Permit CITY OF TIGARD
COMMUNITY DEVELOPMENT PLUMBING PERMIT
PERMIT #: PLM2006 -00543
DATE ISSUED: 11/7/2006
TIGARD:, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 112BD - 00700
SITE ADDRESS: 14655 SW 76TH AVE 25 ZONING: R -12
SUBDIVISION: MARCIENE II APARTMENTS LOT: JURISDICTION: TIG
Project Description: Apts 24,25,26,27 RAIN DRAIN REPAIR.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BOOTH - HEYDON LLC
PO BOX 1185 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 11/7/2006 $72.50
[TAX] 8% State Surcha 11/7/2006 $5.80
Phone : Total $78.30
Contractor:
TED RUDIGER JR. EXCAVATION
16235 TRACEY LEE CT.
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 887 -8089
FAX NA
Reg #: LIC 162133
PLM PB201
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 o tain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � / Permittee Signature:
� _�_i
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.
Plumbing Permit Applica,tonr L ; ,-
Building Fixtures t1t.s.i ,, . f . M, " ' volt c -, , ^ 1T ' � .,it 1I r •
City Tigard SW 1 2006 Date/BY `1 /7�� i9' Penult No.:F/ eM b�op 57/3
$ to 13125 SW Hall Blvd., Tigard, OR / /�lrl i �/
•
rill ®A Phone: 503.639.4171 Fax: 503.598.1960 '- Plan Review
Other Permit No.:
Date/By.
x Inspection Line: 503.639.4175` Vii" ,, I , A ' Ready/By: Jw;s: la See Page 2 for
; 41 c Ii s d � � _ < .3 .i.y Date Ready
;,?�. Internet: www.tigard- or. Notified/Method: Supplemental Information
Tom-_ r 7- � _
. 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 (1) bath 249.20
❑ I- 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: I I & SS 5 7 t A- t/ e- Catch basin or area drain 16.60
City /State /ZIP: -r e„ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. noRti iI Project name: J L,, -t44 t Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: /3p„�, 4- 44,
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: 1 ) 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 Page 2
Yak de,t �/<1 JG e a i fi__- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
• Ejectors/sump 16.60
• Name: 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
El 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/basin/lavatory 16.60
• Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
. • CONTRACTOR • , • Water closet 16.60
• Business name: "reS1 (24,4 I, tti •R_ 1 „rrIG Water heater 16.60
Address: i ‘ 2 3 ,r 7f / N Lee_ c-t Other:
D Subtotal
City /State /ZIP: (' 2 et OA. C 4
` Minimum permit fee: $72.50
Phone: (S'o) 9S 7 'O i9 Fax: ( ) Residential backflow minimum permit fee: $36.25 7a -0
• 1
CCB Lic.: 1 0 Z 3 / Plumbing Lic. no.: Pk/ Z 4 / Plan review (25% of permit fee)
l State surcharge (8% of permit fee) ..
Authorized signature: ' �/ TOTAL PERMIT FEE tie. 3Q
• Print name: -7-: e ✓ _ /itti i (( 7 Q�_. Date: 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.
1:\ Building \Pemits\PLMF- PemitApp.doc 04/06/06 440.4616T(10/O2JCOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities
Qty.' Fee (ea) Total . Square Footage:: Permit Fee:
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 - 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
Fixture or 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 Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by, licensed
•
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918 780 - 0040.
Car Wash - Each Stall
- Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher -Commercial
Domestic Isometric or Riser Diagram .
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
• Eye Wash that meet the qualifications above.
Floor Drain /sink - 2"
-3 „
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can 'be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
•
i:\Buildineermits\PLM-PermitApp.doc 09/22/06