Permit 11, n CITY OF TIGARD PLUMBING PERMIT
1
° - COMMUNITY DEVELOPMENT Permit #: PLM2010-00214
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/02/2010
Parcel: 1S135CD02402
Jurisdiction: Tigard
Site address: 11895' SW 95TH AVE
Subdivision: BOETCHERS ADDITION Lot: 8
Project: Carter
Project Description: Replace:40' ^water service
Owner: FEES
CARTER Quantity Description Date Amount
11895 SW 95TH AVE
TIGARD, OR 97223 40 If Water Service 07/02/2010 $62.54
PHONE: 1 12% State Surcharge - 07/02/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 07/02/2010 $9.96
Contractor:
Plumbing
ANCTIL PLUMBING INC.
16900 SW MERLO ROAD
BEAVERTON, OR 97006 -0000
PHONE: 503- 642 -7323
FAX: 503 - 642 -7755
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
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This permit is issued subject to 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 notlstarted 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 OUNC by calling 503.246.6699 or 1:800.332.2344.
Issued By: 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.
Plumbing Permit Application. ,
� S� `rvrb ,» id c�� a $y� ,.
a.r d6 v�,�
.rtti - -
Building Fixtures ,1 \�E M if7�llh :Fic l C )'f1
C0. of Ti gait s „ �a
II y a i312 SW:klagBlvcl. Tigard. 'OR 97223 ate/ a 0 er, ' _ Peat* No, -, iii -# ® � A
Phone: 50 3. .
639417 JUL J U L 0 2010
a .1 Fax`.503.598.196b
Other Permit No:: t` Inspection Lim: 503.639.4.175 Date/By '
l ' ,,,4 )' CITY OF TIG Dat
� Interns t www tigard gov �� ° See Page 2 for
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_ Notified/method. Su lemental,toforrmation •
i 1 a e t 1 i i t �i "ri y � �,p�"S�fi�l }t�Ul�f}T,A " ,� } � '1{7�rj'+,� Y . �r . � j ,' ; { 1 4Re � r� t " 1 41i , ry }} Iii 1.41+7271,914 a • d h dt. : i: �it�t :.,) i l. ,t, I? ISkisidi�9il (Ilfitf..tltlL'eYa'1�`.,d,LeF. {ia ,:7i i f i { ,t ; , � �1I A 11:' .1d1l14� a { tl . ni • „ if . , 4 , ` , , !:
❑ New. construction ❑ Demolition for s, ecial in ormation use-ehecklist r
- - Oescri, ;on mEsiman Total -- .
PliA ddiuon/alteration/replaeement 0 Other New 1- 2 -mm11 dwellings (includes 100 ft. for each utili connection
' ! d , r �, tli y . � ' ' A Itxar Pa�*�f.� t + t�ri'!l {a g r ,
h 1 1 t ,,,10. E, .��t t , � t 4 �mcr' itdtt � ' tml Jna r ititsi side i,dii6 I I ,, i Igo 312.70 M.
P and 2- family dwelling ❑ Como-dal/industrial SFR (2) bath IIIIIIE
• Accessory building �..__ ❑ Multi- family SFR (j) bath 500.32
' Each 0 Master builder 0 Other: re Sadditional
rtld oatath/Ritchtn 25.02
F�F P id i ; 'l ql r � R �' ° ` i �C 4y t � tr : . 4 C i I �f } r i t x p er ( sq. ft.) Page 2
, 6.., tt! .:i • ,, , . 4 i. ,, :, rgTal i saI ltttf rt i , i } . , i T, iii ' .Hl., Liit Site utilities:
Job site address: jr l r Catch basin, or 'area drain 18.76
City/Statc/ZIP: DrYxcll leach line, or trench drain IIIIIIIIM
Footing drain, (no. linear ft.: ___,)
Suite/bldg./apt. no:: Project:narnn: Orlir ami Manufactured home utilities 111 50
Cross street/directions to job site: Manholes 18.76
.Rain dran;oonnector 18.76
Sanitary sewer (no. linear ft: ,_.) IIIIIIIIIIZSEIIIIIIIIIII
Storm sewer (no. linear ft: _) 111M1 Page 2 ME
Water service (no. linear ft: i' irmaziradNA,
Subdivision Lot no.: Fixture or item;.
laxmap /parcel no Bacltflow pm-venter
. „ i i e , � t i k +t dq P eN3 r m � g + ' }( (+}j1j Backwater valve � �
�4Y x �'f 'bad i�iii. d 4iij ,,, i ' I ',�,l ,� t tl '1 d u ' S t 4 , 1 s , �r'NI�1'i 1 !bin .....#
A'"7 �,+�,�{{1,+��� �ttt dt1?ntdwrlrutn„ r u s ,.�a ,t. r Clothes was her NNE
' [ 1 �� 25.02
1 Dishwasher,
21.02 IMMO
Drinking fbutttain 25.02 MUM
Ejectors/sump .11111 i;5;' iti� 4� c 4 .1e Lr� J .''t i 1 d 1 . : 5Fll$ j fkij {tt1T r 1 i tank 11111.111=11.111111
i ,ni t'i• J ... , ,1 ' , ' , 0 iiIE ;,,! G4'0,I , h t �i
l b IA , '.4f i "'t � , � tf, EXPansim illy ,
2502
d
Name: r Fixture/sewer cap 111111 25.02 MEM
Address: Floor drain/floor sink/hub Eli 25 -02
City /State/7IP: id/ Garbage disposal 25.02
Hose bib III 25.02 IS
Phone: ( ) F a ; ( )
Ice maker � i ���.lfii� h � � Yh° i Ill I i H � d d "d dF IFSP1t I n „ - :, �i, Er 1 ; 0 � 1 :sEt ` '1 f,11E ma � r, . d , t( I t " Itz /grease tra > � r �:: ���� � �16tE)� R ^ d ., P
Business name: Medical gas (value: $ )
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Contact warm
Roof drain (commercial)
Address: ME
Sink/basin/lavatory 25
City /State/ZIP: _ Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan El 12.51
Email Urinal UM 25.02
� � I tdi ' 4 `i 4 • PI}4(tL` q ��p.� p t 1 i' d Water CIOSet
y t.. �, ___ t 'r , EMS= ;# t't _�r1__ � $ "' i { a� I, r 25.02
� � � W ater heater 11111 37 52 I =
y� Waterpiping/DWV in 56.29
Address: 'r 0 0 ) m 6 i C44) g ,D Other
25.02
. Subtotal Sax�II
Phone: '1 s -
1 ) - i Z Fax: ( - ) Minimum permit fee: $72.50 IM►
CCB Lic.: Plutnbirr Lic. t 7► / Plan review (25% of permit fee) MIN
_
.moo 1
State surcharge (12% of pcm7it fee)
a�
WA.uthorized signature: ,^,. v /
r r
` �� PPl
i ` a A PEE ,
_ - h a d , L Date: 9-- / --/ w T his perm a lcatiott expires if a p ermit TOT is L oot obtained ERMiT F `vithin 180 dny5
after it ir tree sepepted as complete.
*Fee methodology set by Tri -Coungy Building Industry Service Board.
I:\nuildin ■Petm":ta1PLMU- PennitApp.doc 1niot /0 440�616T(10/02/Ot�1(WEi
t o / ,. r,,. n -C, �i'.._ _. /-7\2 1_0.17 . 7 1 e--
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P1'u,r bin Pennit Application City of Tigard
JPage`2 SuppleuaentalInf
• Fee . S . chedule tial Fire Su ression S stems- , „, , \ ,, )�.� Res de
� �t�,. k, h < ? �Itij�� . 6 Q E i' � � ' . ' I n i a 1 h8815 � '° ( (g 1 I1il it t 1 1 � I r + �'1vl g �' .'� 1 '�d , •
>, a , {Ut'fiiiid �i Ii �iat,u�, ,,, ts. dI ', �,
1�m;: :,lll ,.' C , 1 ': ; ', ' ;,Et 9 �
Footing drain - 1 50.03 0 I0 2000. • $121.90 ,
Footing drain - each additional,l00` 2,001'6,3'600 2 _ , • ,
Sewer 1st 62,54 3,601 to 7 290_ $233.20
,I00' V
7201 and ater
$327:54
Sewer -each additional 100' .
Water, Service - 1st 100' (j 62.54
r r' stems:
water service -`each additional 100' Syr "" $ Gas S
b2 . 5 4 �, , H. 000 ;e'9 lint F1 �mtcg,ii "Im, 3 M9 i4 6' 7 ' . ;Y -: ` � :1, •
• Storm Raln Drain each00 ' r i = ; ,,
r Fe $ 0 to $ $ 2 fo fee $7 o
S marm & Ratn Diata 1st additional 100' :$5;001 A0 to $10 $7 f the first $5,000.00 ands 1.52 for
1 r ,,, ,
ck (' t .r, . ra ,� 9 . . .
i 1 i1 11 . � � ` � f I each additional $I00.00 or fraction thereof, to .
InS cction of eziting plumbing or for and includin_ $10 004:00.
which. no fnc Is specifically indicated ■ 90,00/hr
e
$10.001.00 to $25,000:00 ac a 0 for the first $10,000.00 and $1,54 fur
minimum ch a 1/2 hour each additional $100:00 or fraction thereof, to
Inspections outside of normal business 90.00/hr $3d.u3clu for t1i first $250.
hours minimum char: 2 hours $25041.00 to $50,000,00 $399:50 for Clio first $25;000.00 add 51.45 fins
Reinspcction Fees 90.00 /hr ea 'addrtiortal $100,40 or fraction thereof, to
and inciudia• $50 000:00.
Additional plan review for revisions 11111 90.00/hr 11111 $50,001.00 and up $742.00 for the first 550 ;000.00 and $1.20 for
(minimum cb> c— {!2 hour each additional. $100, 00 or fraction thereof.
Subtotal
Commercial'FixtureWork:
review is requj
A re you capping, adding or replacing fixtures? If "yes", iii, 441,1 5' fk
Y i . „ ;I 1 4`.? ,. a a + s I �> ti o ee .'
Plan please indicate work performed by:fixture. Failure to ���.ire' d fo of the following.
u -a1 wi .w e �x a ;�,: ,, ,
tt reor atly'of ng.
accuratetx report fixtures could result 111 increased sewer fees Please check.all apply_
a nand t7K4tlre tf rk') ;et'fA D Any new commercial building,with water service 2" and
Fixture Type: i ) Itephaep.. greater, except systems designed and stamped by licensed •
VBa.tistry/Font � engineer.
Bath -Tub /Shower ❑ New exterior plumbing site utilities for any c o[rlplex struchtrc
laciuzi/whirl:ool' as defined in OAR918- 780 -0040.
Car ash -Each Stall �� ❑ Medical gas at�d;:vaeuum systems for health care facilities.
17rt: i Thru . �� ❑ Any multiple rpose:fire sprinkler system.
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Cus, idor/Water As irawi
0 Any complex structure as defined in OAR918480 -0040.
Dishwasher Commercial IIIIIMIIIMIBMMEMI
- Dpmestic Submit 2 sets of plans with any of the above.
Drinkin,'1 ountain MMIIIIIIIIIIIIIIIMIIIIIMII
Eve Wash C fie p i '
Floor Drain/sink - 2^ i—_-i:::L. _ _i______ __ _ l 't f ' ,? ,. � "zn :� . Ci ty f 1' . i ` ii'
❑ lsometrt ar ' � E: , 7 .k'.,.,k „
3'°
n is required for new buildings
4"
that meet the qualifications above,
Car Wash Dram
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Garbage Dorrxatio
Disposal - Commercial
• = industrial Comments regarding fixture work:
-S ' a t oefng. Drains
O iliS arator OasStati ______________
Rec. Vehicle Dump Station � _
• Shower gang � � ____ _ —
-Stall
Sink Bar/Lavaiory � �
- Bradley IIIIIIIIIE
- Commerciale *Note: If the fixture work under this permit results in an
- Service
Swimming Pool Filler increase of sewer EDUs, a sewer permit will be issued and
washer Cloths fees assessed for the sewer increase must be paid before the
• Water Extractor plumbing permit can be issued.
T watgr Closet - Toilet
Urinal En
- Other Fixtures:
http://www.tigard-or.govicity hal l/dcpartments /cd/docs(PLMF- PennitApeioc