Permit CITY TIGARD PLUMBING PERMIT
, �,„t DEVELOPMENT SERVICES PERMIT #: PLM2005 -01002
I - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/3/2005
PARCEL: 2S112BC-04000
SITE ADDRESS: 14780 SW 83RD AVE ZONING: R -4.5
SUBDIVISION: HAMBACH PARK LOT: 024 JURISDICTION: TIG
Project Description: Replace water heater with like kind.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
LAWRENCE DELOZIER Description Date Amount
14780 SW 83RD AVE
TIGARD, OR 97224 [PLUMB] Permit Fee 10/3/2005 $72.50
[TAX] 8% State Surcharl 10/3/2005 $5.80
Phone : 503 670 - 7291 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone :
Reg #:
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 -0 th • ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 5 - 246 -669 • : ! 0- 332 -2344.
Issued B / i Permittee Si nature: !■7
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
Plumbing Permit Application �. , i ,, z , ' y `4 . 91,0 i c. ... I , .I_ ' i � �l y ,,, i _ gym k w - ' ' =` ' �, , • �
City of Tigard Received
Date/By / ?J d /l No.: �j Permit No. `� _ i / �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 m ; fi r,' , Date/By. Other Permit No.:
24- Hour inspection Line: 503.639.4175 Date Ready/By: t„�/! See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ' / !CQ Supplemental information
' TYPE OF WORK 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 CONSTRUCTION SFR (I) 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 AND LOCATION Site utilities
Job site address: / Ci 7- ScJ F Ito ,9- Catch basin or area drain 16.60
City /State/ZIP: 7 2 �,,eC 62 9 z cf Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Arne- 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 11.: ) 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 Back flow preventer Paget
efr / J-/ /k)4-4-42... l.1 eIr;7 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' ' ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name:
Z-/¢/2 y 0.-- L- 0 Z i -c p'L Expansion tank 16.60
(.r '7
Address: / F . Q S r � 2 /421., Fixture /sewer cap 16.60
City/State/ZIP: 7 a g a >2 7 22,-( Floor drain/floor sink/hub 16.60
( � ) (s - 7 ,( Fax: Garbage disposal 16.60
Phone: � ( )
❑ 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
Sink/basinAavatory 16.60
Phone: ( ) 1 Fax: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTO Water closet 16.60
Business name: G _ Water heater I 16.60
Address: % ���
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 •-7� 0
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 (C/
CCB Lic.: Plumbing Lic. no.: `
Plan review (25 %ofpermit fee)
State surcharge (8% of permit fee) I7 r
Authorized signature:
TOTAL PERMIT FEE 36
Print name: LAn rc t7 0,-- �-p Z i •e2 Date: f r:?-- O S This permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Perrniu\PLMF- PennitApp.doc 06/05 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard ;
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) • Total - Foota Per Fee: '
Footing drain - I" 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
Valuation: Permit Fee:. •
Storm &Rain Drain - 1st 100' 55.00 $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
•Fixture Item ' Qty .Fee (ea) Total additional $100.00 or fraction thereof to and
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 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 $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.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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 fixtures could result in increased sewer fees *. Please check all that apply.
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 ❑ Arty new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4 ,'
Car Wash Drain • j Isometric" or Riser Diagram . .
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 work under this ermit results in an
Water Extractor p
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i.\ Building \Permits\PLM- PetmitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-01002
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3/2005
Phone: (503) 639 -4171 ek
Inspection Requests (24 Hrs.): (503) 639 -4175 r ''`L
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7:08AM PAGE: 2
SITE ADDRESS: 14700 SW 83RD AVE CLASS OF WORK:
SUBDIVISION: HAMBACH PARK LOT #: 024 TYPE OF USE:
PROJECT NAME: DELOZIER
DESCRIPTION: Replace vvat.er heater with like kind.
OWNER: DELOZIER, LAWRENCE PHONE #: 503
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 017991 -01 503 - 670.7291 Y
Corrections /Comments/ Instructions:
/
(//
/
`,PASS l I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL _ CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: 3 M/6 1 Date: P////6/ Phone #: (503) 718-