Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00294
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/5/2006
PARCEL: 1 S 135DD -04403
SITE ADDRESS: 11950 SW GREENBURG RD 150 ZONING: C - P
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: (1) new sink.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
FRED ANDERSON Description Date Amount
11950 SW GREENBURG RD # 100
TIGARD, OR 97223 [PLUMB] Permit Fee 6/5/2006 $72.50
[TAX] 8% State Surcha 6/5/2006 $5.80
Phone : 503- 968 -2425 Total $78.30
Contractor:
JTR PLUMBING INC
4272 NE BEAUMEAD ST
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 209 -4290
Reg #: LIC 155929
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: �� Permittee Signature: caakan, 1,toick '`�_
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Bi.ith ing Fixtures;
k. V:
Plumbing Permit Applica \ _ t � � , Y ' I 1 Et ,� r f:
^: R eceived
. a City of Tigard - Permit N...■ `�
Date/By. , o, 1, -, 9
13125 SW Hall Blvd., Tigard, OR 972 ' 1 �'_ nU
G �� i 1 P l an Review ,� � ��
; ;. ®x Phone: 503.639.4171 Fax: 503.598'. 1 • 6 Other Permit Noi
Date/By x' if'-� , ff� 6 a f Q 7
<z.. Ins ection Line: 503.639.4175 Jens
aTc1 G.NR,I� p Date Ready/By: ! s) , 1 ® See Page 2 for
,,, Internet: www.tigard- or.gov C �,$ Of` � p (Uf j; Notified/Method: 111 U I Supplemental Information
FEE* ', SCHEDULE•
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
• - CATEGORY OF CONS RUCTION SFR (1) bath 249.20
❑ 1- and 2 -family dwelling Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE -INFORMATION . D LOCATION Site utilities
Job site address: ) 1 "l s Caw GI v t e b u rc 2c,1 Catch basin or area drain 16.60
City /State /ZIP: �, . rcI 0 R c a 3 Drywell, (each line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 G 0 I Project name: I t
Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
_ - ,_ .. _ _•. _ DESCRIPTION OF WORK
Backflow preventer Page 2
(l v
‘',5191)/ %C"r 4Zb e '/Z Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER • I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: 'T4 -Q A■A ,A0 V - SQ vl Expansion tank 16.60
Address: 1 " kc1: c �0 s Lk). �cccur J b V v'c1 ck - S0 i E e k 00 Fixture /sewer cap 16.60
C
City /State /ZIP: --N r l 0 , ql - Floor drain/floor sink/hub 16.60
F ax: ( 5 03) q
Phone: ( c1�8- 1 't�. -5 $ °24126 Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON -. Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
m asin/lavatory 16.60
Phone: ( ) Fax: : ( ) i.
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
. ,. CONTRACTOR Water closet 16.60
Business name: E ' 7 g 1 Algp:/v9 • f�C Water heater 16.60
Address: y2 go L s v s..-. s..-. v4 Al s 7 0�� Subtotal
City /State /ZIP : ,t?..G ""0",". 2'7/ O2 c/
Minimum permit fee: $72.50
Phone: (5o3 9' / / dL91 .... e, / ,/ y� e , Fax: ( ) Residential backflow minimum permit fee: $36.25 .. j
CCB Lic.:16 t Plumbing Lic. no.:3'y ��2pg Plan review (25% fee)
/ / State surcharge (8% of permit fee) ..
Authorized signature: / lc( f � 0
TOTAL PERMIT FEE ( D
Print name: - Date: This permit application expires if a permit is not obtained within
i - 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1: \Bui(ding\Pennits\ PLMF- PermitApp. 04/06/06 440 -4616T(10 /02/COM/WFB)
Plumbing Permit Application - City of Tigard '
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
' Q Fee (ea) Total •
Site=Utlities ` • S quare Footage: _ Permit Fee: - .
Footing drain - l' 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 - 1st 100' 55.00 7,201 and greater _ $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 -
Storm &Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & 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
Qty. - ` Fee ' (ea) Total additional $100.00 or fraction thereof to and
Fixture or Item including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow 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 $25,001.00 to $50,000.00 $379.50 for the first $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.
$50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report.f xtures- col!Id -result-in i ased.se:rer fees*. Please check all that a, ply.
Quantity by (Fixture) Work•Performed ❑ Any new commercial building.
Fixture Type: Replace . ❑ Any new exterior plumbing site utilities.
- Previous` Capped Added : Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
4„ .
Car Wash Drain 'Isometriic`or RiserDiagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains'., .
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service , _ -
•
Swimming Pool Filter .
Washer - Clothes *Note: If the fixture wor u this ermit results in an
Water Extractor . . p
Water Closet - Toilet in crease of sewer EDUs, a sewer permit will be is and
Urinal , fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Petmits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2O06.00294
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 615
Phone: (503) 639 -4171 , , A
Inspection Requests (24 Hrs.): (503) 639 -4175 �__: 'k'IL.:
INSPECTION WORKSHEET FOR DATE: 6/30/2006 TIME: 7:0 EAM PAGE: 5
SITE ADDRESS: 11950 SW GREENBURG RD 150 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: Relocate existing sink.
: ANDERSON, FRED 503 968.2425
OWNER ON
. � PH #:
CONTRACTOR: JTR PLUIVEE3ING INC PHONE #: 503 - 209.4290
Inspection Request Scheduled For: Date: 6/30/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 032493 -01 503968 -2425 N
Corrections /Comments/ Instructions:
,OF — O
i 7 . ,"/7/ 1 "
. / t it ;
)6ASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
i FAIL CALL FOR INSPECTION Ii ADDITIONAL FEES ASSESSED
Inspector: l
)■,.., t Date: I Pho ne #: (503) 718- "
Accumulative Sewer Tally Parcel # ( \ ' rly9 - 77 5° y 0,7
Te,ant Na'me: Spec Space This SWR#
Site Address: 11950 SW Greenburg Rd # 150 This PLM#
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 _ 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 _ 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
•
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16 = 0.1 Current EDU 1 EDU = $ 2,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 2 divided by 16 = 0.1 over (under) $ 260.00
Enter EDU Change Here 0.1
Notes:
Authorized Name /Signature: Date:
Building Division
(Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i:\ Building \Sewer Tally \SewerTallySheet.xls 7/1/05