Permit r , ' - c 4
a CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00061
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/20/2008
PARCEL: 1S134AD-08200
SITE ADDRESS: 10570 SW WINDSOR CT ZONING: R -7
SUBDIVISION: WINDSOR PLACE LOT: 020 JURISDICTION: TIG
PROJECT: HOOVER
Project Description: Changing out six feet of water main.
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: 6 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
LARRY & VI HOOVER
10570 SW WINDSOR CR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/20/2008 $72.50
[TAX] 12% State Surch 2/20/2008 $8.70
Phone : 503- 639 -4787 Total $81.20
Contractor:
NICHOLS PLUMBING
PO BOX 68551
4375 SE MARK KELLY COURT REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97268
Contact # : PRI 503- 653 -2069
FAX 503 -513 -6402
Reg #: LIC 132527
PLM 3 -414PB
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 folio I -s adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952-0001-010 o Y•. may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B y: Permittee Signature:
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 ,
FOR OFFICE USE ONLY
City of Tigard R eceived n Permit No `,y�
■ 13125 SW Hall Blvd., Tigard, OR 97223
Date/By rl (j � � � t"/ / _
CC/0 •
111111 C D an Review Other Permit No..
Phone 503.639.4171 Fax: 503.598.1960 DateBy.
• Inspection Line: 503.639 4175 Date Ready/By: lo os. ES Page 2 for
l" I G n It D Internet: www ti ardor. ov y • B
g g Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Descnption 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
❑ 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 LOCH• ON _ Site utilities
+ Job site address: ma ,`1�t + Catch basin or area drain 16 60
City/State/ZIP: \�CA Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 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: I Lot no.: Water service (no. linear ft.: /) Page 2
Fixture or item
Tax map /parcel no.: -
Absorption valve 16.60
D� N OF Backflow preventer Page 2
6A(n9. 1 M Backwater valve 1
e 16.. 60
Clothes washer 16.60
1 Dishwasher 16 60
�J PROPER OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: \ y Expansion tank 16.60
Address: D W �\\1\\ pc A. Fixture/sewer cap 16 60
City/ State/ZIP: Floor dram/floor sink/hub 16.60
r '�
Garbage dis osal 16.60
Phone. `��M Fax: ( ) p
LI � �,`\ 1 ` C ❑ CONTACT PERSON Hose bib 16.60
❑ AP
� 7 �� �\ \� Ice maker 16 60
Business name:
1 Interceptor /grease trap 16.60
Contact name: ‘.\ \C�� Medical gas (value $ ) Page 2
Address: T Pnmer 16 60
City /State/ZIP: Roof drain (commercial) 16 60
�C5)) b i „�- l Dk I Sink/basin/lavatory 16 60
Phone: J 0 � Fax:: ( )
Tub /shower /shower pan 16 60
E -mail: Urinal 16 60
ONT3tr OR Water closet 16 60
Business name: \ % J \,1 \ \\1) 1 Water heater 16.60
Address: ! G Ac., x. 5( A j-7S xj� ,/N.,/i Ll /i( Other. \
6/ Subtotal
City/State /ZIP: lM/ /WCM^ rt CE Cl )�1r
b � b t ��_� Minimum permit fee $72 50 n
Phone: � Fax: Residential backflow minimum permit fee. $36.25 / � -s..-0 CCB Lic.: \ p I 1 (a / Plumbing Lic. no.: \oCA`t TOTAL PERMIT FEE "7// /0,� Plan review (25% of permit fee)
1 . e ( ( State surcharge (12% of permit fee) n - '7 0
Authorized Si afore: , . " l��
�,
Print name: \ I Date a 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.
1 \Buiiding\Permns\PLM- PermitApp doc 1 1/27/06 440- 4616T(10 /02/COM/WEB)
i •
. a
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 - 1 100' 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 °55'S& Medical Gas Systems:
Water Service - each additional 100' 46 40
Storm & Rain Drain - 1st 100' 55 00 Valuation: Permit Fee:
$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
and including $50,000 00
specially requested inspections - per hour 72 50
Subtotal Ss $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:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Tub /Sowr ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S erlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
- Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash, Isometric or Riser Diagram
Floor Drain/sink - 2" . ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-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 *Note: If the fixture work under this permit results in an
- Bradley
- 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:
t \Building\Permns\PLM- PemiiIApp doc 12/27/06
CITY OF TIGARD " -
BUILDING DIVISION PERMIT #: PLM2008.000&1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/f0/200t3
Phone: (503) 639 -4171 �c
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I �..
INSPECTION WORKSHEET FOR DATE: 2/21/2008 TIME: 7:00AM PAGE: 18
SITE ADDRESS: 10570 SWWNDSOR CT CLASS OF WORK:
SUBDIVISION: WINDSOR PLACE LOT #: 070 TYPE OF USE:
PROJECT NAME: HOOVER
DESCRIPTION: Changing out six feet of water main.
OWNER: HOOVER, LARRY & VIRGINIA PHONE #: 503 - 6354787
CONTRACTOR: NICHOLS PLUMBING PHONE #: 503 - 653.2069
Inspection Request Scheduled For: Date: 2/2112QQ8 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 065393 -01 503 6532069 Y
Corrections /Comments /Instructions:
C4 n
•
'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr6V+ -^-AA\-^ Date: 7 . \7\\ h7\ Phone #: (503) 718-