Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00092
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/24/2011
Parcel: 2S102CB00900
Jurisdiction: Tigard
Site address: 13070 SW GRANT AVE
Project: GARGER Subdivision: Lot: 0
Project Description: Repipe water and waste for interior bathroom. Separate job from PLM2011 -00026 per contractor.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: GARGER, JERRY E
P.O. BOX 2830 13070 SW GRANT AVE
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 235 -8784 PHONE:
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
2 ea Water Piping /DWV 03/24/2011 $112.58
Specifics: 1 12% State Surcharge - 03/24/2011 $13.51
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $126.09
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 N. • ation Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -01 0090. You may obtain a copy of the rules
or dire' questions to OUN . . in. 503.232.1987 or 1.800.332.2344.
Iss ed By: Permitt Signature:
��1� :� A i ;� "il - -
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
MAR 15:26 RRS /JackHouk /RescueRooter (FAX)503 491 2932 P. 001 /003
Plumbing Permit Application .
Building Fixtures
FOR OFFICE USE ONLY
City of Tigard ReeaiKd r Nalt9 //- ).,
t
II 13125 SW Hall Dtvil .,'I'igard, OR 97223
DatclB : ! �n Permit No.: [- 0 r
- A , . Phone: 503. 639.4171 Fax: 503.598.1960 Plan gam
TIGARD
inspection Line: 5036394175
DatcB : RLherPermitNo.:
Internet: www tiglird -0r gov
Non Date RearyMy: M See PNis 2 for
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New construction _ ❑ Demolition Forspeciaf information use checklist
i
Addition/alteration/replacement t cemcn 0 Other: Deseri.tion I . Ea. Total
: tcrt
,� ,i �4' +t:t ltu ai / r cane' Irr +, :Ir s„ s'aO New 1- 2- family dwellings (includes 100 for *1 'A + 4U it n l , , 1 � { l,1 4 t 1 r, t N I -t � , • +,w .er' » {I ( fI. Or each utility connection)
1 t*Ili sr t i ' ∎?`CR"hbl °� ^ RaL.tw �BIQy l{� *,,i ry q _ � h1 , I; ,tl + 1{ s i �,.,
a i n ,ludt,wi II Y•,,,er, r .1 xi N ; . ax ,, > • 4 . 1" WW. .,4 ;Arh E t � /11.44 /OS 1, aa't utAt ,,� SFR (I) bath 312 "70 MN
k1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
Accessory building (] Multi - family SFR (3) bath 500.32
Master builder Each additional bath/kitchen 25"02
�] Other
1 p'tt '"tK�� t cc;aNro antrallyl lelat, x, �C tq wwti 1f r , , t � ny w r Firc sprinkler (,_ sq. ft.) Page 2
�����pyq y t t 11 t I p t' `d# Cop fit,( {1L`[p s�' l +h o nl�.ti )��,. 11 '1'tin"t ,s, i
W,4 }1.+1U1i {ilslLl U, ,. illy 1 VMi �, (k.iwa (,7i'+1'!l,Lw�^f't r f•A' �r�a X1 �• I h I' (14� , ,tS r trill .Site atilt ties:
h l f ,ne$ sY I t ,!W,t!✓X.,,,,e
.lob site address: f. i ' 77 Catch basin or area drain 18.76
City /State/ZIP• Al t� F Urywcll, leach lint, or trench drain 18.76
' Footing drain (no. linear ft.: ) Page 2 NMI
Suile/bldg. /apt. no.: Project name; 4 , w /.�_ d Manufactured home utilities
50.03
Cross street/directions to job site: Manholes
18.76
Rain drain connector 18.76
i Sanitary sewer (no. linear iL: 49%4 ' , 15 1 X,/ � �
Storm sewer (no. linear ft.; )��'
Water service (no. linear ft.: J ~i, rj i
^ subdivision: Lot no.: Fixture or item: p - �� �
�
Ti x map/parcel no
t, Backflow prevent= �j�N`S +1 I d`tpK^"Irrr , +t � w YI±11 ;yti :a� ! .V Ar r F r
I":I+)1,0, t! lit i , U�1 % lire (til w'�l O •'�� i� 1",i ro l li. + " 1 "I 1 , , {', , Syl 4- Backwater valve
,wl .r 4 q .. -Iw��l �i ,ry .f..w11, �yV ).d„tr I.t., r� .i l WINE. r �}'�,- Clothes mom, I :/A L+ +d v / / "r'����/Al/LsV 25.02
Disltwlztiher _ 25.02
Drinking fountain 25.02
Iy 'd�Pi'1d! 11 }�•d p a cltl � 1)II +t71C • tv+11 I ul r, `Ejeetors/slntl
„ r s ,w 4 „ t: 1 ' { ! r A 4 L P 25.02
C� Imo�„ �y .t W,� yy r t I 1 � r7 a 11, �1 s r Ir t >, , p
.drttlt ..1 hl0„...44 ;+,e?:, s. to 41.".1 M1l ,mat l .' 1 .. , ,' : :, i ntlr " .h' t ilif- °IIX � �..4.441,0•1,t1:', .f wl` wh tt «i t� Expansion tank 12.51 •
Name: w/ 4116 > ,!.� ,� Fixture/scwer cup , 25.02
Address: a74. . dice''4 d Floor drain/floor sink/hub r 25.02
City/State/ZIP: �ti✓ �1 .A� 6esposaV 25.02 MIM
Phone: ( �� � " - Hose bib 25.OZ NMI
p sss��� r ty ��� lee maker _�
; 1 1 I 1 �j i�tf M'06I 1 d I ii , I � �1r I 7 {S(� rs °P i «1 ,7Ut L Rn v V t r+,IM : a1 nf?
1 ,1 twd. irfao7. isu tlfnAr,, TItr v. a.+ `�'u:i '�1i w'',10,;u .0. :t 'Iv.1;� + 4.g; ;q 4,. ,W 1 interceptor /grease trap 25.02
Business name: ARS dha JACK nOWK/RESCDE ROOTER _Medical gas (value: $ ) Page 2
Contact name: JOYCE DENNIS _Primer 12.51
-
Address: P.O. BOX 2838 Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02
City /State/ZiP: CLACKAMAS, OR 97015 Solar units (potable water) 62.54
Phone: (503) 850 -3100 Fax: : (503) 491 -2932 Tub /shower /shower pan 12.51
E-mail: JDENNTS(DAILS COM Urinal 25.02
} 11 l(( l,jT�iNw !11ft1f tl lti tlI i "1 t ts,lb! `l i t ``i lyrut �fyy y a+ ) a' C t IU D,,, F 1 ,p + , ,« I ,r ry { r w r `• Water closet 25.02
tfii +l• {, w',w�'sndnS,l'rwiu.�ltc, 1 { 4 j `4 c;' 1.11(1 Ir l. I +l i r s . , 1 , 1 „ 1` }}
+w,0,4 , ,..I ,o fl 1 I JP, L S,4.4. c.a ∎or,t. , „.:;,,, , 1 d t 1: at ,;;,4 Water heater . FAME 37.52 Er
Business name: ARS dba JACK 11 0WK/RESCUE ROOTER
Water piping/DW V 56.29
Addra: P.O. BOX 2830
Other: ■
25.02
Ciry /State/ iP: CLACKAi�(AS. OR 97015 _ Subtotal ■ r ∎ im
Phone: (503) 850-3100 Fax: (503) 491 -2932 Minimum permit fee: $72.50 ( �
CCB Lie.: 127325 Plumbing Lie. no.: 34 -168PB Plan review (25% of permit tee) t 3
State surcharge (12% of fee) i�r�v:
Authorized signature: F ' _ �
TOTA4 PERMIT i gar Ijii/l
Print name: JOYCE DENNIS Dutca / This penult apprication expires if a permit is am:mai.ed wit rin '0 days ( after It his been accepted ns cmapt i
-F � //yj��,� - ,522r.., y+(C 'Fee methodology set by Tri.Cottnty Building Industry Service Bo. . D
t 1HullslintaermitsUPL IU NrritApp I nit ii..0't't)0(0 1,4, . � `�' / a'�
� :_y)
MAR- 23- 2011(WED) 15:26 RR5 /JackHouk /RescueRooter (FRX)503 491 2932 P. 002/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
I�''i �q('g��, ",!��'vemr i r+ l , 1 +�+� r ' � „ , � Residential Fire Su � � ressaon S stems: i''�Il i �� l.0 adi.'L "Yd4 (�r, ,. � " : , P { � 11ri( Q, w�.l�G�,tl e t'� 1' 1 � "(� of •,� q , .,,,�.,� a� �, . ' L� +'" f t' iT y �, n.wr,,rt w, � + �. t ,.,
r pme„ .nixl a l 1 in,lv(I;1a111b,1 li 7 I�f�.' „ F �'t l M 0 �y ' P"�,�,,, F �� 7222!; ) "'V'F"! , '1 14 °T'i
Footing drain - 1' 100' I.t ! 0, 50 03 1 l,.aW tr {ul :R L`.�l!l +tds 1ir'.i 1 , !11,.��Fa 1� . kwht!wf �� ..1 +w
$0.07 0 to 2.000 7 S w ,l ,i lrca I rkM i14 fG lit
S 12! .40
Footing drain - each additional 100' IMO 37.52 001 to 3,600 $169.69 _
1 � _ . �� rnA ` 7 601 to greater Sewer - 1st 100' i $233.20
Sewer - each additional 100' �� w 7,201 and grc $327.54
water Service - 1st 100' "..74— Mi/ /r,
Water Service - each additional 100' yjr-js;� MCd1Cal Gas S stems: ry
�' � 1V0 Vo c ++ "r tit , ii 1�, Cj m ... 1 i PY l 4I 7 JI , s t„, 11 .,., �,,w
�r `r9 'Ni •
Storm it Rain Drain - 1st 100' � ` ����r�ivu'l�,l„- „, ,,. , .� ��,1 :',i , ilyy;w •tl :..itt43
Storm Rain Dram each additional 100' $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
51.00 to 55,000.00 Minimum fee $72,50
d2
gg,r o r m +wRaintt+ Ic . ,. T „� 9 �
ttI. 4. ; � tl:J.h,! 4Wi t I j 1 1. Y ol ? ; 4 re �,11 i�. ' g1L1?,wil ''`4 each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or for and includin; $10.000.00.
which no fee is specifically indicated 90.00 /hr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and for
(minimum oh. • e- 1/2 hour) each additional $100.00 or fraction thereof. to
Inspections outside of normal business 90.00 /hr
and includin; the 250.
hours minimum elm • c -2 hour, S25,001.00 to $$0.000.00 5379.50 for the first $25,000.00 and $1.45 for
Keinspection Fees _ 90,00/hr each additional $100.00 or traction thereof, to
and includin_ $50,000.00.
Additional plan review for revisions i l 90.00/hr — $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum char - e- 1/2 hour _ each additional $100.00 or fraction thereof.
Subtotal: ttom; +►
Commercial Fixture Work:
Arc you capping, adding or replacing fixtures? If "yes”, ':+c" i n . r, m•-- ••'a��
lease indicate Y a r t tr; . w l r^ r
Irate performed fixture. Failure :',:;�ilil�nq r � ; ��.a9 ,ir.a � M � r��
�,� 'r",i'i �� "' zrlq li �' � • t' lt:,i
P work rformed by fi are to 1 the f following. 1� al l'x ,U1,:;...117.:.;. „s
Plan review is required for any of te fllo
accurate! re, . rt fixtures could result in increased sewer fees * . Please check all that apply.
N 1iS I p 1 t p r� ` c 10 a i axliirt � Q Fisd ... r'-I 1ri:a rxt 1
,,,'11% 1 .tt �+ �...�:,�;.;�, ❑ Any new commercial building with wetter service 2" and
l '' ' � ,f f i r t t
1 ry I U '��' X 1 1 �e 1 r ' l N n '' ' n i di1 , i �' ', 1 1 1r 9, , 7 eater, except systems "� . L t, t`„ii3O,4 '+ soniv e Cep Y s dc3igned and stamped by licensed °1 engineer.
Bath - Tub/Sluxwer ❑ New exterior plumbing site utilities for any complex structure
-Jueurz we r�xool as defined in OAR918- 780- 0040.
Car Wash -Each Stall ❑ Med gas and vacuum systems for health care facilities.
-Drive Thrtt ❑ Any multip urpose fire sprinkler system.
Cuspidor /Water Aspirator CI Any complex structure as defined in OAR918-780 -0040,
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinkin_ Fountain
111 Eye W p
tuh
2 I�''! 'S t11 +,1�1"{ Ik' l 1 S T " q�rq 'I+ ���rl� J iy n il, ,"` A ' i i 77! n ∎v 1 • � ti ro
Floor Drain/sink 1, „:4i:,'44,.ri.., .r. , ..L ;.,'.1......4.7, � ae..4.,_ .+-e.. .,u,tl�„W;
• isometric or riser diagram is required for new buildings
-4~ - — _ that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
-Industrial Comments regarding fixture work:
ice Mach. /Refrg, Drains
—
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang -
-Stall
Sink - Bar/Lavatory -
- Bradley
- fixture work under this permit results in an
-Service - Commercial rvice
* Note: if the fi
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Clout - Toilet
-
Urinal �IMMIM
Other Fixtures;
Intp://www.tigard-or.gov/cily ha Wdeportmcnts /cd/docs/PLMF- PermitAnd oc