12170 SW MARION STREET 12170 SW MARION ST
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00355
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/21/03
SITE ADDRESS: 12170 SW MARION ST
PARCEL: 2S103C&04700
SUBDIVISION: WILLAMETTE NO.2 ZONING: R-4.5
BLOCK: LOT: 026 JURISDICTION: TIG
CLASS OF WORK: F.LT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 00 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: REPLACE 60' OF BROKEN WATER SERVICE
Owner: —___ FEES
-- - — Description Date Amount
DAHL, STEPHEN MARION S I'I I %IHj I'VIwit 1 7/21/03 $72.50
12170 SW MARION
TIGARD, OR 97223 I I slalc I a\ 7/21/03 $5.80
Total _ $78.30
Phone
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone : Water Service Insp
Reg#: I Ic 81837
Ili %,1 26-4451114
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 follow rules adopted by the Oregon
Issued By: .�_ > Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building; Fixtures
Plumbing Permit Application Received Plumbing
DateB _ Permit No. ( n a mj3 3,5j"
Planning Approval Sewer
City of Tigard Dalc/B : Permit No
13125 SW hall Blvd. Plan Review Other
Tigard,Oregon 97223 Datc/t; : Permit No.
Phone: 503-639-4171 lax: 503-598-1960 Post•Revicw land Use
*� Datc/[J . Case No.:-1�
Internet: www.ci.tigard.or.us Contact Juns.: N See Page 2 for
24-hour Inspection Request: 503-639-4175 Namc;Melhod: Supplemental information. J
TYPE OF WORK FLE"SCHEDULE fora ecial Information use checklist
New construction
_ 7emolition Description�I t1U. Fcc(ca.) Total
New 1-&2-family dwellings
Addition alteration/replacementOther: includes 100 ft.for each u Ility connection
CATEGORY OF CONSTRUCTION SPR I bath 249.20
1 &2-Family dwelling J Commercial/Industria, SFR(2)bath 350.00
Accessory Buildin _Multi-Famll SFR(3)bath 399.00
MiEtzi Builder Other: Each additional bath/kitchen 45.00
_JOB SITE INFORMATION and LOCATION Firesprinkler . fl.: P_a a 2.
job site address: ( Z-1-7 u 5 4 /Yl c rt o✓- Site Utilities
�-�- Catch basin/arca drain _ 16.60
Suite#: � .gIdS./Apt.#: __ Dr ell/leach line/trench drain 16.60
Project Namc. T) .L� --- Footing drain no. linear fl.)_ Pae 2
Cross street/Directions to job site: Manufactured home utilities 110.00
2- 1 •►t' Z h cM VY'1r1,: Manholes 16.60
Rain drain connector fl,2
_
Sanitarysewer no. linear 11. P _
Subdivision: Lot#: Storm sewer(no.linear fl.) P�--- Water service no.line rR•1 P _
Tax map/parcel #: Fixture or Item
DESCRIPTION OF WORK 4bsoor tion valve 16.60
{-� kLj ;r � .� .S�C Backflow preventcr Pae 2
Backwoter valve 16.60
- - -�- Clothes washer 16.60
--__,__, -------------- ---- Dishwasher 16.60
___ _ _ Drinkingfountain_ _ 16.60
PROPERTY OWNER TENANT _ E'cctors/sump _ 16.60
Name: / ,� 1( Expansion tank _ 16.60
.JL / -, Fixture/sewer ca 16.60
Address:� ___� Floor drain/floor sink/hub 1G.G0
7��
v City/State/Zip: Ct' Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
APPLICANT_ CONTACT PERSON Ice maker 16.60
l� ~� Interceptor/grease trap 16.60
Name: Pae 2
`,� _--------_-- - - ---�- Medical gas-va,ae: 5
Address: Primer 16.60
l fl Cil /State/Zip^_ i _-_-_ -_�__ Roof drain(commercial)___ 16.60
Phone: Fax: __ Sink/basinnavato 16.60
_ - Tub,'shower/shower an _ 16.60 _
E-mail: 16.60
CONTRACTOR� Urinal
r Watcr closet 16.60
r Business Name: r� I -*Lli�l 6' Water heater 16.60
AddreSSq ,�_.? ?" _ Other:
City/State/Zip: , Other:
PlumbimEernilt Fees*
Phone: C,L ' Fax: 6, 2 '1 2 t 7 3 subtotal $
CCB Lic. #: -'�.s'3 Plumb. Lic.#: Z yyJ . Minimum Permit Fee$72.50 S ��? , �U
Authorized ♦7� Residential Backflow Minimum Fee V6 25
Date: 2► U 3
Signature: __- ��`'�' �- Plan Review(25%of Permit Pee 5
State Surcharge(8%of Permr Fee S =
- ({'lease pent name) - _ TOTAL PERMIT•FEE 5 3 1t
Notice: This permit application expires If a permit is not obtained within Ail new commercial buildings require 2 sets of plans with isometric or
180 days after 1t has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Hoard.
i:\UstsU'ermit Forrns�PlmpermitApp.doc 01/03 Oc�
PlumbingPermit Application -City of Tigard
Page 2 - Supplemental Information
_Fee Schedule: _ Residential Fire Sup >ression Svstems: _
Site Utilities i ty. Feie(ea) Total S ware Footage: _– Permit Fee:
Footing drain-I" IOY 55.0(1 6 to 2,000 $11500
---- -
2,001 to 3,600 $160.00
Footing drain-cacti additional 100' 4640 — -
3,6(11 to 7,200 $220.00
Sewer-Ist 100' 55.00 7,201 and grqter $309.00
Sewer-each additional 100' 46.40
Water Service_1st I(V 55.00 Medical Cas S stCms:
Water Service-each additional 100' 46.40 _ Valuation: Permit Fee: _
Storm&Rain Thain-Ist f00' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 _
Storm&Rain Drain-each additional 100' 46.40 $.x.001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(a) Totftl including$10,000.00. _
Commercial Hack I-low Prevertion Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$In,(M.(l)and$t.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof',to
minimum permit fee$36.25 27.55 and includin $25,000-00-
Rain
25 000.00.Rain Thain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first 525,000,00 and$1.45 for
each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or I and including$50,00100,
s Endly requested inspections- er hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or traction thereof.
Fixture Work:
Are,you capping,moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by(FIxhre-Work Performed Comments regarding fixture work:
Fixture Type: Replace
_ New Moved Existing Capped
Baptistry/Punt _ —
Hafn -Tub/Shower
-Jacuzzi/Whirl wl
ar Wash -Fach SWII --
-Drive Thru
Cuspidor/Water As irator
Dishwasher -Commercial -
-Domestic
DrinJ ing Fountain _ _—.-
Lye Wash _
Floor Drain/sink 2" _ —
3"
.4"
Car Wash Drain — *Note: If the fixture work under this permit results in an
(1:ubage -Domestic increase of sewer EDUs,a sewer permit will be Issued and
Disposal -Commercial
-Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refrf .Drains — plumbing permit can be issued.
Oil Sc arator (les Station
Rec.Vehicle Dump Station
Shower -(sang
-Stall
Sink -Bar/Lavatory _
-Bradley
-Commercial
-Service
swimming Pool Piltcr _
Washer-Clothes
Water Cxtractor
Water Closet•Toilet __
Urinal --
Other Fixtures: _
ODsts'Termit Forris11lmPemiitAppPg2.doc 01103