Permit C ITY OF TIGARD PLUMBING PERMIT
������ i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00536
'-~- '' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/3/2006
PARCEL: 2 S 102 D C -00403
SITE ADDRESS: 09235 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 016 JURISDICTION: TIG
Project Description: Installation of 170' of sanitary service, no connection to lateral or house at this time.
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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 170 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ELIZABETH KING
9235 SW EDGEWOOD ST Description Date Amount
TIGARD. OR 97223 [PLUMB] Permit Fee 11/3/2006 $101.40
[TAX] 8% State Surcha 11/3/2006 $8.11
Phone : 503- 670 -9098 Total $109.51
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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 -0100. You may obtain copies of
these rul - or questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. .
Issue By: � Permittee Signature: Om.. '.- i
0
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that b • • - da • .
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.
• Plumbing Permit Application
Building Fixtures - i ,. 1' 4.Ol 2. OFFICE IISCON LV '
City of Tigard Date/By // .0 Q 0 Ate/ Permit No : /t g _ 46 f
'i 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review //
_ ' ® Phone: 503 639.4171 Fax: 503.598.1960 Date/By Other Permit No •
Inspection Line: 503.639.4175
T I CA ' K D Date Ready/By O ® See Page 2 for
, Internet: www.tigard- or.gov Notified/Method. 00' Supplemental Information
TYPE OF WORK ' . FEE* SCHEDULE
❑ New construction ❑ Demolition 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)
. CATEGORY OF CONSTRUCTION ' . SFR(1)bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory buildmg ❑ 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 LOCA ION • Site utilities
Job site address: If 2._ 1 „. Atli Au , S Catch basin or area drain 16.60
City /State /ZIP: ` ` i/ 4a-3 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Kt yi5
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
Subdivision 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
la ' , / . 21ri 4...� / " Backwater valve 16.60
r Clothes washer 16.60
Dishwasher 16.60
. ❑ PROPERTY OWNER - ❑ TENANT. Drinking fountain 16 60
J Ejectors/sump 16.60
Ali Name: / /. i di ,,� V' . Expansion tank 16.60
Address: ���� ` r` , Fixture /sewer cap 16.60
City /State /ZIP: / _ ' Floor drain/floor sink /hub 16.60
Phone: (5?) 3) / G' -i Q5 (' Fax ( ) Garbage disposal 16.60
' ❑ APPLICANT ❑ CONTACT PERSON , Hose bib 16.60
' Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name' Medical gas (value: $ ) Page 2
Address: Primer 16 60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) l Fax: : ( )
Sink /basin/lavatory 16.60
Tub /shower /shower pan 16 60
E -mail: ' Urinal 16.60
' : CONTRACTOR ' ' Water closet 16.60
Business name: /ps .'��iii o44, ,-,J /! r� 1 a , %' _ ,-, Water heater 16.60
Address: Other
City /State /ZIP Subtotal
Minimum permit fee $72.50
Phone: ( ) - .. . ) Residential backflow minimum permit fee. $36.25
CCB Lic ' ■'A&II Ply }fig Lic o.� Plan review (25% of permit fee)
Authorized signature I � � I��, State surcharge (8% of permit fee)
TOTAL PERMIT FEE
tor
Print name. •.. • : 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 \Budding\Pennns\PLMF- PermdApp doc 04 /06/06 • • 0- 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
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 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including
specially requested inspections - per hour 72.50 the $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.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan 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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous - Capped Added Existing ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash -Each Stall
- Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher - Commercial
Domestic Isometric or Riser Diagram
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink -2"
-3"
- 4„
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
-1 ndustrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall •
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees asse for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures•
I \Bu ldmg Permits\PLM- PermitApp doc 09/22/06
CITY. OF _ ' L.
��m�� m . m TIGARD
' BUILDING DIVISION PERMIT #: pLM200�U0536
13125GVV Hall Blvd.. Tigard, OR97223 DATE ISSUED: 11/3/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 v �inV"!
INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 09235 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 018 TYPE OF USE:
PROJECT NAME: KING
DESCRIPTION: Installation of 170^ of sanitary owmice, no connection to lateral or house al thio1inna
~
OWNER: KING, ELIZABETH PHONE #: 503-670'9098
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/17Y2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 059979-01 503-870'9098 Y
Corrections/Comments/Instructions:
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PASS | PARTIAL APPROVAL El CANCEL | I NO ACCESS
|| FAIL CALL FOR IN .PECTION 0 ADDITIO iAL F ES ASSESSED
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O r ��� �� � Inspector: Date: ' � � e/ �~~~ Phone #: (503) 718- ^� Z2;