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10115 SW MURDOCK STREET-2 1S Na0auffl MSS 6� 6 cn x IL o U) _J m O r 10115 SW MURDOCK ST CITY OF TIGARDO BUILDING DIMICIN PERMIT#: PLM200&00240 13125 SW Hall Bivd.,Tigard, OR 97223 DATE ISSUED: 6/311005 Phone: (503) 639-4171 Inspection Requests (24 Mrs.): (503) 639-4175 INSPECTION WORKSHEFT FOR DATE: 6110/2005 TIME: 7.05W, PAGE: 29 SITE ADDRESS: 10115 SW MURDOCK ST CLASS OF WORK: SUBDIVISION: TIGARDVILLF HEIGHTS LOT#: 022 TYPE OF USE: PROJECT NAME: MATS DESCRIPTION: Line work to connecting residence to lateral. `yepa%, systern to be pumped and filled or rernr_wed OWNER: MAYS, KFNNETH W+KARI_EEN R, r(IONE #: 503684-1252 CONTRACTOR: CANTRFI..L&SONS CONTRACTING PHONE #: 503638-0800 Inspection Request Scheduled For: Date: 6/1012005 Pour Time: Code # Inspection Description Confirm # Contact # Message Sanitary Re 00098401 503-635,6428 Y C sections/Comments/Instructiovs: 4317 ^1-3 'A49�L� �r P a r~ J k�!. I ASS "'PARTIAL APPROVAL F] CANCEL NO ACCESS FAIL [JCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: — _— Date: v Phone #: (503) 718- �, e 1 CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00253 13125 SW Hall Blvd.,Tigard, OR 97223 503-639-11171 DATE ISSUED: 6/8/2005 PARCEL: 2S 111 ETC-02501 SITE ADDRESS: 10115 SW MURDOCK ST ZONING: R-3.5 SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 022 JURISDICTION: TIG Project Description: Water line replacement. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DPi TRAPS: STORIES: WATER HEA mi S: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWED LINE: ft WATER CLOSETS: WATER LINE: 80 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES MAYS, KENNETH W+ KARLEEN R Description _ Date Amount 10115 SW MURDOCK ST TIGARD, OR 97224 [PLUMB] Permit Fee 6/8/2005 $72.50 [TAX] 8%State Surcharl 6/8/2005 $5.80 Phone: 503-694-1252 Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone: Reg#: a _ This permit is issued subject to the regulations co i:ained 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 Wnot started within 180 days of issuance, or if wt"K is suspended for more than 180 days. ATTENTION: Oregon lav/ --i 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 OUNC by calling 503-246-6699 or 1-800-332-2344. Issued By: ' ��U ��— _ 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. Building Fixtures Plu mbine Permit , v Received City of Tigard OC Uate/B� 11� Permit No. 13125 SW Nall Blvd.,Tigard,OR 97223 1 \ J Plan il!" +� JJ Phone: 503.639.4171 Fax: 503.598.1960 'l J" Other Permit No Uete1H 24-Hour Inspection Line: 503.639.4175 Date Rem WRY ® see Page t for Internet: www.ci.tigard.or.us I1 Notified/Method: supplemental information Q New ooMttvetion $ Demolition _ For special information Nse checklist. Description 93 Addition/alteratiodreplaee:ment ❑Other: New 1-2-family dwellings(includes 100 R.for each utility connection) r. �! SFR(1)bath 249.20 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath - _ 350.00 ElAccessory building ❑Multi-family SFR(3)beth 399.00 Each Pdditional bath/kitchen 45.00 ❑Master builder []Other: Fire sprinkler(__sq.ft.) Page 2 Site utilities Job site address: 1Q 11 IF sky Mwar,102' Catch basin or area drain 16.60 City/State/ZIP: -T i OR amwM '_! _ Drywell,leach line,or trench drain 16.60 Suite/bldg./apt.no.: Project name: Footing drain(nn.linear R.: ) Page 2 Manufactured home utilities 110.00 Cross streel/directions to job sift: -'--' - Manholes 16.60 �` it 14..4o0%)L _ Rain drain connector 16.60 Sanitary sewer(no.linear ft.:,� Page 2 Storm sewer(no.linear ft: ) Page 2 Subdivision: Lot no.: Water service(no.linear ft.:, ) Page 2 -- Fixture or Item Tax map/parcel no.: '- Absorption valve 16.60 M. Backflow prcventer Page 2 s_ Backwater valve - 16.60 Clothes washer 16.60 Dishwasher _ 16.60 Drinking fountain 16.60 Ejectors/sump 16.60 Name: Expansion tank 16.60 - Address: XW la I -_�� Fixture/sewer cap 16.60 City/State/ZIP: 10V. 9 Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone:(SQ:I) q084•I3.S Z Fax:( ) -- 16.60 Nose bib _ �.. Ice maker 16.60 - Business name: 0 t'A -ur Interceptor/grease trap 16,60 vJ fZ Contact name_ Medical gas(value:S ) Page 2 t� Address: Primer 16.60 N City/StatdZlP: Roof drain(commercial) 16.60 Phone:( ) Fax::( ) - Sink/basin. _ 16.60 i -� ub/s'_..wer/shower pan 16.60 E-mail: Urinal 16.60 (a mill 111 ;yti„° '` Water closet 16.60 W Business name: Water heater 16.60 Address: Other_ -- Subtotal City/Stale/ZIP: - - - Minimum permit fee: 572.50 �l Phone:( ) Fax:( ) Residential backflow minimum em-tit fee: $36.25 /.Z CCB Lic.: Plumbing Lic.no.: Flan review (25%of permit fee) State surcharge(8%of permit fee) -r Authorized signature: Www TOTAL PERMIT FEE Print name: 1Genwa Ms Date: V/8•1ox This permit application expires If a permit Is not obtained within 190 days after it has been accepted as co nplete. *Fee methodology set by Tri-County Building Indus,ry Service Board. i\Building\Pardo\PLMF-PennitApp doc 12103 4401"16T(10M2fCOM/Wna) Plumbine Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression S stems: 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-I st 100' - 55.00 7,201 and greater $309.00 Sewer-each additional 100' 46.40 Water service-1st too' 55.00 Medical Gas S stems• Water Service-each additicmal 100' 46,40 Storm&Rain Drain-1 st 100' -_ 55.00 s $1.00 to$5,000.00 Minimum fee$72.50 _ Storm oft 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 J additional S100.00 or fraction thereof,to and including$10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $145.50 for the first 510,000.00 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 S25,001.00 to 550,000.110 $379.50 for the drat$25,000-00 and$1.45 for Inspection of existing plumbing or each additional$100.00 or fraction thereof,to specially requested inspections-per hour 72.50 and including$50,000.00. Subtotal: S50,001.00 and up 5742.00 G the first$50,000.00 and S1 20 N each addiu al$100.00 or fraction thereof. —f Fixture Work: Are you capping,moving or reply existing fixtures? If "yes",please indicate work performe fixture. Failure to accurate) re ort fixtures could result in eased sewer fees*. Com is regarding fixture work: Ba tis /Font Bath -Tub/Shower --- -Jacuzzi/Whi,l ool Car Wash -Each Stall -Drive Thru oo — -— — Cus idor/Water Aspirator - _ — Dishwasher -Commercial -Domestic _ '— Drinking Fountain — E�e Wash rloot Drain/sink 2" --- —_ --- 4., D. Car Wash Drain Garbage -Domestic M Dispcsal -Commercial to -Industrial Note: If the fixture work under this permit results in an Ice Mach./Refri .Drains increase of sewer F,DUs,a sewer permit will be issued and J oil Separator(Gas Station) fees assessed for the sewer Increase must be paid before the m Rec.vehicle Dump Station plumbing permit can be issued. 0 Shower -Gang ILI w -Stall J Sink -BanTavatory uantity Total -Bradley Isometric or riser quantity diagram is required if fixture tit -Commercial g q q Y -Service — total is>9. Swimming Pool Filter Washer-Clothes _ Water Extractor EV Review Water Closet-Toilet Plan review is required if fixture quantity total is>9. Urinal Other Fixtures: y i.\nuildina\Permin\PLM-PerrrtltApp doe 3101 CITY OF TIGARDO r BUILDING DIVISION PERMIT#: PLM200fr00253 13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 6/912006 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6/10/2006 TIME: 7:05AM PACE: 28 SITE ADDRESS: 10116 SW MURDOCK ST CLASS OF WORK: SUBDIVISION: T.GARDVILI_k HEIGHTS LOT#: 022 TYPE OF USE: PROJECT NAME: MAYS DESCRIPTION: Water line relac:ement. OWNER: MAYS, KENNETH W+KARLE&I R, PHONE #: 503.684-1262 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 61101M. Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 008984-07 503.638.6428 N Corrections/Comments Inst;uctions: VV ,PASS ❑ PARTIAL APPROVAL F-I C.ANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES)ASSESSED Inspector: _ ► ' Date: _ lo/to Phone #: (503) 718- w 9 CITY OF TI CSA R D SEWER CONNECTION PERMIT DEVELOPMENT' SERVICES PERMIT #: SWR2005 00167 DATE ISSUED: 05 13125 SW Hall Blvd.,Tigard, OR 97223 503-639-4171 25111 PARCEL: 2S111 DC-02501 SITE ADDRESS; 10115 SW MURDOCK ST ZONING: R 3.5 SUBDIVISION: 'TIGARI)VILLF. III-161ITS LOT: 022 JURISDICTION: TIG Project Description: Connecting existing residence to street lateral. Septic system must be pumped and filled or removed. Plumbing permit required for line work. TENANT NAME: CWS NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1.0 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: L"fPSWR IMPERV SURFACE: Owner: FEES_ MAYS, KENNETH W+ KARLEEN R 10115 SW MURDOCK ST Description r Date _ Amount TIGARD, OR 97224 I(SWUSAI ;'wr Connection Fee 6/2/2005 $2,500.00 (SWINSPI S(wer Inspection Fee 6/1/2005 $35.00 Phone: 503-684-1252 ��Q Total $2,535.00 9 Contractor: '1 9 ,� REQUIRED ITEMS AND REPORTS A* Phone: , Reg F` O This Applicant agrees 1iComply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all di-ections from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You m, obtain copies of these rules or direct questions to OUNC by calling 503-246-6699 or 1-800-332-2344. / nature:/ Is �./I Permittee SI g Call 503-639-4175 by 7:00 a.m.for an Inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the Job site at the time of each Inspection. Buikung Fixtures � • 1J�D City of Tigardl \� 2005 Permit N 13125 SW Hall Blvd.,Tigard,Olt 97W 97 ';��' � Phone: 503.639.4171 Fax: 503.596.1960 Flan Revs Other Permit Na: 24-Hour Inspection Line 503.639.44 I Y OF 11GARU nztue ' --- ---- Date Ready/By: Jury 0 See Pale 2 for Internet: www.ci.tigard.ar.us G p�VI$) NotidsdlMet6od: supplemental Information MEN= New construction For In ormuton use checklist ❑ ❑Demolition Dcription_ Ea. 1 otal ❑Addition/alteration/replacement ❑Other. esNew 1-2-family dwellings(includes 100 ft.for each utility connection) SFR(1)bath 249.20 ❑1-and 2-family dwelling ❑Commercialrndustrial SFR(2)bath 350.00 ❑Accessory building 0 Multi-family SFR(3)bath 399.00 ❑Master builder -4Each additional bath/kitchen 45.00 []Other: Fire sprinkler( sq.ft.) _ Page 2 Site utilities Job site address: 10115 Sl„ M j 0 L'a Catch basin or area:rain _ 16.60 City/State/ZfP: _�� IL OK Drywcll,leach line,or trench drain 16.60 Suite/bldg./apt.no.: Project name: Footing drain(no.linear fl.: ) Page 2 - b:anufactured home utilities 110.00 Cross street/directions to job site•. Manholes 16.60 Rain dram connector 16.60 Sanitary sewer(no linear ft.:^� Page 2 Storm sewer(no.linear ft.: Page 2 Subdivision. Lot no.: Fater service(no.linear ft.:_)- Page 2 - --- Fixture or Item Tax map/parcel no.: Room --- - Absorption valve 16.60 Backflow preventer A Page 2 tZ . Backwater valve - 16.50 J Clothes wa3her 16.60 Dishwasher 16.60 Drinking fountain 16.60 A Ejectors/sump 16.60 Name: K 4 Mains Expansion tank 16.60 Address: loth ILW M.4-o6 M, b4 Fixture/sewercap 16.60 City/State/ZIP: --.. �z ,l Floor drain/floor sinkthub 16.60 Phone:(6p;) 10S4_t1 Fax:( ) Garbage disposal - 16.60 Hose bib 16.60 Ice maker 16.60 Business name: -' Interceptor/grease trap 16.60 Contact name: Medical gas(value:S ) Page 2 IL Address: Y-- Primer 16.60 City/State/ZIP: Ror r gran.'^ommemial) 16.60 NSi ik/basin/lavatory 16.60 Phone:( ) s�Fax::( ) -- -- Tub/shower/shower pan 16.60 J E-mail: ------ Urinal 16.60 Water closet 16.60 T W Business name: Water heater 16.60 J -- --- Address: Other: City/State/ZIP: Subtotal Minimum permit fee: $72.50 Phone:( ) Fax:( ) Residential backflow minimum rmit fee: 536.25 _ CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) Authorized signature: y�,t,� Stste surcharge(9%of permit fee) TOTAL PERMIT FEE Print name: „ u_ _ Date: `/3L/OSThis permit applicatlon expires If a permit Is not obtained within 190 days after It has been accepted to complete. "Fee methodology set by Tri-County Building Industry Service Board. i\nuildina\Permits\PI,WffPermitAppdoc 12/03 440-A616T(10/02/COWWHH) �jj ../' Piurabin>s Permit Application - City of Tigard t -' • \Page 2 - Supplemental Information Fe Schedule: Residential Fire Suppression Systems: Footing d 'n-1"IOf 55.00 0 to 2,000 115.00 Fcnting drai eact additional 100' 4640 - 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer-1st 100 55.00 7,201 and 'ter $ 309.00 Sewer-tech additt .•1 IM' 4640 Water service-Iat 1 _ 55.00 Medical Gas S stems: Water Service-each ad Conal 100' 46.40 4 11 P�lrwm POOP 911111 Storm&Rain Drain-lst IN 55.00 $I DO to$5,000.00 Minimum fee$72.50 storm&Rain Drain-each ad tmal 100' 46.40 $5, 1.00 to SIo,000.00 $72.50 for the first$5,000.00 and$1.52 for each addition!5100.00 or fraction theeeof,to and including 510,000.00. Commercial Back Flow Prevention ice 46.40 310 1.00 to$25,000.00 5146.50 for the first$10,000.00 and SI.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.15 27.55 _ and including$25,OW 00. Rain Drain,single family dwelling 65.25 $1 1.00 to$50,000.00 $379.50 for the first 525,000.00 and$1.45 for each additional S I00 00 or fraction thereof,to Inspection of existing plumbing or and mcluding 5;0,000.00. specially requested inspections-per hour 72.50 $ ,001.00 and up $742.00 for the first 550,000.00 and 51.20 for Subtotal: each additional$100.00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fixtures. If "yes",please indicate work performed by fixture. Fallur. accuratel,re ort fixtures could result in increased sewer omments regarding fixture work: -13aptistryfficlat Bath -Tub/Shower -Jacuzzi,'Whirlpool Car Wash -Each Stall -Drive Thru - Cus idor/Water Aspirator Dishwasher -Commercial -Domestic -Drinking Fountain Of ----- E e Wash Floor Drain/sink -2" 3.. - 4" Car Wash Drain ��--~•--- Uarbage -Domestic Disposal -Commercial _ *Note: If the fixture work under this pe it results In an -Industrial increase of,ewer EDUs,a sewer permit wil a issued and Ice Mach./Refri .Drains p Gil s arator Gas station fees assesses.'ter the sewer increase must be p id before the Rec.vehicle Dump Station plumbing permit can be Issued. Shower -Gang -Stall - - Sink -Bar/Is ory _ -Bradlc --- OaantitY Total -Co rcial Isometric or riser diagram is required Ii fixture quantity -S cc total is>9. -Swimniing Pool Filter Washer-Clothes Water Extractor Plan Review_ Water Closet-Toile! Plan review is required if fixture quantity total Is>9. Urinal -Other Fixtunea: i.\Building\Perm0s\PtM-P"TnitApp dor 3103 CITY OF TI G ® R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2005-00240 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 DATE ISSUED: 6/3/2005 PARCEL: 25111 BC-02501 SITE ADDRESS: 10115 SW MURDOCK ST ZONING: R-3.5 SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 022 JURISDICTION: TIG Project Description: Line work to connecting residence to opteral. Septic system to be pumped and filled or removed. 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: 88 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: _ FEES — MAYS, KENNETH W+ KARLEEN R Description Date Amount 10115 SW MURDOCK ST —_ TIGARD, OR 97224 [PLUMP]Permit Fee 6/3/2005 $72.50 [TWX]8%State Surcharl 6/3/2005 $5.80 Phone: 503-684-1252 Total $78.30 Gontractor: CANTRELL& SONS CONTRACTING 6860 SW NORSE HALL RD REQUIRED ITEMS AND REPORTS TUALATIN, OR 97062 Phone: 503-633-0800 Reg#: LIC 97005 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 130 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 952-0901-0010 through OAR 952-0001-0100. You may obtain copies of these rules or eirec+questions to OUNC Dy calling 503-246-6 9 or 1-800-332-234 , eo l Issued By: z ce – _ Permittee Signa`ure: Call 503-639-4175 by 7:00 a.m. for an inspection that business slay. This permit card shall be kept In a conspicuous place on the job site until completion of the prr4ect. Approved plans are required on the job site at the time of each Inspection. Building Fixtures ^ Plumbing Permit ApPfic1, E0, City of'Tigard 1 qq.� Received / Permit No 13125 SW Hall Blvd.,Tigard,OR 97223 lY (� 111��1 Date/By l�j L (1f75—� `y Plan Re',iew Other Permit No Phone: 503.639.4171 Fax: 503.599.19QQj J Y QF TIUgi D.ce/B . _ 24-Hour Inspection Line: 503.639.41'�(jjj i)1N Dale Ready/Dy: / 0 See Page 2 for Internet: www.ci.tigard.or.ua �I �iV�-, Notified/Method. Supplemental information ❑New construction ❑Demolition For s ecial information use checklist Description Qty. Ea. ?oral ❑Addition/alleration/replecement ❑O ;r• New I-2-famlly dwellings(includes 100 R.for each utility connection) SFR(1)bath 249.20 �l-and 24hirtily dwelling ❑Cotnmerciallindustrial SFR(2)bath 350.00 ❑Accessory building ❑Multi-family SFR(3)bath 399.00 Each additional bath/kitchen 45.00 ❑Master builder ❑Other: —' r + y ; Fire sprinkler((_sq.R.) Page 2 r.'..: . Site utilities Job site address: Catch basin or area drain 16.60 City/State/ZIP: OldQ t Drywell,leach:ine,or trench drain 16.60 Suite/bldg./apt.no. Project name: Footing drain Ino.linear R.: ) Page 2 Manufactured hi.me utilities 110,00 Cross street/directions to job site: -- — - -- Manholes 16.60 Rain drain connector 16.60 _ Sanitary sewer(no.linear R.: Page 2 Storm newer(no.linear R.:_) Page 2 Subdivision: —� Lot no.: Water service(no.linear fl.:_) Page 2 Fixture or Item Tax map/parcel no.: — — — � Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 } ,r, Drinking fountain 16.60 Ejectors/sump 16,60 Name: Khmocal Expansion tank 16.60 Address: Fixture/sewer cap 16.60 _— City/State/ZIP:' Floor drain/floor sink/hub 16.60 Phone:( ) Fax:( ) Garbage disposal 16.60 Hose bib 16.60 r Ice maker 16.60 Business name: CA- ' _ _ _ Interceptor/grease trap 16.60 fl Contact name: �tD` Medical gas(value:S ) Page 2 Address: Primer _ 16.60 � 9�1D6 City/State/ZIP: Roof drain(commercial) 16.60 Sink/basin/Invatory 16.60 J Phone: � ) Fax::( ) -- Tub/shower/shower pan 16.60 _m E-mail: Urinal 16.60 I � �_-�J uJ l lr `t qC1,, J' Water Closet 16.60 W Business name Water heater 16.60 Address: Other: _` — City/State/ZIPt _ Subtotal Minimum permit fee: 572.50 A Phone:( ) -,`a ff Fax:( ) Residential backflow minimum permit fee: 536.25 C� CCB Lic.: Plumbing Lic.no.: — Plan review (25%of permit fee) State surcharge(8%of permit fee) - Authorized signature: �_ _ TOTAL PERMIT FEE Print name: A�� TiP� Date: This permit application expires If a permit Is not obtained within /i 190 days after It has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i\BuildinatPertnhx\PLMF-Fera,itApp doc 12103 440.4616T(10/02/C0M/waB) Plumbline Permit Application - City of Tigard Page 2 -Supplemental Information l+e Schedule: Residential Fire Sjilippression S stems: 7dr � Foodn ' SS.00 0 to 2000 5115.00 Footindditional 100' 46.40 2001 to 3600 $160.00 3,601 to 7 200 $220.00 Sewer 55.00 7 01 and ater $309.00 Sewer-each ad 'onal 100' 46.40 Water Service- I st X, 55.00 Medical S Systems:Water Service-each a itional 100' 46.40 Storm&Rain Drain-1 st 0' 5555.00 S1.30 W=3 .00 Minimum fee$72.50 Storm&Rain Drain-each a tional 100' 1 40.40 1 $5,001. o$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fmctioi thereof,to and including 510,000.00. Commercial Back Flow Prevention vice 46.40 510 1.00 to$25,000.00 5148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Devic each additional 5100.00 or fraction thereof,to minimum permit fee 536.25) 27.55 ano 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 of xisting plumbing or each additional$100.00 or fracdon thereof,to inspection e _ and including$SO,U00.00. s eciall re uestcd in ecdons-per hour 72.50 SSU,W 1.00 and up $742.00 for the first$50,000.00 and 51.20 for Subtotal: each additional;100.00 or fraction thcreo�. Fixture Wcrk: Are you capping,moving or replacing existin txtures7 f "yes",please indicate work performed by fi ure. Failure accurately report fixtures could result In i creased sewer fee. '. omments regarding fixture work: Baptistry/Font Bath -rub/Shower ��--- -Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru -- -� �- Cu idor/Water Aspirator -- Dishwasher -Commercial _ -Domestic Drinking Fountain ---- -Eye Wash Floor Drain/sink IL C Wash Drain Garbageomestic U) Disposal -Commercial *Note: If the fixture work under s permit results in an industrial increase of sewer EDUs,a sewer perm will be issued and Ice Mach. efri .Drains fees assessed for the sewer increase must be aid before the J Oil Separator Gas Station P m Rec.Vehicle Dump Station _ plumbing permit can he issued. Shower -Gang W -Stall J Sink -Bar/Lavatory - uantity Total -Bradley Isometric or riser diagram is required if fixture quantity -Commercial total Is>9. -Service Swimming Pool Filter Washer-Clothes Water Extractor _ flan Review Water Closet-Toilrt Plan review is required if fixture quantity total Is>9. Urinal Other Fixtures: i\Bm1din#Terrn nlPLM-P, hApp doc IMI