Permit u I CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00108
TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/16/2007
PARCEL: 2 S 103 D B -07000
SITE ADDRESS: 11160 SW EDEN CT ZONING: R -4.5
SUBDIVISION: GENESIS NO. 3 LOT: 055 JURISDICTION: TIG
PROJECT: BAKER
Project Description: Approx. 80' water service replacement.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: ft
WATER CLOSETS: WATER LINE: 80 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JUDY BAKER
11160 SW EDEM CT. Description Date Amount
TIGARD, OR 97223 [TAX] 8% State Surcha 3/16/2007 $5.80
[PLUMB] Permit Fee 3/16/2007 $72.50
Phone : 503- 639 -8953 Total $78.30
Contractor:
ROTOMAN
3150 SE 22ND ST.
KEIZER, OR 97303 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -393 -3200
Reg #: LIC 155373
PLM PB50
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION• Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -0001 -0010 through OAR 952 -0001 -0100. You may obtain c%pies of
these rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: S 7/ 0 I__ i14
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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/ r , City of Tigard y Received A
t %,,, ' ' 13125 SW Hall Blvd., Tigard, OR x(72 3� !� 1
200 � � � a� /J Permit No . I ` , l _ M D
■ . Phone: 503.639.4171 Fax: 503.59$ 1960 � p p�� a Other Pe ••.,'t L No.
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T I C'A K D Date 2 for
; 4: Z Internet: www.ti ardor ov Non t Information
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❑ 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)
: -- ' a w'. eiTidialiiiIVK 01 igifib I'ION " i i s " ` ' r°
�,,, , - -' SFR(I)b
�.� �� 4 ..ast�..;. , ��r - � 0 X''' �� ; �. �''� �; 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:
1° ��.W a _k >u ,���,�. »�, Fire sprinkler ( sq. ft.) Page 2
,
'.; - .a ,,",,"1% ;5 „�°1 O,B SITE ei i ATION„ A CATION' x 10 ` _ {t ' '%
k ,' ., ,• . , -a ,. ,, . �....,..., „ r , fr a e.Y� 1 , � Site utilities
Job site address. /// 6 0 ' ee G7 Catch basin or area drain 16.60
City /State/ZIP: 77‘741. q O/ 9 7ZZ3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 9 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
Subdivision: Lot no.: Water service (no. linear ft. 8 63) Page 2
Fixture or item
Tax map /parcel no.:
g: a >:a:� , , f i. t ,„ -r: ";, . >, .'' .�,;ayi, '"),:*'"1,''''"^
. Absorption valve 16.60
',.: '"EeeiU 'r. ?DESGRIPTION: �M'4 F t -. ' : ,
.$, "'i .,nS i- tca,�:. `..+4� ^ .. ., "s•n -- �g .,., ¢.�s,. W, ,.�c � .�+ +.,, F"¢z "', S`;
/ }� Back flow preventer Page 2
A -, p lGe ,�'/ Aki � g 4/ � Backwater valve 16.60
fr J/ c _ /
C Clothes washer 16.60
v Dishwasher 16.60
" � - ° x Drinking fountain 16.60
" ,;.,® � PRC/PER7'Y.OWNR : fi r 7 ®TElYi1N7%�
' 9 J " /C t„ „ Ejectors/sump 16.60
Name: V e / / `j',, Expansion t tank 'N 16.60
Address: /// U/ e) /GgPV/' C 7 Fixture/sewer cap 16.60
City / State/ZIP: 7/7Q,-.or Z l 7ZZ5 Floor drain/floor sink/hub ■ 16.60
Phone: (" 1 2 3 ) 4. • '9 5 3 Fax: ( ) Garbage disposal 16.60
_ - s.. 1 7 n+ e f " ...ti5' do Ho a bib 16.60
mAPI'LICAIVT: , , " . ,® :'CONTACI•PERSON'"
a •_. •.�1 ;:- 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' Sink/basin/lavatory 16.60 \'
( ) Fax )
w Tub /shower /shower pan 16.60
\\ E -mail:
• t, d,,-P ::; ' ` =,a4, „; . x . . + .« "f'"P ! °.,,; Urinal 16.60
Q =a„ oi; ' §' . a :r:- r ,, ; `„s: -, .., - .s_i•„ y �• '". rw �°r .
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- - ,ri.:. m ay M � ,r > ; .., . « ... , t : k � � �, �4�• " :c �fi�;''' r• , 'c ,.. «qs? � .., � w�k.^:: ' Water closet � e eo< /74 N / 16.60 \
\` Business name: 'W Water heater 16.60 \
I` Address: 3 j 0 ;2 -2-47ci 5 Other: \
City / State/ZIP /,, Subtotal
Minimum permit fee. $72.50
,i X Phone: (5�)3) 3c 3 .. 3aoo Fax. ( ) 1 f Q Residential backflow minimum permit fee $36.25
CCB Lie.: / 55 3 7 3 r+ Plumbing Lic no : f a 5c, Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature• ��� TOTAL PERMIT FEE ' . „
e* ►`ff�"' - S, 'J(/
Print name' �f.- / ' / , p \ . Date: This permit application expires if a permit is not obtained within
,, ,/. 7 ,#.,,y77.
/r 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1 \Buddmg\Pennus\PLM- PennuApp doc 06/26/06 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
..,;,,. a�,�.�. -€ �..� +'�`��x'= ^` ° - 'aw +e„ � -+�... ate., r- .:.� ,,��t,,�a•
'S1te UtllltiCS�ie.: s° r „ ', , Qty. Fee t(ea): ;: Total rt 1+z•^ ;" , .- ,•r,:. a r w
,..u. ?i�..���.�r��.•�.�x � �.•,,. . , ; A ,v � �S' uare "'Foot_�ge, �� Pe rm><tEee:s�
Footing drain - l 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 ya1uation: ;s �� 'P ermit ¢
$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
1N 1XU1'e01' gtem # "7 ` " x 'k " • ;Qty: ' F e e'( ea ): = additional $100.00 or fraction thereof to and
•� " ° t . 'T oaT 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 $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
.�• , �,. PIan; Review�fo" r .Plulinliing=In`_stallati ®ns °'` ••;
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
greater, except systems designed and stamped by licensed
Quao'titYby(Fixfa "r ' e)` WorkPerformed7= >'� an P Y
F(iitrire Type`�a . � >• a, �w tt«:.,;.. t� � - �:�,� � -�y ',., :�, ,.� : Replaec l ` engineer.
iu Ni':`s aPrevious ,r'cepped AA`dd ° "Eidsding+ ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain, 3I1 > w "'
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink -2" that meet the qualifications above.
-3"
- 4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial lumbin permit can be issued.
- Service P g P
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal -
Other Fixtures
° \Bwiding\Pertnus\PL.M- Pe,msApp doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00108
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2007
Phone: (503) 639 -4171 Ali l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/30/2007 TIME: 7:00AM PAGE: 25
SITE ADDRESS: 1'1100 SW EDEN CT CLASS OF WORK:
SUBDIVISION: GENESIS NO. 3 LOT #: 055 TYPE OF USE:
PROJECT NAME: BAKER
DESCRIPTION: Approx. 80' water service replacement.
OWNER: BAKER, JUDY PHONE #: 503-639-8953
CONTRACTOR: ROTOMAN PHONE #: 503 -393-3200
Inspection Request Scheduled For: Date: 3/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water seivice 045763-01 503 N .
5 g R
Corrections /Comments /Instructions:
C4 re-
[PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CV 114 - A_J `"� Date: -3/3c0 47 Phone #: (503) 718-