Permit CITY OF TIGARD PLUMBING PERMIT
IN ' COMMUNITY DEVELOPMENT Permit #: PLM2009-00112
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/08/2009
Parcel: 2S 110AB02800
Jurisdiction: Tigard
Site address: 14355 SW 114TH AVE
Subdivision: COLE'S ACRES Lot: 13
Project: Metzger
Project Description: Replace up to 300 feet of water service.
Owner: FEES
HUGUS, ZONA GAY Quantity Description Date Amount
14355 SW 114TH AVE 300 If Water Service 05/08/2009 $147.80
TIGARD, OR 97223
PHONE: 1 12% State Surcharge - 05/08/2009 $17.74
Plumbing
Contractor:
AMERICAN PLUMBING SERVICES INC
5905 N INTERSTATE AVE
PORTLAND, OR 97217
PHONE: 503 - 289 -6498
FAX: 503 - 247 -2429
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $165.54
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
Issued By: j k Permittee Signature: S J2 Appl cir;k1 (NA
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.
May 0 09 01:56p L 01 p.1
Plumbin Permit Application �(�
r � ✓
FOR OFPIC:F, Itsl: ()NIA
City of Tigard Received o
Iv a , • 13125 SW Hall Blvd., Tigard, OR 97223
Date/ •� 'tJ I
Phone: 503.639.4171 Fax: _ Perm' No_- P(J ' v2l_,�r� • Q Q O Z
ax: 503.546. ] 960 Plan Review
T I G r1 It D Inspection Line: 503.639.4175 Date Re Other Permit No.:
Interne[ www.trgard -or gov Date ad3/Hy:
c �i 71 ? N g ppme
rental I rormanon
otified/Method
❑ New construction . �_.. � .... .... _... �..:.:. .. a :• _ ° -- . • -•
❑ Demolition Fors•ecial in ormakon use checkltSL . :.
Addmtron/alteratron/replacement Other: Descri.tion Ea. Total
- °
New 1- 2-family dwellings (includes 1 000 each utility connection)
3 a} r >il', a • yr ,
_ .... ,, .. t '4 SFR (1) bath
1 •and 2- family dwelling ` °" - ' '° • "� ". th
- 249.20
❑ Con mercia ttndustria] SFR (2) bath _
Q Accessory building 350.00
❑ Multi family SFR (3) bath r 399.00
Each additional bath/kitchen
❑ Master builder 0 Other: _
' 45.00
.• . ; a� J " i ' -- , 3 -?. -L- , t : rt : C 1 Fire sprinkler L , sq. ft.) Page 2
Job site address: ' /4 3 W t 14 ; Site utilities
City/State/ZIP: Catch basin or area drain _
T� 0I - 0R 16.60
Suite/bldg./apt. 9��� Drywell, leach line, or trench drain _
a ./apt. no,: Project name: G 16.60
m GI U s Footing drain (no. linear ft.' _J 1111111�
Cross streer/direciions to job site:
Manufactured home utilities _
110.00
Manholes
16.60
Rain drain connector _
16.60 NM
Sanitary sewer (no, linear ft.: _) _-
Subdivision:
Storm sewer (no, linear ft.: __) �
Lot no.: Water service (no. linear ft: ___.) _ Page 2
Tax map /parcel no.:
Fixture or item
-) - ..;,_ -; 2as . s r � 'Ys f ,. Absorption valve _ 16.60 MN
Backflow prcventer _112123
16.60
Clothes washer _
16.60
Dishwasher _
�` ' ,foa , .i ; f 16.60
" ' fountain
�.. - ni'rs ) Drinking 16.60 Min
Ejectors /sump _
16.60
Address: Expansion tank 16.60 _
_ 16.60
phone ( ) Floor drainaloor sink/hub 111111 ) Garbage disposal 16.60 r
ti.jiirr h.i r ` 5 16.60
x ��n1 t Hose bib
16.60
Business name: '
_ 16.60
Contact name: Interceptor /grease trap I= 16.60 Mill
Address: Medical gas (value: $ )
16.60 mown
Roof drain (commercial)
16.60
Phone. ( )
Sink/basin lavatory _
E -mail: 16.b0
Tub /shower /shower pan 16.60
_. . + e�,�a t o `F,t -,-rM _ 16.60
`_`' .' 1 Wate closet
Business name: American Plumbing cl _
Services LP 16.60
Address: 5905 N Interstate Ave 16.60
Other: = 1•1111•111•1
City/State/ZIP: Portland, OR 97217
Subtotal
Phone: (503) 289 -6498
Fax: (503) 247 -2429 Minimum permit fee: $72.50
CCB Lic.: 151062 Residential backflow minimum permit fee: $36.25 R"-.
Plumbing Lic. no.: 26-567PB Plan review (25% of permit fee)
Authorized signature: j�� ,/t
1 State surcharge (8% of permit fee)
•
Date: TOTAL PERMIT FEE
`- This permit application expires if a permit is not obtained within
tlauitdineermits1PLM- Pami :App.doa CV26!06
180 days after it has been
unty Build ng Industry methodology set by Trit Service Board.
440- 46167 '(10102/C6WR'F8)
163.54-
May 05 09 02:23p p
�, .-'.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • •
• essloll s#
Footing drain - 1° 100• ._r..:, ..._..i:- il . l 1 'e x ! . J` , r ,t 1'0;t .,n`' stems:
• ..
Ins:
SS 00 0 to 2,000 $11 ~
Footing drain - each additional 100' 46.40 NMI 2,001 to 3,600
Sewer - 1st 100' $260.00
55.00 3,601 to 7,200 $22000
Sewer - each additional 100' 7,201 and greater $309.00
46.40
Water Service - 1st I00' ( 55.00
Water Service -each additional 100' MI 46.40 ` , �E -00 Medical Gas S stems:
•^�tWa i
Storm & Rain Drain - 1st 100' 55.00 �� , o o $s e r r �i rl Y
$J 00 [0 55,000 00
Storm & Rain Drain ach additional ] 00 46.40 inimum ec 572.50
m
$5,00I.00 to $ [0,000.00 $72.50 for the first $5,000.00 and $1.52 for each
additional $] 00.00 or fraction Thereof, to and
Commercial Back Flow Prevention Device 46.40 indudin? $10 000.00.
Residential Backflow Prevention Device $10,001.00 to $25,000.00 $148.50 for the first $ [0,000.00 and $1.54 for
minimum termit fcc $36.25 27.55 each additional $100.00 or fraction thereof, to
Rain Drain, single family dwelling 65.25 and includin: $25,000.00.
$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
s • cull .. ucsted ins.ections -ter hour 72.50
and includin. $50,000.00.
Subtotal: 111111 _11.II $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: _
fixtures? Ifs es" avie i ' 4 "' '' a' l i p ' A � 6 "9 '
Are you capping, adding or replacing
please indicate work performed by fixture. Failure to Plan e e c h e c is required
th ap for any of the following.
Please c all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
?„ }' '' ' ' ' ,bbl j.t j , r, I greater, except systems designed and
,,,r “.,)_ yea • . - t , . - "�.. a gi stamped by licensed
A � : . ;; ..ilia 1 ..._ r I-
„' a.tj engineer.
Ba.tis . (F ont ` = = ❑ Any new exterior plumbing site utilities.
Bath Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
Jacuzzi / S tl loo! =��� ❑ Any multipurpose fire sprinkler system.
Car Wash Each Stall ❑ Any complex structure as defined in OAR918- 780 -0041.
-Drive Thru
s shwa titer -Co for
Di Submit 2 sets of plans with any of the above.
Dishwasher or/Water
- Do ��
r - r
-Domestic 1 01re tK nx Yk9 qi :
Drinkin_ Fountain
❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" =i� that meet the ualifications above.
Car Wash Drain = = = Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial MEM
-Industrial
lee Mach./Refri:. Drains
Oil Se.arator Gas Station Min
Rec. Vehicle Dum. Station EMI
Shower Sho
Shower _GGa g
-Stall Gan � *Note: If the fixture work under this permit results in an
Sink Baz/Lavatory increase of sewer EDtJs, a sewer permit will be issued and
Bradley fees assessed for the sewer increase must be paid before the
- Commercial Mill plumbing permit can be issued.
-Service = ~_�
im Clothes
Filter
Washer
Washer r - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures: .1111.111111.111
l auildinePumitiPW- PennItApp.doc 09122/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Pi-N a I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 hoo lfilltwip
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6 Ali/( TIME: PAGE:
SITE ADDRESS: 3C S 5„J I yl ru AVL, CLASS OF WORK: //I-'
SUBDIVISION: LOT #: TYPE OF USE: So'i
PROJECT NAME: ,K r4 /°►¢T z6&2 5F
DESCRIPTION: l nck 3 EA./ AT kit. S La_ v.
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6 .4/o Pour Time:
Code # Inspection Description Confirm # Contact # Message Oo.i y A 7. _
iscp- 0
3 3 U tAi 5LaJ L-
Corrections /Comments /Instructions:
( r (.,q Sew 1a f 8 4/oo / 4574 /0 ij C4'-&- ee.rsc 4
71/%-e- ms i . ? Sw1 t 15 Sit i j' 4..,. , c„
714 s ° t -s 6-4 4/ c'fsC
`s ,rte -
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: Date: G i ltj / 9 Phone #: (503) 718-