Permit CITY OF TIGARD PLUMBING PERMIT
111111 111 .�1 COMMUNITY DEVELOPMENT Permit#: PLM2013-00030
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2013
Parcel: 1 S125DA07500
Jurisdiction: Tigard
Site address: 9375 SW 69TH AVE
Project: Jensen Subdivision: KINGS VIEW Lot: 61
Project Description: Replacing 45'of interior waste line.
Contractor: JACK HOWK PLUMBING/RESCUE ROOTER Owner: JENSEN,VIRGINIA N
PO BOX 2830 9375 SW 69TH AVE
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503-246-2491
HONE: 503-235-8784
FAX 503-491-2932
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 01/23/2013 $56.29
Specifics: 1 12%State Surcharge- 01/23/2013 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 01/23/2013 $16.21
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81 20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct que ns to• NC by calling 503.232.1987 or 1.800.332.2344.
Issued By • / Permittee Siure -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
JAN-22-2013(TUE) 16: 52 AR5/Jackhouk/RescueRooter (FAX)503 491 2932 P. 001/003
•
Plumbing Permit AppliCJtionRECE1 * ED
Building Fixtures JAN 2 3 2013 FOR OFFICE USE ONLY
City of Tigard rtrosivrrl
CITY Ot=TIGARD oatdBv. / ,23 /5 Pcm„it •Nu.. !,x/,,767-Ir
r 131'_5 tiW Hall Qlvd.,'ligurd,UR 97223 Ilan I<evie
t Phone: 503.639.4171 Fax; So3.598_{ t ILDtNG DIVISION
Dutc/Bv: Other Permit No
Inspection Line: 503.639.4175
T1 GARD Internet: www.tigurd-or.gov
Date Ready/8y. RM., F3 see Inge 2 for
la • A ;�, ,°r� fir,l r L t{`Y ; - , Notified/Method: lt�tr � Supplemental ln formulism
♦ ��
i.ikvi iii0F,.'.1;'4?H,lj', ,I Iii�a�d' .tr, .P Chafe i�ra ,' '��� il'ti h�i, t^r�' ;*,4`{1 ,;,',It { `'!f S 1 ��';;,..,1 '1w��II.. � w f c 1 s l ti34ilS? „wro;ii
❑New construction ❑Demolition For sredalIn ormafian use chealls7.
Description ON Ea fowl
r Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 fl.for each utility connection)
' ,R�..,,. "trJ,ay yr o�,� r
,il ffi 1;,,li �11t70,t,' 1Yl,1',,i-Tv �{, ur'ut[f ',? �(� l;�ntw,l�p{� l�,t''�, r� ; ' �1 ," SFR(1) 1 n
tAdl,illlkrsck}Rlt.,l 's3ti �,f}� .� i i 1f1 4i1�1:i�rY ( ) - 31�70
:4 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
Accessory SFR(3)bath 500,32
ry buildin
❑ building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other
r Fire sprinkler sq.I1) Page 2
lq; 'tl m r 11I;ji0 I?�rrt u' Gt.I t 'i 5�1 I li M�t i akli i;u'.li ,1110p
�M-��.�' � �� » r,�lt le��''�i;w�. >sl !w,'vlji Site utllilirs:
.lob site address: • '� �� Catch basin or area drain 18.76
y , 4, �j _ _G �" Drywcll,leach line,or trench drain 18.76
Cit /SrrlydZll: r yr /
Suite/bldg./apt.no.: Project name: 'w f'��
Fruiting drain(no.linear ft,;_) Page 2
Manufactured home utilities 50.03
Cross strceUdirections to job Site: Manholes T 1M 18 76
Rain drain connector 18.76______
pu
Sanitary sewer(no.linear fl.: l''!:air�
" Storm scwcr(no.linear 13.:_) r �tcv 41r- � �'
ilU
Water service(no.linear it.: ) Page 2
Subdivision: blot no.: Fixture or item:
Tax map/parcel no.:F�j�,�{� Backflow preventcr
11111111111111
E iii, 'i,n `1is URr1.t .�;p�pjlyr��'o .% Irtpv.,1 e..wr. Cpy�t' Backwater valve
t. k'y 4l Fwlyl�r�t9tl�".�f Y i � 0 I� �{ wi :. dw�f'N11
fl,, Dishwasher r ' Cinches washer ME 25.02 MIN
25.02.4e7119 4 -0"_` r e Drinking fountain 25.02
�';r�, !f` ply Ejectors/sump 25.02
v1 VT a,�tilt'�,H}!lJA • , ,ty{k`IIIM 1111 r?t 1 t 1{1�i u'1`tY 4 Expansion tank
;l 'i .f�J �� � G:. r r:r.+.� �?74�91'� - 12.5) Mil
EMU ,i / o f So Fixture/sewer cap M 25.02
Address: 46:r
�` / Floor drain/floor sink/huh 25,02
- - Garbage disposal 25.02
City/State/ZIP: ,`J/ Gr l to c Mb 25.02
Phone:( 0 . ,..„.7-
L �t7r1� Ice
r,r, 7g� maker 12.51
•
','$�ii.k'i G'QIJ N1 �!'5roi er llil,r '°jig*;C{Jt J�`"r Irttli� c''fy"%c{� if" Interceptor/grease tr.p 25.02
"rdk�t1rU 1I lt ;�x I1Ftr 1v ".ta �l�.. 1 .F 9
Business name:ARS au JACK NOWK/RESCUE ROOTER Medical gas(value:$ } Page 2
Pr
Contact name:JOYCE DENNIS Ir 12.51
'- Roof drain(commercial) 12.51
Address: P.O.130X 2830
-
Sink/basin/lavatory 25,02
City/State/ZIP:CLACKAMAS,OR 97015 Solar units(potable water) 62.54
Phone:(503)RS0-3100 Fax::(503)491-2932 Tub/shower/shower pan 12.51
E-mail:JDENNIS@ARS,COM Urinal 25.02
Mil t111Ai {I {,pr Ir,i U1e�1. 'G�r Y1 f i a 1 rt 11'1 a' " ,r v`1 f:.r Water closet 25.02
5-02
' ut ; i, d Y it.t ,:` d r fit,.tt3'. it�t.IS t�I,Gl4' ' ti °t i� iuii;�.'' water heater 37.5 2
Business name:ARS dba JACK HOWIURESCUE ROOTER
Water piping/DWV 56.29 /(�
Address: P.O.BOX 2830 �e`v�
Other, 25.02
City/State/ZIP:CLACKAMAS,OR 97015 Subtotal rfi ll
Phone:(503)850-3100 Fax:(503)491-2932 Minimum permit tee: $72.50 �%,
l:..aL�:W 1�
Mb.
CCI3 Lie,: 127325 •lumbing Lie.no.:34-168PI3 Plan review (2S'%of permit fee)
State surcharge(12%of permit fee) �4
Authorized signature: �� _ / -
g �r +! •' TOTAL PERMIT Far/ 1'/�,/'
Print name:JOYCE OENMS nat . Online,� T This permit application expires if a permit ix noOnline, with 'I da vs
after it has been accepted as complete.
P1671;:6- pt): /44/---,... .c;?^Err rnethodology set by'tri•County Building Indrrsicy Service&and
vr,ou u•�r�rrr PU6,MU-rrrr,m� c1,r $
08 pp. .1'uUO 440.46 16T(1w1J2 OM/WEB)
JAN-22-2013(TUE) 16: 52 RRS/JackHouk/RescueRooter (FAX)503 491 2932 P. 002/003
Plumbinzs Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Su. .ression S stems:
c ti •,^"�'(�,M.1'[1'M,!"q..111Q•`•1,�.,rt i S lilts ,N �` y�i` +lf g''� f :1'r v �' i?r {' V,�I�-_!.r L^..��,r�., -r�����.1y..Y i�'Lu.7i% 1n ' ', �r-.41 Tr.m.,�i1:,'
1'!� 4irdittY C��w„r J,,. {�a,�>^1+M q, t�tj"F'Mi'!(1 �• fi 1 �r�apri ,P'' a tr !S r�t ''i.-rrt s, "q. ,2,•,�� t r t r 1 l� r M t
L.47,6' ' .«..5,r.1 w.; ,�. ...44::a:ithi,.1a1.1ti:..,,s,�lac.,,",ii; L'-: ,.;;rt, .�tLc..i..:. ,. ,.'... «:,. 'T- M wWI cM`�,I� ,N„t..,l� c.I.�. ."..t, 1i1%
Fooling drain-1"100' 50.03 0 to 2,000 $121.90
Footing drain•each additional 10(1- 37.52 2,001 to 3.600 W5169.69
Sewer-1st 100' �irA#��;�'-�';""""�sw �.. 3,601 to 7,200 5233.20
-via: T,'- 7,201 and greater , 5327.54 .
Sewer-each additional 100' 37,52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 �� 4,�',7.!l1'',:„.,4�'r.;,,',47 !2''tf1'r j7%',:i',1ii r.;�'t'.:!L.i,r: ,.�tl,ai ',�rr,!.'411:12.::a 14 Storm At Rain Drain-1st 100' 62.54
51.00 to$5,000,00 Minimum fee$72,50
Storm&Rain Drain-each additional 100' 37.52 55,001.00 to 510,000.00 57230 for the first 55,000.00 and$1.52 for
1��1,'� ,i!11^� t r r d I'Lh 7,72,..0.-4-1,V.
lay r I (t�.��� 1i r rylr�'1 1r a'}S.,Ir1+r�, I)'�1+:��'1'` each additional$100.00 or fraction thereof,to
i,'i,:cla;.;s.1,r,.n,„tde..nK nai...r�!..rf,e,1 :z.r.,1 ,1�lr..lr:. ...1.flu,si:.0,.1.�t?.u!.1,:r,..: and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 5148.50 for the first 510,000.00 and$1.54 for
which no fee is specifically indicated 1111 90.00/hr each additional$100.00 or fraction thereof,to
minimum char'e-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25.001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including 550,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the fist$50,000.00 and$1.20 for
(minimum ch. e-1/2 hour each additional$100.00 or fraction thereof ._
Subtotal: Er, .fit_,
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? U"yes", .:LI.:.l.rl.:illt���'�y jrt.l� `r 6.,D...-a 4.... 41t ∎'L2: -F3ti'O k�L:.S.s'u
please indicate work performed by fixture. Failure to Plan review is requited for any of the following.
accurate) re.ort fixtures could result in increased sewer fees*. Please check all that apply.
Sa +7A4wz. ag77.':F, J iii bs�YNr M'r-i"l t� rS't`'il L 0 Any new commercial building with water service 2"and
r ; ,2 i i1. NNell.,a+ 4A.i`f '1 4:11.. r .°^-'L.., 1;i'd lig"t;I engineer.
Baler,except systems designed and stamped by licensed
e
Baptistry/Font
Both -Tub/Shower ❑ New exterior plumbing site utilities for any complex suucturc
-Jacurdlwhirlpool as defined in OAR918-780-0040_
Car Wash Each Stall ❑ Mcdical gas and vacuum systems for health care facilities.
-Drive Thru ❑ Any multipurpose fire sprinkler system.
-
Cuspidor/Water Aspirator ❑ Any complex structure as defined in 0AR918-780-0040.
Dishwasher -Commercial
-Domestic h Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash 11i'
y ( ,_ !„�?l!�4L}?r? '.,l�?rrdk�� 'lt::Nt3Njt�-i��I�r .1.:?Jl ..l ,.....Ic�
Floor Drain/sink -2- ❑ Isometric or riser diagram is required for new buildings
3^ - - that meet the .ualifications above.
-4"
Car Wash Drain
Garbage -Domestic
Disposal -Commercial
-Industrial Comments regarding fixture work:
Ice Mach/Refrig,Drains _
Oil Separator(Gas Station)
Rec.Vehicle Dump Station -
Shower -Gang _
-Stall - _
Sink -I3ar/Lavatory
-Bradley
-Commercial „_ *Note: If the fixture work under this permit results in an
Service • increase of sewer EDUs,a sewer permit will be issued and
ahe Swimming Pool Filter - - fees assessed for the sewer increase must be paid before the
Wwher-Clothes
Water Extractor _ ' plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures; _ ,
http://wwvv.tigurd-or.gov/eity_hal I/depart:nen ts/cd/docs/PLMF-PcrmitApedoc