Permit CITY OF TIGARD PLUMBING PERMIT
11,1 • - COMMUNITY DEVELOPMENT Permit #: PLM2013 -00241
Date Issued: 07/16/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S 16/201 9600
Jurisdiction: Tigard
Site address: 12961 SW 116TH PL
Project: Scott Subdivision: HUNTER'S WOODLAND Lot: 8
Project Description: Repair 15 feet of sanitary sewer line.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: SCOTT, LAURETTE L
PO BOX 2830 12961 SW 116TH PL
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 850 -3100 PHONE: 503 - 521 -8974
FAX: 503-491 -2932
FEES
Quantity Description Date Amount
15 If Sewer Service 07/16/2013 $62.54
Specifics: 1 12% State Surcharge - 07/16/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 07/16/2013 $9.96
Plumbing
Class of Work: OTR
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 questions to � OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / / Permlttee Signature: ���' 6 ,7e 7O�
� to 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.
JUL- 12- 2013(FRI) 09:36 office staff (FRX)503 491 2932 P.001 /003
Plumbing Permit A tic
•
Builldin cB\IED
Building Fixtures , ...... .
- • 'FOR OFFICE USE' ONLY
City of Tigard 1I 2013 Re��i ;
I N .. 131?5 SW hlall IIlvd., I ig,nrd, OR 9722 Dote/B / / /t / /3 ' 4 - Frnnir No.
y e .uy,20 /3 may
�` ' Phoiw: 503.639.4171 F.L.: 503.5
Plan kevtna
t
TIGARD
oetion Line: 503.639.4175 � ° OFTIGARD Dnte1B :
Ins
Other permit No.:
Internet: www ti(;urd or gov , DIVISION Note datl Fin m See Perte z
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i
v ❑ New construction 0 Demolition !:ors (Tied n ormpllon use checklist.
Adduion /allernhon/replaeemcnt ❑ Other Dann ton Total
1 f t l� ri {tl ,,.� i m u lit t ecru ;�` ll�r tli i � r '�� •
,t � + - � 11n • New 1- 2- family dwellings(includes 100 IL for each utility connection)'
,t tEla.' ∎r e h'r1xidi' a�..,,;w4..". :A..: n . •...l..rd?I4 Wlj l'� EG" r` 9, 1 SF (I) b 312.70
`iJ I- and 2- family dwelling SFR
❑ Commcrcialrndnstrial (l) bad 437.78 IIIII
❑ Accessory building ❑ Multi - family _ SFR (3) back 500.32 MIN
0 Master builder Each additional bath/lotchen 25.02
❑ Other
r tf, `i i t •rt, .r . • Fire sprinkler (`_ Sq. 1/.) Page 2
r1 {) y +71��d?�f 1 �t ° nl 2iJy, p l ( 1 q � {�t y,p �,�, r. � 4 t y +'Jr��{ l ��y r r �nrr py �
'�r III d0.. .`.`aJ'� n7"i 7.'Nd�i1., t fir` r •1 .i3, r i:5� j r �'r � l Y,y� }1��.'i�al ,.h7�>)'"�`?
nt..�(r�•,.r'rt,...._.. 4""�:.t.,.$ arr, /'),.l�i„w�{:�!��5�� Site utilities:
1 oh site address: ( - C W .. C b or area drain _
�? 18.76 mi M
r City /Statc/ZlP: (1 / f Dmvell, leach Zinc, or trench drain 18.71;
Suite/bldg. /apt. no.: Project dame:
Footing drain (no. linear ft.: ) Page 2
1 _,1 Manufactured home utilities 50.03
Cross street /directions to job site: Manholes
1 8.76
Rain drain connector 18.76
Sanitary sewer (no. linear 11.: ) rat Page 2 r S!,
Storm sewer (no. linear ft.; i ) Page 2 3+
Subdivision: • Water service (no. linear ft.: ) Page 2
Lot no.: Fixture r r item:
Tax map /parcel no Backliow preventer MN 31.27
Irui ^��7A ltlr:llr�l y'��tFkc Qt y is 1?��i, r �,�rj S't' f 1 1441 r� T „r� P, e..
7r ill t (I�,{,+ n,�' �Y's' a�blri 'MJu��fYl1t'�'�"� ,r`��e °�� ^r'� '.r'�`'a DQCkwatCT valve 12.51
' wl. � 1`rJ� Pb`4 .l � 1 pkl' r r ._ } r� }- S.;,j.+;u LT.. �i 0 1,, , K �' 'S� i'.:, 45 1Y-r �;. il clothes washer
W / //� J -errJ ._� 25.U2
- � v _ � � ! � r Dishwasher a 25.02
` i� I �� 4 4 / = 4w ''�i `a Drinking fountain 25.02 .
r • kt ^P�"ur^} y x J " "� :. u t ; r r ,, Ejeclors/sump 25.02
•
t � 4' ,i li t itt'f e .g o�� t�� E vrv"" F n '' 7 �a i IZt 5 w 4 0t ' ' �
4ga:x;�,w 1✓,���,h +4,! :'i+..11.4 - ,- .....` ���..t�r,. e.'-- ,,•'s1 -, rt �� a.f. �ft�rMi Expansion tank
Name: • // J i /S r j: � Fixture/sewer cap • ' 25.02 N
Address: --Ad , �/� Floor drain/floarsink/hub 25.02
City /State/ZIP:
� . / �L Garbage disposal 25.02
1 � r -' Hose bib 25 -02 M
� �� Ice maker .
Il k �� i lrnu�e'� t" trvu 7� ? y ,r�>n� rfrnn wl�� C4w„r Y St (r t, n 4W OY,'C, d) L.r aLq L r r r
•
RR t{ �nF l�lr�f'w1 1)rtlf)d %�" a r. I r P i t 1 { it a r a l r w y{ P 25.02
Yn'r�1 "t.11u(V1F,A, U ,�.ha1V('wS'tiW.W1!A.1,L",GYM. � gl.rli51'f'�n r'.$....«da"�l aw a�tlt :4 : �4tw ;�M� y6 �...w �G�dA ,CCi���h�.ikl,'57 InterwPMrlb7WSC tra
Business name: ARS dba JACK IIOWK/RESCUE ROOTER Medical gas (value: $ ) 111111 Page 2
Contact name: JOYCE DENNIS • Primer 12.51
Roof drain (commercial) 12.51
Address: P.O. BOX 2830
Sink/basin/lavatory 25.02
City/Stutz/ZIP: CLACICAMAS, OR 970)5 Solar units (potable water) 62,54 -
Phone: (503) 8SO -3100 Fax:: (503) 491 -2932 • Tub /shower /shower pun 12.51 Mill
E-mail: JDENNIS@ARS COM Urinal . 25.02 -
'a :4W %I cii7) " " fi 1; g4 i' nt� l t t • �a" !���,,j t Ipilti ,r r e I r Wnterclaset 25 :02 t N MIMI
:.�' t6I'A.- -1 :41 I ...:1' .0 4.r :].f.::•. : .,-.. { i c ur . }. •.a!:dA •?L .. r.' :. :::41.'i•8: j� 10. t ''K a
4
Business name: ARS dba JACK IIOWX/RESCUE ROOTER Wei heater 37.52 MN
56.29
25.02 -
Address: Y.O. BOX 2830 Other
CirylStutcl2lP: CL.ACICAMAS, OR 970]5 : Water piping/DWV MIMI
MI Subtotal
Phone: (503) 850 - 3100 Fax; (503) 491 - 2932 Minimum permit fee: $72.50 AKIN,
CCB Lie -: 127325 Plumbing Lic. no.: 34 -168PB ! r Plan revie (25 "/0 of permit fee)
Authorized signature: �� State surcharge (12% of permit fcc) �ii/
""'�'�' TOTAL PHRM[T F�r�
Print name: JOYCE DFNNIS r te / T utu permit a Itca,ia
D a � / L� PP n expires if a permit la no obtain , d w(thi; • d
}� }ice, ;r .. iI ;� Es "1' hy A Tri owi it c dsn g I ry
1/ 5 ne gtr
• „ n R w �e.., "Fce mallt o c b Triowi Building t t,st
: lfuildlncV `ermitsli rermitApp ail /1/(�� 444 1- 46167(1ND]]Z:OMIWr,p) •' •
JUL- 12- 2013(FRI) 09: 36 office staff (FAX)503 491 2932 P.002/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule Residential Fire Su . • ression Systems: 1���� �, � ,
,�, � '�,�" tt. ti � "� � f 2, Y ! } i . 1 . .w {,��� rr' { t ��r''�'�"+ w > ,�,�a •.��� q "`5 dr t 1 CmS
s e�+d. i t i. n ,. r P l 7. 1 ! 1 r w f a k9 t q , t tyy�1 D s. r,
I�Ii�..t. 3 Ylu ; ..i". � L C..- "�:.. °ti -Ir ft`,;1�n Wwi _ "{� $1 21. � �5 " A �a`F,..,Si.'i^Ntw Wilt..'µ�if,4IM',
Footing drain - 1" 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' NM 37.52 2,001 to 3,600 $169.69
Sewer - 1st 100' r 62.54 9,601 to 7 200 $23320
��Lr7 7 at and user $327
Sewer - each additional 100' 37.52
..Water Service -- 1st .100'.. , 62.54 -.
Medical Gxs S steins:
Water Service - each additionai 100'
37.52 - I i , i a n y r •*+ t` 21 m „, a
Sturm & Rain Drain - 1st 100' �� "',. ,tck t l i i "�`t.1,. ,A „ {.r ,1. : 1111. 11 f �� G, '1, . 1 t'` 1 °IW £ �1 ; ) � L h .,' s 11
_ $1',00 to $5'000.00 Minimum fee $72:50
Storm & Rain Drum each additional 100' $5,001.00 to $10,000.00
�' ,; �,,s r r o� � , t , v� � � ,� , ��� $72.50 for the first $5,000.00 and $1.52 for
r
* 411",.1 1" i ' y V; Ia °k � , :, ,,,� 1 - ' -141" r: , . t i a each additional $100.00 or fraction thereof, to
Inspection of ousting plumbing ar for and including $I0.000.00.
which no fee is specifically indicated 90.00/hr $10.001.00 to .T25,000.00 $148.50 for 0,000,00 and for
minimum charge- 1/2 hour each additional al $100.0100.0 0 or fraction thereoereo f, to
hr and i .50 oin the z
Inspections outside of normal business 90.00/ 25,0
hours minimum char • -2 hours $25,001.00 to $50,000.00 $379 50 for the tint $25,000.00 and $t.q5 for
Rcittspcction Fern 9000 /hr each additional $100.00 or fraction thcreo& to
and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
mini char a -12 hour) each additional $100.00 or fraction thereof.
Subtotal: _EW E •
•
Commercial Fixture
Are you capping, adding or replacing fixtures? If "yes ", " r �` !(:,s �a� 1 �I ' a,'; :` , ` wri y,;. c • t: ' �',;
please indicate work performed by fixture. Failure to Plan i .s 1 '� ; ! t any of f3 -
h e r , r_ol w: q rr. ; i lt . tt x : %14: ( it;
lan review is required for any th e following.
accurate) re.ort fixtures could result in Increased sewer fees * .
� ',
� 'lrt j N. '�1 i � 1.1' -i f3� °4� 1" y • � t I ��- z.� Please check all that apply.
f ,;: r . .,x'? f i,+,� lq } ,i ZT4:1.,�T.: Q i�ia, +' �. ink ^,:'� ❑ Any new commercial building with water
Gr 4�,ia' a"�i ,il I r` � { 1 � w ,', t i 1 t, �r'V*• M .. YG'}rt r r �] g service 2" and
ri .�„i "w} .' a .,_r iC �'� , ' al J't i 1 f �I f it �i.,i'Ml i�r�`.G„'�� Cater,
S r- �. -' t 4rAL ,;12_1 • `�' 1,..t{. �u.:;,'t +z .tI'iJ�r sig H'I except systems designed and stamped by licensed
Baptistry/Fnnt engineer.
Bath Tub /Shower ❑ New exteriorplumbing site utilities for any complex structure
Tub /Sh /Whirl.00l • as defined in OAR918- 780 -0040. •
Car Wash Each Sall ❑ Medical gas and vacuum systems for health care facilities.
- Drive Thu, ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator 0 My 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 14',+, p 7' 14z' v ,, ,: ri 4 . ; Q1.: °f �;, s i
FloorDrain/sink -2" t� s...it ,r, y ,;: !! 7 �
; �•tu , "�� Y ,ci" + r Jd } 1 x is
3" ❑ Isometric or riser diagram is required for new buildi
- 4° that meet the • ualifications above.
Car Wash Drain
Garbage •Domestic
Disposal -Commercial
-Industrial Comments regarding fixture work:
ice Mech./Refrig. brains
Oil .orator (Guts Stdtion �� 1 - .�_
Rec. Vehicle Dump Station
Shower -Gang
-Stall ___________
i _
S ink - Bar/Lavatory -_
_____. .
- Bradley
- Commercial *Note: If the fixture work under this permit results In an
- Service
Swimm Pool Filter • - increase of sewer EDUs, a sewer permit will be issued and
washer - clothes tees assessed for the sewer Increase must be paid before the
Water k ! plumbing permit can be issued.
Water Closet - Toilet
•
Urinal .
Other Fixtures: .. .. - .- ..- ........ : . .
zttp: / /www,tigard or.gov /city hall /department sled /docs/PLMF- PelmitAndoc '