Permit CITY OF TIGARD PLUMBING PERMIT
* COMMUNITY DEVELOPMENT Permit #: PLM2009 -00113
T [ Ga A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/08/2009
Parcel: 2S110AB02900
Jurisdiction: Tigard
Site address: 14335 SW 114TH AVE
Subdivision: COLE'S ACRES Lot: 14
Project: Mirich
Project Description: Replace up to 500 feet of water service.
Owner: FEES
MIRICH, MARCI D Quantity Description Date Amount
14335 SW 114TH AVE
TIGARD, OR 97224 500 If Water Service 05/08/2009 $240.60
PHONE: 1 12% State Surcharge - 05/08/2009 $28.87
Plumbing
Contractor:
AMERICAN PLUMBING SERVICES INC
5905 N INTERSTATE AVE
PORTLAND, OR 97217
PHONE: 503 - 289 -6498
FAX: 503- 247 -2429
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $269.47
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: iJV /1 r t V` � p _ 1\ 1 � Permittee Signature: App 1' Oa/ � Call al 503.63 by 7:00 a.m. for an inspection that business day.
JUL V1
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 07 09 01:53p p.1
• , • • '
P ,_ e e _^ umbing Permit Application �� �%
5 FOR OFFICE USE ONLI'
City of Tigard �/1� Received
13125 SW Hall Blvd., Tigard, OR 97223 • C�.•(l Da te/6 : S • ' 09 LA Permit No. 2O0Ct 001 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Ti G A R D Inspection Line: 501639.4175
Date/By: Other Permit No.:
Internet: www. tigard e r.gov
Date Rcady/Ry: �' ""Fr"Ya�"� s } Notified/method!
' SerePage
- 'ros`'.e q ?, '' .. ' ' i ' ' �/ 4 K� '��` _ Mfr
* 40.410a .•..,w. 1I mati
,-- Suppkmenta nfur o0
.S .4.5.E s ���� ^�3.� J]:'rr -1,. t 71 tt Lt J {k. '��` A
construction m(j4 , u t,�» , ('
❑ New
❑Demolition Description For special information use checklist 10 Other. I Qty. Ea. Total
l , New 1- 2- family dwellings (includes 100 ft for each utility connection)
J 1 and 2-family dwelling SFR (1) bath 249.20
❑ Conunercial /industrial SFR (2) bath
350.00
El Accessory building ❑ Multi- family SFR (3) bath
399.00
0 Master builder 0 Other Each additional bath/kitchen 45.00
ry(3 . Ah1�1 . t6, Fire sprinkler ( sq. ft.) Page 2
¢ ��V i =" site utilities
Job site address;
1 443 35 ` Catch basin or area drain
City/Statc/ZIP: 77 try oQ 9 7 a a tl 16.60
G i = f Dtywell, leach line, or trench drain 16.60
Suite/bldg./apt, no.: l linear ft.: Project name: � )� Footing drain (net. �� P e 2
Q YG r Y f di
Cross street/directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 1660
Sanitary sewer (no, linear ft.: ) Page 2
Storm sewer (no. linear ft.: ___) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.:
Page?
Tax map/Parcel A Fixture or item
xf 1' hr �ps}j�WI y + a Absorption valve
�•.. a... Y. Y.. 1' 3 A !*• - _ age 2
' � Backflow preventer
,_Gonl 6- te a kr .5 ;cc 3 Xe1�1• o� Paget
t {-tom L r
WC D = YIO(/� Backwater valve 16.60
1 h eS Clothes washer
16.60
[ Dishwasher
f �� 1V it`' -� ; k PF 'L`NA1V E jectors/sump 16.60
Name:
.xK , r4 r�] Drinking fountain 16E jectors/sump 16.60
Address: Expansion tank 16.60
City /ZIP: Fixture/sewer cap 16.60
Floor drain/floor sink/hub I 16.60
Phone: ( ) j Fax: ( ) Garbage disposal
Jr."" z -, i s �D"" t c� ,� bib 16.60
16.60
'' Hose k
r ;
Business name:
Ice maker 16.60 •
Contact name: Interceptor /grease trap 16.60
Address: Medical gas (value: S ) Page 2
Primer 16.60
City/State /ZIP:
Roof drain (commercial) 16.60
Phone: ( ) f Fax: : ( ) Sink/basin/lavatory 16.60
E -mail: Tub/shower /shower pan 16.60
; „ ,: ` .. `,•-., D)± 2A QR ; �. r.y�
Drina/ 16.60
. :• .16,: r r.., �{ rY'YY�` t m s { �' v
"` `Z 4 $ water closet
Business name: American Plumbing Services LP 16.60
Water heater 16.60
Address: 5905 N Interstate Ave
Other:
City/State/ZIP: Portland, OR 97217 t
Subtotal
Phone: (503) 289-66498 Fax: (503) 247 -2429 Minimum permit fee: $72.50
i CC13 Lie,: 151062 Residential backftow minimum permit fee: 536.25 aW/ - go
Plumbing Lic. no.: 26 567pB Plan review (25% of permit fee)
Authorized signature: . / p . �ij 7 State surcharge ,(84 of Permit
/.l� Je° FEE
„ ,� - TOTAL PERMIT FEE 4p, 7a
Print name.
s Date: This permit application expires if a
180 days after it has been accepted as complete. within
*Fee methodology set by Tri-County Building Industry Service Board.
iliBuddieswermicort \t_PermilApp.dee 06/26
440 . 4 616T(10/02/COM/ WiB)
May 05 09 02:22p p g
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire
' Site° itl ltY ... , t: K •atat 4 �w, sk Sly ression S sterns:
Footing drain - 1" 100'
xy, t p0. et: "u tt`�
55.00 0 to 2.000 •e_ `' , :te.:,,:xs4
Footing drain - each additional 100' $l 15.00
46.40 2,001 to 3,600 $160.00 ' —
Sewer - 1st 100' 55 3,601 to 7,200 5220.00 .00 I Sewer - each additional 100' 46.40 7 201 and Rreatgreater 83d9 00
Water Service - 1st 100' 55.00
SS. °O Medical Gas Systems:
Water Service -each additional 100'
q 46.40 n�
•
Storm & Rain Drain -1st 100' av yd . 4 r :-
55.00 � y s �.1P�e��at��,.
Storm & Rain Drain - each additional 100' ' 46.40 $1.00 to $5,000.00 Minimum fee 572.50
u ti $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each • :Fixture mr te>cn • st ; t, �S 4 -Wee ea pq m additionat SI or fraction thereof, to and
Commercial Back Flow Prevention Device 46.40 including 51 0,000,00,
Residential 13ack(law Prevention Device $10.001.00 to $25,000.00 $148.50 for the first 510,000.00 and S1.54 for
(minimum permit fee $36_25) 2755 each additional $100.00 or fraction thereof, to
Rain Drain, single family dwelling - and including $25000.00.
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 addit
each aional $100.00 or fraction thereof, to
specialty requested inspections - per hour 72,50 and ddit in y e S50,o00.00.
Subtotal: 550,001.00 and up $742.00 for the rust $50,000.00 and $1.20 far
each additional $100.00 or fraction thereof.
Fixture Work: r
Are you capping, adding or replacing fixtures? If " es" -P '. ^4. of following.
" F ' - ' R -`
"yes", P lan 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
tWr x�'° 4 aSx xa�. v V *tiara f: fat ' iiilCPetd"ur'iiened greater, except systems designed and stamped by licensed
' i �°p t engineer. • _. . .Prec,d,g� - pp . :1.- , ll yf4 q. - "
Baptistry/Font
Bath - Tub/Shower
= ❑ Any new exterior plumbing site utilities.
❑ Medical gas and vacuum systems for health care facilities.
•Jacuai/Whiripool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR9l8- 780.0040,
- Drive Thru
Cuspidor/Water Aspirator Submit a sets of plans with any of the above.
Dishwasher - Commercial
- Domestic I '
Drinking Fountain ,. ∎ ;, , O tl4.'ix�w.t: l 1 l . X T~ ---1
❑ Isometric or r iser dia t
Eye Wash
g1'am is required for new buildings
Floor Drain/sink - 2° that meet the • ualiftcations above.
4 " Comments regarding fixture work:
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial i
lee Mach/Refrig. Drains 11
Oil Separator (_(3as Station) I
Rec. Vehicle Dump Station 1
Shower -Gang
Stall *Note: If the fixture work under this permit results in an
Sink Stall vatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must he paid before the
Commercial plumbing permit can be issued-
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
-
Urinal -
Other Fixtures: �
BBuiIdina'We ran itOPLM-P emit App.doc 09/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ' -00)13
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 w�d�lhu�tit���
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: j w °i TIME: PAGE:
SITE ADDRESS: 1 4 i 3 5 Stn! 1 I `'( CLASS OF WORK: .Ayr
SUBDIVISION: LOT #: TYPE OF USE: 51 -7-- PROJECT NAME: ,rc1 -I
DESCRIPTION: g igLAi4. 5-001 wATr; -r 5friz v et.
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: C/9 tI %L17 Pour Time:
Code # Inspection Description Confirm # Contact # Message %0 L) 2 7_ o
30 wok z_ 5h.v ''I 69 ti
Corrections /Comments /Instructions:
') d1ew t,.,,g`, 16e_ o-4. e. t,T 14.E 4J -fieIst,"e
/k,.0 A - 7-W j C,n -Ge !„f /7 7t 4- ( -5 off' �✓�
o e c. 4 Se/v 1 f Iletritre.i t15 t
PASS n PARTIAL APPROVAL CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR' INSPECTION 1 ADDITIONAL FEES ASSESSED
Inspector: / q-- Date: 4 ,Vet /Df Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: pi-A/ _ 001, 13
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/ 19/1 TIME: PAGE:
SITE ADDRESS:H 336 SW 119 AVE CLASS OF WORK: ,4
SUBDIVISION: LOT #: TYPE OF USE: 5 F
PROJECT NAME:fvu - n-x 6 "
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: a I evu Pour Time:
Code # Inspection Description Confirm # Contact # Message Oc)•ay z 7 — 6:3
Corrections /Comments/ Instructions:
A -OM W PO46 pr Vet X•4J a/UL -4 L (144.10 t
i‘ 41)trA4t.4 iTe 41/ oiltreo
9) 46)g_ _ /9kvaij - is ,'t eree g Al 4 tin g I /oai �Q•.� O
X10 v4)c s vIdvs/ t e,c,.P g7g rz s a r v►►c
445I f 41 T i tj
1 5 455
PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL I 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: //q /2f Phone #: (503) 718-