Permit CITY 1'IGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00067
l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/6/2006
PARCEL: 25111 BD -00411
SITE ADDRESS: 14965 SW 96TH AVE ZONING: R -3.5
SUBDIVISION: DARMEL NO. 3 LOT: 031 JURISDICTION: TIG
Project Description: Sewer connection.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KIMBERLY ZENZANO Description Date Amount
14965 SW 96TH
TIGARD, OR 97224 [PLUMB] Permit Fee 2/6/2006 $72.50
[TAX] 8% State Surcharl 2/6/2006 $5.80
Phone : 503 684 - 9057 Total $78.30
Contractor:
ARTS EXCAVATION LLC
6580 SE HAZEL AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97206
Contact # : FAX 503- 230 -1730
PRI 503- 473 -1800
Reg #: LIC 156488
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 les are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or dir•ct que 'ens to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
/ - --
Issued By: 7 Permittee Signature: r, -----
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.
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Building Fixtures ® ,j
Plumbing Permit• 1 . 01 1 - non FOR OFFICE USE ONLY
City of Tigard 0 6 2006 Receive _z2( _ � (..----) Permit No.' O o d�q
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13125 SW Hall Blvd., Tigard, OR 9722 Plan Re d �-•[ `�
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 yrr }� %.*1. • Permit
24- Hour Inspection Line: 503.639.41p 11V �' i"i l i I � D aze /B y.
OF - j � � 1 . _ _,� Date Ready/By: s: ® See Page 2 for
Internet. www.ci.tigard.or.us �� 1 - � Notified/Method: Supplemental Information
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WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
• 1- and 2- family dwelling ❑Commercial /industrial SFR (2) bath 350.00
Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
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Job site address: , Ct S ({� �,IJ 9c, '' Catch basin or area drain 16.60
City /State/ZIP: ) l C (.0 � Drywell, leach line, or trench drain 16.60
' C�t. /
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
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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 Backflow preventer Page 2
_ce /,r .4" _..-- to 01,1 4 (i / A_ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
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Ejectors/sump 16.60
Name: t r\'\' 2 �yt 2-0._ r ( Expansion tank 16.60
Address: 1. In./ Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub • 16.60
Phone: ( ) Fax: ( ) Garbage disposal • 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
L Ice maker 16.60
� Business name: / 4-s Q C _ (^ [) C.- t ci-----` Interceptor /grease trap 16.60 •
Contact name: /a--� (..4f- cc-e, h Medical gas (value: $ ) Page 2
Address: 2306,0 j= '�c.,_ / / L ,Q k Primer 16.60
City /State /ZIP: LN / 4 y4/7"--640 G-1 f 7D/ ( Roof drain (commercial) 16.60
. Phone: (c�) 136 i 7 )0 I Fax: : ( ) Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: • Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP:
Subto
Minimum permit fee: 72„$.V �� ,{j1
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 11
CCB Lic.: / Sy 4(8- ff Plumbing Lic. no.: 3 - 0'( Qf Plan review (25% of permit fee)
State surcharge (8 %ofpermit fee) efs- „
Authorized signature:
TOTAL PERMIT FEE 7Y.- 3
V ) t/
Print name: /. t SL t ( . , __ Date: Z - - 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.
is \Building\ Permits\ PLMF - PermitApp.doc 06/05 440-4616T(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' 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
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Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00
$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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
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Fixture Work: Plan Review for Complex Structures
• Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees - Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash CI Any NFPA I 3-D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or ri diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall •
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in-an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal - fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
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FROM : FAX NO. : Feb. 09 2005 09: 24AM P1
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...Molalla, OR 97038 DATE
(503) 829-7600 -/
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1 CCB# 158543 DEQ# 38346
Complete System Instaketio
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TERMS: Net 10 Days. A service charge of 14 (18% per annum), $2.00 minimum will be applied to past due accounts.
PLEASE DETACH AND RETURN WITHYOUR REMITTANCE $ r7-
DATE • CHARGES AND CREDITS .DALANCE
BALANCE FORWARD 11 0
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CITY OF TIGARD
BUILDING DIVISION • PERMIT #: PLMM2006- 000$;7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2160006
Phone: (503) 639 -4171 /Omml%b upr ,I
Inspection Requests (24 Hrs.): (503) 639 -4175 ' !
INSPECTION WORKSHEET FOR DATE: 2/7 /2006 TIME: 7 :02AM PAGE: i}'
SITE ADDRESS: 14865 SW 96TH AVE CLASS OF WORK:
SUBDIVISION: DARNEL NO. 3 LOT #: 03 TYPE OF USE:
PROJECT NAME: ZENZANO
DESCRIPTION: Sewer connection.
OWNER: ZEWLANO, KIMBERLY PHONE #: 503-684-90 Ea
CONTRACTOR: ARTS EXCAVATION L.LC. PHONE #: 503.473-1800
Inspection Request Scheduled For: Date: 2/7/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 S: nitaly WW1 026413 -01 503 - 4731800 Y
Corrections/Comments/Instructions:
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PASS % PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: rinj Date: / . Phone #: (503) 718-