Permit CITY OF TIGARD PLUMBING PERMIT
131111,
' = COMMUNITY DEVELOPMENT Permit #: PLM2011 -00223
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
Parcel: 1S135CD00790
Jurisdiction: Tigard
Site address: 11520 SW 98TH AVE
Project: LAMM Subdivision: Lot:
Project Description: Replacing 50 ft. of sanitary sewer.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: LAMM, DEAN EDGAR & BEVERLY M
P.O. BOX 2830 3920 SW ALICE ST
CLACKAMAS, OR 97015 PORTLAND, OR 97219
PHONE: 503 - 235 -8784 PHONE:
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
50 If Sewer Service 07/15/2011 $62.54
Specifics: 1 12% State Surcharge - 07/15/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 07/15/2011 $9.96
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
•
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JUL- 13- 2011(WED) 15: 11 RR5 /JackHouk /RescueRooter (FRX)503 491 2932 P. 001 /003
PIumbing Permit Application ECE i'Ffl
Building Fixtures JUL 1 3 201 FOR OFFICE USE ONLY
14 - City of Tigard Received 2 /
n 1312$ $W Hall Blvd., Tigard, OR 97223 Nte/B : / j� Permit No.: p 41 a/
!'hone: 503.639,4171 Fax 503.598.196 �B pp TIGAi� �,Plen Review
��, _L_ u1 IU DIVIS! QrKe/B Other PcrmirNn,:
TIGARD
Inspection Line: 503 6394]7 V s3
ate Ready/By: J = • B See Pin Z for
i r y,�W Notified/Method:
WRW:egurd�lrg0
i "(r'lrry' 1{�l�'is311''it' � ' Y t + "Y i r f ;r1n^ ya�trr. X4 t4Yfr i y4s 1, ,, n n.. e s . ■ t� I r f iattmi dm
;V 11 ),,, Ir „ ,e .r5 1. t r.il +dr Y r� t{.S...1M1¢ 1 p.•,.S a r � f 11 udr. {{ .r!, 1S 1 ..pr,.,t t�l.!t'li.. e��,Si ,ftYC4 frr�i�n- ^rr•. „.t� M• �. ..z
(�ly,.,Pl, nJ1 ,1 .1 ( ..4 re r.. }. �,. �, .)K d ll�Y 11.� 4.4 �r� 1 r.. �V dCl,V 4 : k. .,e.,yr.sr lfrM r �.1., ,'I, �•r. 1� irsr �..l ,fir .•1,�• �., 1n,{ � r. i iW;.+f .. ,wr:� I t. rrr rS • t�m:m. ur
tra,a,ee.•. lL.!J }Mr S;�'d .�Lwl Rdify1. TSilC �l•..0 ��y�}.�qq ... t �,d�n t ,,A�lYinr•r1l {t n1S41111 ,1 .rj r.`! 1l, r7, Yr. rN1,.,r{i7L•k11.,?�,.}S.•rC•n.� 1,.1.rr 11 • .lp:1 r ,r...x ,rY•1r �r; �..�
�s a1frlAr�:Felx. rrwR ilY^!}. ri., lfl�wl..l,:> �. Idrl,, :w•�SrVt.,3�wluc,1P_�.e1S�wuA'� AtYq {1�h:��;�u}.... rr1Y ' �,i�i{ �I.W�SII�¢IMi M,' 1i1.. �> t✓` Y.{ ti� •'��{ #f11f�4i��i�:"5��7�i4����i �i" ' Q t �b� ' Gi� '^ ���}. K •�• r �4�Ji r t�i � rw1.�1 +k�Y t�f�ln {��N��� +'.
❑ New construction 0 Demolition For special information use checklist.
Addition /alter ttioi>/replaccment Descri tion 4•A . Ea. Total
❑ Other: New I- 2-family
rN�; } r rlGv ry� rlf} p,� „�•,,y} �'�� y] pQ dtvellinss (includes 100 8. for each uLili connection)
S;1bt:Y,
� 1 i 77: tt, l lit kJ� t t n^l A ?! 't YY 6 .kw i `:at11�4'r8,}uP , .'p �eW I tN (l i i 1GVV,11 4,id1TI i iyIfr :i�. ri S!'•R� b
u , a1. y r, r4 ( u1 Y. �trdrt,.`a 1iF h t4 late Jrt1W la'�hJwr 312.70
41 - - ily . w r g ❑ Commercial/industrial 5PR (2) bath
437.78
0 Accessory building [] Multi - family SHR (3) bath 500.32
❑ Master builder 0 Other: Each additional balls /kitchen Page 2
MI ihm 4 ,a K 4 7 , r i�ySJ , i r Fire sprinkler ( sq. ft.) PA e 2
u ywJr a la•S.a!sf ! li a t f} / {i "itr a r a r �a S �,,. Zt 'u M I �,1t'i;1�ar 1 V �1 "1't FS g
1Y ��� i!i "i" SY) �,1 ��l � w.. �"��� at ?�1 ��ai� ^Jm'�J,��draa''i1v���5 At�Urt�z (> Site lliilitica:
Job site address: l /r ', 4 ,. r Y igliMMIIM Catch basin or area drain 18.76
• �l r 6972,20 Drywall, leach line, or trench drain 1836 ME
Suite /bld ./a L no.: p ro J �/'T�
Manufactured home utilities Footing drain (no, linear ft: ) Page 2
B p cct name:
50.03 I.
Cross street/directions to job site: Manholes
18.76
Rain drain connector iR.76
Sanitary sewer (no. linear 11.: ;e 2 G ".r 4,
Storm sewer (no. linear It: ) Page 2
m
Water service (no. linear Ii.: _ NM Page 2
Subdivision: + Lot no.: Fixture or Item:
Tax map /parcel no Backflow preventer M�
,J 1 t" 1 t l h k ti:' w;141 w r. s ro a +r rt ti 12.51
q!• I CSINN E .J '1r qt4 P A �t etd t p Vd i X1'1 Vt�i ed � ter 41R i t17Zk1y� 1S ' 1t i�J{1ter�Yf
la d.r?a a ,i�e�', ,,,,,,,,k1.d" Vr ,)t,r, P�C, P, r l 8( r ltd,, S
G, t.., �u., w. h�. rh�. rtr`« �ttas}` Su1Yy (1;1�,un� Backwater valve Clothes
'/ ./ r f` j/ a D washer 2.5,02
r 1 iShwashcr 25.02
` �� � J "IV Drinking fountain _ _ 25.02
.w 1 �� Ejectors /sump 25.02
u�,, Yer
� � 1r1t ^ r Ti►.I.� r .e � {� ! 1 4 a r �,� k `� ?St tSrlrx 1M j7 � � r 1.itA Y i ' IJ d ll ? 1� f�M� �Y'�.,nr� :..i p �^1 t t tl. ..�
t " L44,..��,,, Ltl . kJls 4 w r affia �' �` t~m.. 'r,4::4' r c." SAS Ili!�,0, ∎,' 14 i41, EXpnnsron tank 12.51
Name: �T' / ii r Fixture/sewer cap 25.02
Address: / ....,R, A/ rwiwr Floor drain /floor sink /hub 25.02
Lei Garbage d 25.02
City /State2TP: /r /j
Phone ( r 4" / w A Hose bib 22.51
"i maker � 12.51
r � Ice
i i {"�! }r�rr Nil' ro ql r'Y 1,111f� r 1 t fYmt�i r �rmt� 1 n r< ,r 1 rd^�al t c q IIM
Piv { ,,111 r�vr}4 M u1 "11 rklx4ia1.1i y ajakfa,fit, .1,~�a li oft n� i`q�tf1 y r' i Yr �� I m 4 lntereeptor /gnawtra
1 r 4 }r r r 41 wis ,t t vs 1 },14,, s, to s1t,..411 a ,.., i p ME 25 -
Business name: ARS dba JACK AOWK/RE$CUE ROOTER Medical gas (value: $ ) 111.1 Page 2
- IMMO
Contact name: JOYCE, DENNIS Primer
Address: P.O. BOX 2830 - Roof drain (commercial) 12 -51
Sink/basin /lavatory 25.02
City /State/ZIP: CLACKAMAS, OR 97015 Solar units (potable water) 62.54 M
Phone: (503) 850 -3100 Fax :: (503) 491 -2932 Tub /shower /shower pan 12.51
E-mail: JDENNTS@a ARS,COM Urinal
€i�i�t3' }r�hjl''�y,'�i�+ }ii( Sti11)n,p�a��� Y ' }t k >a��J�V� ti ` 4� q ~r, r 25.02
P!. 4 1 t rl' t a IC �r 1 rn� rfl + t 1 Niba�4t 1 �i 71 } 'frbJal� t" l ttl I4Y1� 1 { t��Ayl l y�rv? 11 Y r 1 , 4 i 1 V�"i�1n 0.�Sjjllr ,Ill }'((irJ>;ili -Wailer C
iii, 4{�ltrU�t,all l... „u �Mi� 1��i9r 1 �h�� {!Aarrk��t,�'l I1B14..0 d Gall.11W U:fa ar ,1. �' a�{ �1,; 1Iu�S1. ti�uUu��trYpjr�eYd�Sr ...,EJwaAl.�kl l {�iG)1E�r��ti�l� da er ilIQSet ea tCC 25.02
Business name: ARS dba JACK HOW /URESCUE ROOTER 37.52
RS
Water /' 56.29
Address: Y.O. BOX 2830 ..o, -
011 A e,,, a 25.02 = .
City/Slutc/ZIP: CLACKAMAS, OR 97015 AO' Subiutal Tr
Ph one: (503) 850 -3100 Min imum permit fee: $72.50 -
• � " CCE Lin.: 127325 ding Lie; no.: 34 -168PR 1 / I Plan review (25 % of permit Ice) ��
Authorized signature: )1/14(t) State surcharge (12% of permit fee) ; . -7
Dale -//- ,L,, TOTAL PERMIT FEE ,
Print name: JOYCE DENNIS //07 ,i
f This ptrn tn pp it
, ( eatlon expires If a permit is not ow/lined within rap days
alter tl has been accepted as compute.
12 6/ .(�Gy� �r(L],.+J� "Fee methodology set by'!'ri•County Building Industry Service Board.
M ulldinglPennitatl t,M1J- Pe d n ryI • 44O- 4,5,6,0Ola2 Ol n `�- 5
JUL - 13 - 2011 (WED) 15: RR5 /JackHouk /RescueRooter (FRX)503 491 2932 P. 002/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental information
Fee Schedule: Residential Fire Suppression S stems:
p p rX♦�r ��'� q tikn ',+�• { f"V , ;)1..,r.�tl�w�;11 "y�i�i 't� d� ' 1Fr"�jSkfl] l'pm�y�,:, ��y {;�tly��1 � a r 1 � �'� +pil4�Vi ,,,„ ... ,
. ,, , tip rw . .r,1 9 w.r r
x �1 { Mwlw 3��' TIRES L '. 1 � 4, r •1V t.ty S• L e w }1,��a, A� , A r 1 P W
»t1t r����4a �`�'dx'11J�4� '�'1A�M .111. Sa ,.r . " ,a �� IVAaS 174 Y" " , x 1..'} ,N Y4f OA i .til�1w .�Ghakti iN , o. I1 ai i'�}i
Footing drain - 1' 100' ME 50.03 , 0 to 2,000 $i21.90 EMI Footing drain - each additional 100' 37.32 11.11 2 001 to 3,600 $169.69
3,601 to 7,200 $233.20
SCWCr- 1st 100'
:V 6154 7.201 and greater $327.54 -
Sewer - each additional 100' 37.52
water Service - I Si 100' 62.54
Water Service -each additional 100 37.52 Medical Gas S stems: `
62.54 ri ii i tl 4` 1 "t`�'I l 1 ` , g591��
t"�'(f! ` ` "f w r a 1 10 y i wN t " ul , " y am; l � t t +tillti���Il�.t W i i.114 l .1 (
Storm St Ruin [Grain - 1st 100' S 11 � { ,1r 1, . + V , fir . 1u €�.0..! „,... 2,50 `;35; tk
$ 1.00 to $5,000,00 , Minimum fee $72,50
Storm & Itain Drain each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000 -00 and $1.52 for
g 1.'y4�tr� 0 f s Y. ari` �,� }C�j r �y,1 V � {�',, if llv ��' [ t •�t�_ yrf"y� r. 4 ir��
t r, nits iga, tt wct,Rl�w�� .r ».} �1ta 71 i1 "I, 1 , r', ,�1 each additional $100.00 or fraction thereof, to
Inspection of existing sting plumbing or for and including $10,000.00.
which no fee is icul[y indicated 90.00/hr I $10,00 L00 to $25,000.00 $148.50 for the first $10,000.00 and $7.54 for
(minimum charge -1/2 hour each additional $100.00 or fraction thereof, to
(mni Inspections outside of normal business 90.00/hr and including $25,000.00.
hours (minimum cha , e - hours) $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
ktcins ( mini s Fees 90A0 /hr each additional $100.00 or fraction thereof to
and includin_ $50 000 -00,
Additional plan review for revisions 90.00 /hr $50,001.00 and up $742.00 for the fast $50,000,00 and $1.20 for
minimum charge-1/2 hour
-�- � ) each additional $100.00 or fraction thereof.
'n w 7
Commercial Fixture Work:
Are you Capping, adding or replacing fixtures? If M v 1 n `'' X.,. t i �t 1i " tV {i. d + ,'Yet . yK.«rCC^!"!'r 16 kP t fMN1
p 1?. "yes", s liwti ,,yi lliztl fla ill t �• k I Q+l'-"r :� ..� IMIEit ,
please indicate work performed by fixture, Failure to Plan review is required for any of the following.
accurately re . ort fixtures could result in increased sewer fees`. Please check all that apply.
1; ,. OW; ` 1 4 V1 S. 't r t c"" ls" •°�°� �t`i+' ❑ Any new commercial building with water service 2" and
1 's ; 1, r i t� t. 1`t' t i t b ' I'''� " Al , 1 X 11" e a" i , i t .'. r ter, except systems designed and stamped by licensed li ,1
Ba fist /Fans MM.
engineer.
Math =fob /Shower � ❑ New exterior plumbing site utilities for any complex structure
,Iacutci /Whirl ool as defined in OAR918 -7801 -0040.
Car Wash - i:ach Stall � . ❑ Medical gas and vacuum systems for health care facilities.
-Drive Thru I ❑ Any multipurpose lire sprinkler system.
Cur. idor /Water As irator IIMMII MINN ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher - Commercial MEM
-Domestic �� Submit 2 sets of plans with any of the about
Rhin Drinkin• Fn tai n
E c Wash µ
��� l4tr i ,, , ,, or tilsr�rt�r�� u N mr j ot" xv^- n ,„ " +� l �ri"1 V
Floor Drain/sink - 2" �� � iU ,t a r or etric or riser .li, 1. , 4.. er di > a i e u iu or new bu illha, .tilkil i o f kal
- 3" �� lsorn eagram is required for
- 4" .- - -■1111 that meet the qualifications above.
Car Wash Drain - -
Garbage - Domesti c
Disposal - Commercial
- Industrial ` MIMI Comments regarding fixture work:
tee Mach./Refri • Drains IMIIM
Re c. nr s Station Station ��
Rea Vehicle Gas
Stati -
Shower -Gang Mi. iiiiiMEMI
-Stall iMin
Sink - Bur /Lavatory MEM
- Bradley MOM
- Commercial � *Note: Tithe fixture work under this permit results in an
- Service MN. IlMil
Swirent"n- Pool Filter ��� increase of sewer)✓]C1Us, a sewer permit will be issued and
Washer - Clothes 111MNIMM Mini - fees assessed for the sewer increase must be paid before the
Water Cxtsactor plumbing permit can be issued.
water Closet - '1 -pilot IMMINEMIMMINI
Urinal MEN
Other Fixtures: MI=�
h tip 7 / /www, t i gard -o r, go v/ city_ h al l kl e p a rim en ts/cd /d ocs/P L MF -P eels i tAp el oc