ /(� Page 2 ��-
Tax map /parcel no.:
Fixture or item
DESCRIPTION OF WORKK Backflow prcventer Page 2
Absorption valve 16.60
E
]� � SCR
t50 V V/ri' /Pry- C - �Z 'I/! Backwater valve 16 60
te a _ f� _:Ad Clothes washer 16 60
Dishwasher 1660
PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
•
Name: Ejcctors/stimp 16.60
1 1, It ' //, Expansion lank 16.60
Address: i
ir/ %� Fixture/sewer cap 16.60
�Z_. %I Floor drain/floor sink/hub 16.60
Phone: ( � ,../' I7Y� — . : ( ) Garbage disposal 16.60
.it APPLICANT [I CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ARS dba JACK HOWK /Rescue Rooter
Interceptor/grease trap 16.60
Contact name: JOYCE DENNIS — Medical gas (value $ 1 Page 2
Address: P.O. BOX 2830 Primer 16.60
City/State/ZIP: CLACKAMAS, OR 97015 Roof drain (commercial) 16.60
Phone: (503) 235 -8784 Fax: : (503) 491-2932 Sink/basiiVlavatory 16.60
Tub /shower /shower pan 16.60
E -mail: JOYCE6RJACKHOWK.COM Urinal 16 60
CONTRACTOR Water closet 16.60
Business name: ARS dha,JACK HOWK /Rescue"Rooter Water heater 16,60
Address: P.O. BOX 2830 Other: MAI
City/Stutc/ZIP: CLACKAMAS, OR 97015 .__. Subtotal ����
Minimum permit fee: $72.50 /
Phone: (503) 235 -8784 Fax: (503) 491 -2932 Residential becktlow minimum permit fee: $3625 i
CCI3 Lic.: 127325 /A ey to Plumbing Lie. no.: 34-168 P,, Plan review (25% of permit fee)
Authorized signature: 11 - Stare surcharge (12% of permit fee) W!oi1
' 4:. ✓ L . / 4 t TOTA1. PERMIT NV)
Print name: f� �
i `! '����a I This permit application expires if a permit is not , btai,e,• i' '
180 days after it has been accepted as to I -
*Fee methodology set by Tri-County Building Industry Service Board
t ■BwidmgPmnitaLMr••P Please FAX 13 ..A.CK • 503- 491 -2932
N -05 -2004 18:19 P.002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Sguare Footage: Permit Fee:
—
Footing drdin - I" 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.411 2.001 to 3.600 $16000
Sewer • lit 100' SS.OU 3.601 to 7,200 $220.00
7.201 and greater $309.00
Sewer - each additional IOU' 46.40
Water Sonicc 1st 100' 6 55.00 / Medical Gas Systems:
Water Service - each additional 100' 46,40
Valuation: Permit Fee:
Storm &Ram !)rain - 1st 100' 55,00 $1.00 to $5.000 00 Minimum fee $72 50
Storm Cr: 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 Qly. Fee (ea) Total additional $100 00 or fraction thereof, to and
including $10.000.00
Commercial Back Flow Pre+ention 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 ufcsISling plumbing or each additional $100.00 or fraction thereof, to
specialty requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: yr $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: 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 chock all that apply.
accurately report fixtures could result in Increased sewer fees *. 0 Any new commercial building with water sen ice 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Eteplace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Bapnatry /Font as defined in 0AR918- 780.0040.
Bath -Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
•Jacuzzi/Whirl ❑ Any multipurpose fire sprinkler system.
Cur Wash -Each Stall ❑ Any complex structure as defined in OAR91 R- 780 -0040,
-Drive Thru
Ct>spidor/water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
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
S hower -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 Filler plumbing permit can be issued.
Washer - Clothes
Willer Extractor
Water Closet - Toilet
Urinal
Other Fixtures.
i \Bwldi iVerro is\l'L.M•PeimitApp dot 12/27/66 - "
CITY OF TIGARD -� ck
I BUILDING DIVISION PERMIT #: PI_M2009 A0001
13125 SW Hall Blvd., Tigard, OR 97223 � / < A TE ISSUED: 1/2/2009
Phone: (503) 639 -4171 III i v
Inspection Requests (24 Hrs.): (503) 639 -4175 �! -4 /
INSPECTION WORKSHEET FOR DATE: 1/6/2009 TIME: PAGE: 29
SITE ADDRESS: 11689 SW WILTON AVE CLASS OF WORK:
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 144 TYPE OF USE:
PROJECT NAME: WTTMAN
DESCRIPTION: Replace 50 feet of water service.
OWNER: WIITMANN, JULIE PHONE #: 503 - 690.4997
CONTRACTOR: ARS RESCUE ROOTER PHONE #: 503.235 -8784
Inspection Request Scheduled For: Date: 1/6/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Mes ge
330 Water service 079403-01 503 - 235.8784 Y
Corrections/ Comments / Instructions:
/ " kJ(rh a
Aid Qije" r 1/1,&j.,_ (42 4/1/J) i? - elf k-,er/
CI -- (f 6t. S LC .
DV
PASS ❑ PARTIAL APPROVAL El CANCEL El NO ACCESS
❑ AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
VZ) Inspector: V Date: 00 D 'Phone #: (503) 718-
- -1 -