Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00348
DATE ISSUED: 7/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111 BA 00901
SITE ADDRESS: 14270 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 025 JURISDICTION: TIG
Project Description: Replace 100' of water service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SHELLY SMITH
14270 SW 100TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 7/17/2006 $72.50
[TAX] 8% State Surcha 7/17/2006 $5.80
Phone : 503- 670 -1825 Total $78.30
Contractor:
OREGON PLUMBING WORKS
PO BOX 217
NEWBERG, OR 97132 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -538 -9911
Reg #: LIC 147008
PLM 36 -90PB
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 -01 . You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
7 1N-3
Issued By: -72-774 ¶ L( J1 Permittee Signatur
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.
Building Fixtures
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Plumbing Permit Applica ',, �� soli OFFICE usr ONLY
Received
City of Tigard Permit No
Ili
v 13125 SW Hall Blvd., Tigard, OR 97223 Date/By 1 D " �` - dad d---o, � 3��
o 1 1 2 Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1961 ,Date/By:
TI G A R D Inspection Line: 503.639.4175 . ja Ready/By: i°ns {..., ® See Page 2 for
Internet: www.tigard- or.gov 110 _ Akai ed/Method: `V Supplemental Information
TYPE OF WO • : i • _ FEE* SCHEDULE ' .
El New construction a .� . Dem'ol ition For special information use checklist.
�� Description I Qty. I Ea. I Total
Addition /alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
e_ • CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20
- _
and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
, JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / y O S 1 0071 Ave. Catch basin or area drain 16.60
City /State /ZIP: ,- q t , ; ,,� n c _, q i 2_y Drywell, leach line, or trench drain 16.60
J t Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: I Project name:
Manufactured home utilities 110.00
Cross street /directions to job site: (ma ci t...dam... Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: /bo) I Page 2 55.0c)
Fixture or item
Tax map /parcel no.:
_ Absorption valve 16.60
DESCRIPTION W WORK Back flow preventer Page 2
() 14TH +- Sa.. - » « /2.1 6%- K ,.....r Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
-❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
\ ` , \� Ejectors/sump 16.60
Name: 1r� �/ �/` �1 S % . `� Expansion tank 16.60
Address: 7 Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) 0 -" / 7. Fax: ( ) Garbage disposal 16.60
[ -�y v Hose bib 16.60
APPLICANT ❑ CONTACT PERSON -
Ice maker 16.60
Business name: 0 12.1= c1 cry,. P4..&1,. i 0 Interceptor /grease trap 16.60
Contact name: Ck y ■ ' ' Medical gas (value: $ ) Page 2
Address: Po ` 60y Zt Primer 16.60
City /State /ZIP: iru-a.-., V c `^ 9'] (3-z- Roof drain (commercial) 16.60
l ` r Sink/basin/lavatory 16.60
Phone: (So3 ) 533 -11 1/ Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR,: Water closet 16.60
Business name: b r h, _ P L ` W 0 .,.. 1 ,..„ Water heater 16.60
r Address: (o z %- Other:
City /State /ZIP: A . a - . 91 / 3 _
S iir. o - o
..Q.
Minimum permit fe • $72.50
^� Phone: ( r j 03 )S 3TJ -.1 --
Fax: ( ) Residential backflow minimum permit fee: $3625
CCB Lic.: /,41 00 ft / ' lumbing ic. no.: 3/ . ?,c) P$ Plan review (25% of permit fee)
Authorized signa State surcharge (8% of permit fee) ...4-.425
TOTAL PERMIT FEE , b _
Print name: <" -6 Q 1 r J Date: e- . 1 7. 0 4 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.
I:\ Building \Permits\PLMF- PermitApp.doc 04/06/06 440-4616T(I 0 /02/COM/WEB)
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information ' .
Fee Sch edule: Residential Fire Suppression Systems:
Site 'LA , -- ' . " " Qty Fee (en) Total' Square.Footage:. - , Permit Fee
Footing drain - 1 s, 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
Water Service - 1st 100' 55.00 Medical Gas Systems: •
Water Service - each additional 100' 46.40 •
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:' : , , .
$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 ", i W , : Q6.. 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 Back flow 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000,00 and $1.20 for
each additional $100.00 or fraction thereof.
Fi 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 El 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 _ ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
4» W .
Car Wash Drain Isometric or Riser Diagram. -
Garbage - Domestic ❑ Isometric or riser 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.
i:\ Building \Permits\PLM- PennitApp.doc 07/06/05
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~~~~"~~~�""°~° ~~.°"~°.~~o� ,, PER[N
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/1712006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639'4175 ...,..._44- « �-...
INSPECTION WORKSHEET FOR 'DA7E: 7/18/2006 TIME: 7:O3AN PAGE: 38
SITE ADDRESS: 14270 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 025 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Replace 100' of water service.
OWNER: BK4|TM.SMELLY PHONE #: 503
CONTRACTOR: OREGON PLUMBING WORKS PHONE #: 503-538'9911
. Inspection Request Scheduled For: Date: 7718K2006 Pour Time:
Code # Inspection Description Confirm # Contact . Message
330 Water service 03325O 12 N
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V,,,..pASS •
ri PARTIAL APPROVAL 0CANCEL 0 NO ACCESS
I I FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
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1 ' � � |Inspector: Date: / 1 ^ Phone #: (503) 718- ./`.