Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00355
Date Issued: 10/10/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S112BB00600
Jurisdiction: Tigard
Site address: 8505 SW COLONY CREEK CT
Project: George Subdivision: COLONY CREEK ESTATES Lot: 2
Project Description: Replace 30'of water service.
Contractor: JACK HOWK PLUMBING/RESCUE ROOTER Owner: GEORGE, DAVE J
PO BOX 2830 PO BOX 2036
CLACKAMAS, OR 97015 PORTLAND, OR 97208
PHONE: 503-850-3100 PHONE:
FAX: 503-491-2932
FEES
Quantity Description Date Amount
50 If Water Service 10/10/2013 $62.54
Specifics: 1 12%State Surcharge- 10/10/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/10/2013 $9.96
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC • ailing 503.232.1987 or 1.800.332.2344.
Issued By: 17 ✓ / , Permittee Signature: QAr /70/0L/e,49-77O /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
OCT-09-2013(WED) 10: 10 office staff (FAX)503 1191 2932 P. 001/003
PJiairrilAr .',r, Permit App3hhcat on ECEIV.D
Building, Fixtures • OCT 9 -2043
Building, IOR OFF1CGri15E:p1ZY
CIO' �rf'li�ard ttr.crryea �d/`dj/3:. ���� , , �(Nor" a0/3
ITY OF TIGARD _D Odl1 Yrin
" 13125 NW Ilan iitvd.,Tigard,OR J'12� y Da3
IIN
t 2 Plm?nr.: jO3.(19.4I'1l Fax: 503AlltEDING DIVISION l'"''Br"" Other Pei No.:
lrispeciinn Line: 5(13,(x39.4175 bole/Dy:
TIGARD' Dale ltc:alytuy:
Internet; www.tlgard-or.gov 61' tics Page 2 fur
^� Notified/m mi 4:
'1 A.. vl;`!r�(,y'!gg''�(�r((�r1P Ni,l ln,�x 1%i!;" i4�'��ii' � .� rrY("� �,,.r'.', A700-0,0;);;I'MI .rfir i�n��r..:x... 1, .,r rp ,; �,, ..,s .A,�r∎.,ril r Su 11DICMClltat Li forma lion �..'.
�! ,,",,,,111t , i ,+h R � I¢{' 1 i1' I �A r 4 " "-G '�i; ° v I,� I{ ti, �T'S�ttr j ''
9 �1 hlr 111;E n ,,lt rt*d".0 ,,tern ,_1.LY �VGs V"0,41,, dr; h11 q,r;111 ,I4,,.�,, , 4 , ) 1171 4', Y,v tip'�.A'q� 4 ���''^' �,I,,. lit i,t1{''I
1.,"M IWPI... kw 'Y ��i.lr,"1�''�ir�i,1
❑Now construction ❑Demolition Fo P$pecialin/ormallon use checklist
- -Description L Qty. I Ea. ,J Total
[,t Addition/alteration/rcplacernenl ❑Other: New I-2-famil rlwelliu xs mcludc 100 R.for each utility connection
r 14.' 1 1I��I''IT�`�Iw�Mslr} w {E�,r`.t1i °0 1743.11:i ' , 1 r, -' r—Tf31,f,,,. .w ryi It X111 ,.. Y ....,_.)
u�x1t�611 174'1>A6o-at r , , , . a t , ,. 4, y ..1,,1 St'R(I)bath 3
�x11 1� W l;rw� .rx ,.�� �rii a k�lw`11t1?1i�t�44��YlitHl��t° �'�,,� . 12,70
g I-'Inc!2-family dwelling ❑Commercial/industrial SFR(2)bath T 437.78
0 Accessory building SFR(3)bath 500.32
_ ❑Multi-I tinily • —
❑ M builder EnGt additional hath/kitchen 25.02
( + Other:
�l 1,a Master
�y A e^,7� t ne a r a q,, Fill:sprinkler( sq.it.) Page 2
� 3 �:
,c"wrrvl 11�.(I� �7' •r. 0,1 1� 1 A ♦ 1 i rr t 'tt h b , , A I 414
;.�,.��ri,,-r, / 1�4,�: ,ri re�. )°i1, ��l, r,?(.tl(��(I� ) 'i �t,,.( Sitnrflllies:
lob site address: �n i � / i �> Cinch basin or area drain - _ I>;.76
City/Stnntc/LIP: ntywell,leach line,or trench drain w 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/hldg•/apt.no.: Project name: Manufactured home utilities w 5
0.05
Cross street/directions to job site:
Manholes 18.76
-+ Rain drain connector _ 1 3.76
Sanitary sewer(no,linear R.: ) Page 2
- Storm sewer(no.linear It: ) -
- - Water service(no.linear IL: ) �'
Subdivision: Lot no.: '��, _ �'"
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
ii't", t Ph �,' a r,qt �a, eh1 cCk'f In t
1I ,r��� ���1'� r� �1' r d:l r 1, �,lr��;v YyJI . t i1V jz fY��n 11l �L 11�i,t1++i in', Backwater valve
'a.m. t yf 'iNi(r v,..I d�%1 t,got ,?�..1):A..., aY t..,, ,r ;1 @t axit,tt � ci$,;1�;�,;(2 lGa ?ritakil� - 12.51
'4 ' 'ripe If
Clothes washer
,� I .� Dishwasher = 25,02 al.
r �� "I�t�', Drinking fountain 25.02
Ejectors/sump 25.02 •
IIS,v 4 Y 9I a# 01g a , � , ( i a h 1 gt1 i M rE+i
1 ' . Expansion tank 12,5
I Mh ' iai�^� t xt ,tn2i, .a xiAtt,;,e„In„,„„u. ,?., ,i0 , fi
Name: ��If a 1/ ,,, Fixture/sewer cam 25.02 Mill
r•
a Floor drain/floor sink/huh
Address: �. . . 25.02 MEM
�s�j�► ,���� '• � � Garbage disposal 25.02
City/State/ZIP: �TtsL� Hose bib 25A2
Phone:( i�.9uI 1�� , r s .
� p � -fee,naker � 1251
°1i �I b�f'"��,y,� t)iR}ad.wArsv ��fr.( ,err lr?'1�11i L��IA:lJw1:�lrh(yF�,,'?�i(�it.11 f..1 �l��1µ1t^ t�� P��JJIC,.,",t',.! ♦�p�t(`'M"r`;y�vg* Interceptor/grease trap 25,02
WN i1'+wl l '�f t ' °∎ 'l,r�� r ° el d 11. r 1' Ya iki,,a Wr'tl .ht.r� 't^i.rvl�ila AAl�.r.1.A 1.11:1.4.$
Business name:ARS dba JACK 1I0WK/RESCIIE ROOTER Medical gas(value:$ ) 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/Slatc/ZlP:CLACKAMAS,OR 97015 Solar units(potable water) 62.54
Phone:(503)850-3100 7 Fax::(503)491-2932 Tub/shower/shower pail 12.51
E-mail:JDENNIS@ARS,COM Urinal 25.02
�1w ;pili1 y a� d %� 0 I wn�T Mlt r � e1 l
K �ZI WAltlr Cf09ef
25.02�� lS lG W�.a A �$,��nN�l 44,�8.0.r Jhwki ,.1.r �-,.) « � �h.wa . Yl( �, d?
Water heatCT 37.52
Business name:ARS dba JACK 11OWX (RESCUE ROOTER
Water pipiag/DW V 56.29
dress:P.O.BOX 2830 Other: 25.02
1
wt City/Sratc/L1P:CLACKAMAS,OR 97015 — Subtotal C
Phone:(503)850-3100 Fax:(503)491-2932 Minimum permit fee: $72.50 �� 'r
—
CCE1 Lie.:127325 'lumbing Lie.no.:34-168PB Platt review (25°x('of permit fee)
/' State surcharge(12%of permit fcc)
authorized signature: ` 0, �. ,
`� �� TOTAL PERMIT F.�� ;i
rint name:JOYCE DENNIS Da 1 Tl la permit:.pplication expires lra permit ix>,ot obtained' it .Or. 0 days
after It has been accepted WI complete. r
/ry'(—.-�yc6.,�W J��+�'7�/]�I�y” (��/`� y��)y/�y[/��� [�/Gy 407-- 3-,_,2'Fce mcihuduingy set by T.i•County Building huiastry Sayler.,loaut
tr dingHPrl'111;1611' U•Permirnpr.nn. In Of t/t1Q-- - - — ): 440-4516T(10/02 WE8) /
OCT-09-2013(I4ED) 10: 10 office staff (FAX)S03 491 ,2932 P. 002/003
Plumbing Permit Application - City of-Tigard .
1'}tg.G, St►ppdt nental,lnfnrtuatioAa,.., : -
Fee Schedule:
4 N., � �.,y„ � M Residential Fire Su i ression S r
115•itl�r '`ltai (i,41a g'''i iil:+ "err o> n ' lr` , °� - `1�- �a �w ,�� ,,„ g 5,. r,r tls
PP�� y y�' em •Footing drain-I"I Qf1' "t w-'�11 , +r idol, 1 •! '. " 7. ,V3. ..''.It,e, '.''°,f ( OM"' f� '.e
g 50.03 0�to 2,000 $121.90
Footing drain-each additional 100' 37.52 2001 to 360(1 $169.69
Sewer•1St 100' 62,54 3,601 to 7,200 $233.20
7,201 and greater $327,54
Sewer-each additional 100' 37,52
Water Service-1st 100' rt 62.54.
� fl Medical Gas S stems:
water Service-each additional 100' „G,i r ray, «�,irpmyn�p�r�,t i.,,,°Ivray�PyJ�,yM�,'!" r 1+�+�5 vv •�, r
Storm&Rain Drain•1St 100' 2 1*.:1: to$5,`:UkL11 !""'u"1�C 1;. ur,,!t,.$7 �•tw,I1'.1 ti:,iii r x f.„,P,'0. ,.2%.,���r
6 .54 $1.00 to$5,000.00 , Minimum fee$72.50
Storm&Rain Drain each additional 100' $5.001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
h'� ^"�ti 11 �, itt�w��l 510^y'J�1 e�'°'Lr Ji1''�",M1 � r ro A '_._
P, f9`g �s,1,{:Flu 1 I. S.pn' g,+, u �c "•a!ia, � ? each additional$100.00 or fraction thereof,to
and including$104000.00.
Inspection of existing plumbing or fur P _
which no fee is specifically indicated 90.00/hr
each a$10,001.00 to$25,000.00 0 for the first x10.000.00 and$1,54 for'
(minimum charge-12 hoar) each additional$100.00 or fraction thereof,to
Inspections patsido of normal business )U.00AIr and including a first 0.00,
hours(minimum charge-2lrours) $25,001.001n$50,000.00 $179.50 for the first-$25,000.00 and$1.45 for
KC1n51(mini11 um - 90.00/hr
each additional$100.00 or fraction thereof,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 -
(minimUnl Charge-1/2 hour t4rmirrowii each additional$100.00 or fraction thereof.
Subtotal: IM IFr+/' I
•
Commercial Fixture Work
Are you capping,adding or replacing fixtures? If"yes", rr�h 1 iCl fi "� •; f ,y yC'irC�r°v `' yiy.;' y4 ,1.'1. .M,,x tar'
please indicate work performed by fixture. Failure to tan re" h )i d =or an���`� �'° lowin ' `F `m i� � ���`I
Plan revlcw is required for ally of the following.
accurately rely•ort fixtures could result in increased sewer fees'`. Please chock all that apply.
an'� �'��"��Sy,v,.'�( 'iVY'..ri�y�'Ari1� t!'1.�° �d.1 tar7,("�d�'1,j" Liigtll i �7
, ,q•,,p a r5 I«. , 1,,, .1 L 1,] Any new commercial building with water service r and
E i �l r N+J0hiAI , ;,4 �P-14'tLr n,t7 r A d 7,14;4, a r.:7 rd-T\r,l,+' , ;-
-n`1 "�. c'�ul� °� :I1 i."r' f x 1=t rp,�!l 'i II i ,i greater,except systems designed and stamped by licensed
-Bath. engineer.
Bath. -Tub/Shower • ❑ Ncw a leiior plumbing site utilities for any complex shuctttre
.1acuE l/Whirtpool ns damned in OAR9I8-780-0040:
Cur Wash -Each Stall CI Medical$�and vacuum systems fpr health care facilitic�.
-Drive Thru d Any multipurpose fire sprinkler system
Cuspidor/Water Aspirator ❑ Arty complex structure as defined in OAR91$-7$0-0040.
Dishwasher -Commercial
-Domestic Suhmit 2 sets of plans wait any of the above.
Drinking Fountain.
Eye Wash 11 rl�c�a ftr*qq1�� r - p �,y r ml -*r
y r�4 C a 1 �i r-y r � u C� a ha Y- "w
Floor Drain/sink -2" � tf11i fu.., ' oa �fi��1�1a!;4 )tilll�ylul�.".i.f3 ��'t'. ��,Ir
2' Isometric or riser diagram is required for new buildings
that meet the •ualifications above.
•
n••
Car Wash Drain
•
Garbage -Domestic
Disposal -Commercial '
-Industrial Comments regarding fixture work:
roe MachfRcfrig.Drains
Oil Separator(Gas Station) - _-
Rcc.Vehicle Dump Station -" -
Shower -Gang
-Stall
Sink aurlt,avytory --
-Bradley
-Commercial *Note: If the fixture work under this permit results in an
-Service Increase of sewer EDUs permit will be issued and
Swimming PoolFilter ,a sower p
washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor , • plumbing permit can he issued.
Water Closet-'toilet _
urinal
•
Jther Fixtures! • .
iI 1p://www•tigard-or.gov/city-hall/depart oleos s/cd/docs/PLMF•PermitAp})doc