Permit M CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00277
r 2' Date Issued: 10/06/2009
T i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S103AC01504
Jurisdiction: Tigard
Site address: 11175 SW FONNER ST
Subdivision: Lot: 0
Project: Erickson
Project Description: Replace up to 100' water service line.
Owner: FEES
ERICKSON GEORGE Quantity Description Date Amount
11175 SW FONNER ST 100 If Water Service 10/06/2009 $62.54
TIGARD, OR 97223
1 12% State Surcharge - 10/06/2009 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 10/06/2009 $9.96
Contractor: Plumbing
ROTO ROOTER SERVICE & PLUMBING CO
23311 MADERO ST
MISSION VIEJO, CA 92691
PHONE: 503 - 682 -9774
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to •UNC by calling 503.246.6699 or 1.800.332.2344.
/ r
Issued By: ' • OA A I I 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.
'ei�� �t
, ur� ��� „ PLUMBING PERMIT
CITY OF TIGARD D
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00277
TIGARD 13125 SW Hall Blvd., Ti ard, OR 97223 503.639.4171 DATE ISSUED: 6/27/2007
9 PARCEL: 2S111AD -10000
SITE ADDRESS: 08710 SW REILING ST ZONING: R -4.5
SUBDIVISION: SCHECKLA PARK ESTATES LOT: 059 JURISDICTION: TIG
PROJECT: FEAR
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JAMES FEAR
8710 SW REILING ST. Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 6/27/2007 $36.25
[TAX] 8% State Surcha 6/27/2007 $2.90
Phone : 503- 267 -7347 Total $39.15
Contractor:
FOREST LANDSCAPE, INC
40437 NW VERBOORT RD
FOREST GROVE, OR 97116 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 357 -3808
FAX 503- 359 -1908
Reg #: PLM 8253
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: 07'1 ce1294,4 rf„trt1zYL
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.
°I-". EC r': V ' D
: Muni bing Permit ApplicationJ 2 7 /1
5 '7y -, 1 it ! I . (1 \ , ,t41
City f Tigard _ AR, � .....� :, . t :',1 1 1 , ��� �
CITY OF I� + Received
DaeerBY i.,. ./
131 SW Hall �Blvd., Tigard, OR 97223 9 w /a 7 p' 113 Permit No.: Lni 7 ?oz7 /
Phone: 503.639.4171 Fax: 503.598.1960 ,
BUILDING '� ��� P y: iaw ��i
x, •Rr
24 Hour Inspection Line 503.639.4175 �� J � Y other Permit No.:
Internet www cr trgard or ru s Date Ready/By lie' S See P
vP 'fir - o , r } .1 , x , Notified/Method: , � • arse 2 for
;a? f ,,oil ■i ` < rli; (. ,. y r { t r r . i f a if. iti r i Yr Y t , g "'s �c _ J BuPPtesn�td L iZ. V V -F
,,.r," ..a t, :i ..x.± . t 7 �'F=r.t2f:r �: 5 } ^ ^I �, ', ! � g z 1 "h i.; 5 `'..,,. p , F[ , 2:6 �' a S'.
r 3, .. 5..., :f� 3 .N + :� "t:F1' Y,... 4 i : � i 4^ .� i '� S 1 V..... St � Zu 1f s v I �f � f� 1 � ;
0 New construction 0 Demolition] - c { 'a r'rr
/: tton/alterstton/seplacement 0 Other: Deseri • Feu special Information use rhauti'ist
5 4t r t s+ x r(, .g t I n-{ 7 w 'r ,, _ , ; --r •I e -.. c: d - - family dwellings (includes 100 lI, for each utility Total
2t ° . 4 • s,q �.!' ;,. Sp , . t , y 7 ', ." a. . 7 connection;
1 .1 5. �� 3 1;,- ar_... ..'. ? y.1i�... ,, SFR (I bath 249.20
1:1 1- and 2 -tbmily dwelling " ` `
❑ Commercial/industrial SFR (2 bath 350.00
0 Accessory building 0 Multi - family SFR C3 bath 399.00
0 Master builder 0 Other. Each : • , 'floss] bathlkitcben
p " "'� { r [ i i i I a F - zr r �- w rt2rr 4 nab t a s . Fire . u -.. sq. 45.00
r• y F
..c
r C l a 2
Job site address: y .4 .,_ :: ' ? ;, +.. Sib des
� -� p Catch .: '. or area drain 16.60
8 . . -' • a
City/State/ZIP: l 1 1 a / O 12. q � , y Drywe leach line, or trench drain 16.60
SuiWbldgJapt no.: pmj : �'! Footing ; . , (no. linear ft: 1 Page 2
Cross street/directions to job site: r • • home utilities 110.00
Cis-ckli a1\fa . Manhol_: 16.60
Rain da connector 16.60
Sanitary ewer (no. linear ft: ) ■ Page 2
Storm ; ; er (no. linear ft: ) Page 2
Subdivision 1 Lot no.: Water . 'ee (no. linear ft: _J Page 2
Tax no.: Fixture . item
F '-i is �`; i, 1 1 F �.
v.j a r 7 , c E r n,,,•1 7 ' S ` '` (,, ` Absorpti.
13 7 , valve ter
�?:, �, .,, . -..,. x : dr . i. 4 ,: , i t 3' s ^Y` a a k`� x� .„, P �i q z 16.60
Page 2
• , . O. w • SI f, ; ti • - , • L Backwa• valve 16.60
•
Clothes her 16.60
Dishwa... 16.60
�� 3 _ + rM 1 r x4 4 12 xr7.<r " ~ 3 r 4 4, , 6 r 4 y t 5 J
:∎ Nx. ti,.. „, < < f 1 , Y , /`, ¢ X e ` i S r Drinking ountain 16.60
Name: ` k ..c Ejectors/.
L lrl.i`(l \e, FP r 16.60
N
^ � . Expansr.. tank 16.60
Address: 5 jt J ¶Q l u Yl eS' Fixture/ • er cap 16.60
City /State/ZIP: T d , / . C 3. 72 (i Floor •, • ' t oor sink/hub
`-�
nk/hub 16.60
Phone: 0 ,� � � , "4 Fax ( ) Se • sposal
16.60
� Y, ,..,.,' } ^h.4sf. r, i ..�.,a 1. .$ r f ar ;1:f.'&i . ?k-rJ / 1j` .�. }y r'A s r Hose bib _
k . . Pr. )1. . ,, ,,..t:1 ... r , s .: a 16.60
Business name: Ice maker 16.60
• <G'+ /. ;# :11 - 14 f •
Contact name: VOnt� t & �9C trap 16.60
v � Z *' XJ f 1 i value: $ Page
Address: (�c(,1C_FI lVLQ \ /er or-f- � ( ) Pe 2
16.60
City /State/22P: . , emmve , 02 Q7 //6 Roof drain oonnmemial) 16.60
Pbane: os r* ar F a x : ` i ]� f Sink/ba, , avatmy 16.60
fir• AZ tir�4% '*t+• y
Eixrarl .� i .! 15rU/ shower pan 16.60
�7r& - y" r iJ?. �S c I r A i I � ri tit's l
y � .?.'CS .:',, ',..+ :. 4t` , 4..F: i s ° Sr :.1N, ., s t# 'C 't+ Urinal 16.60
t, f , .,:. ,. „. __ ;, , r,, w . rr c ;t 2.`.,,. W ,._s f 7 .` Water cI.::. 16.60
Business name: .• s• 1 .. g :. 11• i f A' h _ Water hea :
16.60
Address: • 9- so r l s !e Other: _
City/State/ZIP: � t i e \/9 , C y� q,/ /( Subtotal
Phoam: !� 'al %1 i~►a Fax ► f - i Minimum penult fee: $72.50
i `r 40ie • . “t backflow minimum • errnit fee: $36,25
' - 1 , 83s,_•2> , `
Ir 11 t i n . _ Lic. no.: Plan review (25% of permit fee)
Authorized signature: : v L{ i U I State surcharge (8% of permit fee) F
I Print Dame: I TOTAL PERM TT FEE
V e..k- i `j j e /.,& y a ned f Date: f Q, Z 21 n - il Tbis pe „r application expires If a permk is not obtained within
1 , 1 0 days after it has been accepted as complete,
i: x7103 aao eate'ruorozc:orvw�) 'Fee m . , ology set by Tri- County Building Industry Service Board.
T 'd Xdd 13r213SU1 dH WULS = T I L002 LZ un[
Plumbing Permit Application
R ECEIVE FOR OFFICE USE ONLY
City of Tigard Date/By: i 4 Permit No.:,le Ly 0 _(/��
11 111 - q 13125 SW Hall Blvd., Tigard, OR 97223 0 C T 0 5 2009 Plan Review ��l ll ti Jd L
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
TIGARD Inspection Line: 503 CITY OF TIGAR D Date Ready/By: ur Ea See Page 2 for
Internet: www.tigard- or.gov
BUILDING DIVISI 1 Ufied/Method: '� `'t Supplemental lnformation
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 R. for each utility connection)
- CATEGORY OF CONSTRUCTION • SFR (1) bath 312.70
irj 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 8/ 75 , w t-6) ter s f Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP:
77 j al 9 7zZ3 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
• . , DESCRIPTION OF WORK Backwater valve 12.51
• r Clothes washer 25.02
�P u.
�c.e yrkey 1 NhQt {tit v l or U6�e -V Dishwasher 25.02
d ---v 1 G 1 Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER l ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: G e p rye C',-1e k Floor drain /floor sink/hub 25.02
Address: 5 6,Aw-.4- 6-5 ' 019 J Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT . O CONTACT PERSON Interceptor /grease trap 25.02
Business name: g._ 1._.0 � ci CFTC -l/ Medical gas (value: $ ) Page 2
,� / Primer 12.51
Contact name: 5 eQ � ,vt%L Roof drain (commercial) 12.51
Address: 2Sl 6S 5%,t1 1 0 b y S 1-e-Yt y ra Sink/basin /lavatory 25.02
City /State /ZIP: U Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
' Water heater 37.52
Business name: /20 4 C f�.F' Water piping/DWV 56.29
Address: 2 v 5 S St4J '3Q U S E )- d Other: 25.02
City /State /ZIP: WI L SOy1 tj t i t 7 7 0 Subtotal
Phone: ( b - 9 us/ 9 77 y Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: ( 9 Plumbing Lic. no.: 37 -7 Plan review (25 % of permit fee)
!� State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE 2d
Print name: j. C Z Date: /( - OQ This permit application expires if a permit is not obtained within 180 days
a after it has been accepted as complete.
*Fee methodology set by Tri- County Building industry Service Board.
1. \Building\Permits\PLMU- PermitApp doc 10/01/09 440- 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 Square Footage: - Permit Fee:
Footing drain - 1' 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other .Inspec'tions or Fees Qty. • Fee (ea) " Total each additional $100.00 or fraction thereof, to
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
Jacuzzi / Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator 12 Any complex structure as defined in OAR918- 780 -0040.
Dishwasher -Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain
Eye Wash _ Isometric or Riser Diagram
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes lumbin permit can be issued.
Water Extractor p g P
Water Closet - Toilet
Urinal
Other Fixtures:
1: \Building \Permits \PLMF - PermitApp.doc 2