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Permit CITY OF TIGARD PL UMBING PERMIT 11 11 _ °' COMMUNITY DEVELOPMENT Permit #: PLM2009 00097 Date Issued: 04/27/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103CA00203 Jurisdiction: Tigard Site address: 11820 SW JAMES CT Subdivision: Lot: 0 Project: Mode Project Description: Replace backflow preventer, and (3) hose bibbs. Owner: FEES MODE, DEBRA KAY Quantity Description Date Amount FIELDS, TERRY LEE, 11820 SW JAMES COURT 1 ea Backflow Prevention - RES 04/27/2009 $27.55 TIGARD, OR 97223 3 ea Hose Bib 04/27/2009 $49.80 PHONE. 1 12% State Surcharge - 04/27/2009 $9.28 Plumbing Contractor: AMERICAN RESIDENTIAL SERVICES LLC P.O. BOX 2830 CLACKAMAS, OR 97015 PHONE: 503 - 235 -8784 FAX: 503 - 491 -2932 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $86.63 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 -0100. You may obtain a copy of the rules Issued By: mu r ^ n 9 n Z Permittee Signature: ` , = _ .' ' `A � 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. r t' TiP— ^c`,d- 2004 15:13 P. 001 Plumbin Permit Application Building Fixtures rt Fr City of Tigard ,._�v ' IVED FOR OFFICE USE ONLY Reea,.ed • v 13125 SW Hall Blvd. Tigard, OR 97c R 2 7 2009 tyatc/Bt • 7. Permit NoQ 7 1 9 Phone: 503 639.41 Fax: 503.598.1960 Plan Review — �� '� r Inspection Linc: 503 639.4 Date Idy _ Ocher Permit No . 5 r'I (GAR I1 p .b g C ITY OF TIGARD Date Ready n }: Internet: www.tigard-or.gov fie ® for P I Ir ,„,,4,,,,‘ _ NolitiedIMethod: t TYPE OF wdiii rv' r b 0 5upptemenrpf InPurmation FEE* SCHEDULE ❑ Neu construction ❑ Demolition For s1eclalir ormudon useehecklirt Addition /alteration /replacement Descri lion ❑ Other: New I- 2-family dwellings rinctudes 100 Ili each unlit> `once Tot cti a on) CATEGORY OF CONSTRUCTION SFR (l) bath �� ►* 1- and 2- family dwelling ❑ Commercial( industrial SFR I21 bath IMO © Accessory building ❑Multi - Tamil? SFR t3l burp ��� ❑ Master builder Each additional bath /kitchen In 45.00 MEM ❑ Other: JOB SITE INFORMATION AND LOCATION Fire sprinkler I sq. ft.) MIME Job site address: . 0 5 it �y Catch basin or area dram Mil 16 .tiU • ,•, e ! e �^•��7 7 Dryvtell, leach line, or trench drain 10 60 • Suite/bldg. /apt, no.: r A Footing drain (no. linear ft.:,) - Cross street/directions to job site: Manufactured home utilities ��� Rain 16,60 Rain riraiu connector EIRIMI___111111 Sanitary sewer (no, linear tt) Pagc 2 Storm sewer (no. linear ft.: _) Page 2 _ ' Subdivision: Lot no.: Water service (no. linear ft.: :) Page 2 an Tax map /parcel no.: Fixture or item Absorption valve `l' 115.60 II M r Bnt kflow prcventcr ME . DESCRIPTION OF WORK lei._ 11 Backwater valve 1�' .� �1� 16.60 L..�.�� J ..., Clothes washer � 16.00 _ Dishwasher 16.60 al )' PROPERTY OWNER Drinking fountain TENANT 16.60 Name: A '.. r%/, /n , y Ejectors /sump 16.60 Address: ���i /� 1 % Fx Parts i on tank 16,60 ' _ � -fi Fixture/sewer cap 16.60 12=11111111. Ai J �-` f MM Floor drain/floor sink /hub 16.60 — �� � Garbage disposal 16,60 NM 0 'CONTACT PERSON Hose bib Business name: ABS dba JACK i'� HOWK / Ice maker � �� , wog Rescue Rooter 16.60 Contact name: JOYCE DENNIS Interceptor /grease trap 16.60 MEI Medical gas (value: $ l M Page 2 am Address: P.O. BOX 2830 City /State /ZIP: CLACKAMAS, OR 97015 ltoofdrai � �� G.60 Phone; (503) 235 -8784 Fax: : (503)491-2932 Sink/basin /I- ': r„. ,..... E - mail: JOYCE@.IACKHOWK.CO4i Tub /shower /s ' r �" CONTRACTOR Urinal MI 16.60 Business name: ABS dba JACk H01VK Water closet 16.60 Mil /Rescue Rooter Water heater Address: P.O. BOX 2830 16.60 Other: MIN11111111 City /State /ZIP: CLACKAMAS, OR 97015 Subtotal Wag Phone: (503) 235 -8784 Fax: (503) 491 -2932 Minimum permit fee. $72.5 Residential backflnw minimum permit fee: $36.25 CCB Lie,: 127325 Plumbing Lie. no.: 34 -168 P Plan review (25% of permit fec) Authorized signature: �'�i/ State surcharge (12 % permit fee) IMMO v� ,[ ,� �� � , E' y � IOTA!, PERMIT FE '� r ' 4J p� This permit application expires if a permit Is not oh Mil! �� ° J i 180 days after It has been accepted as complete. ''ve�� w'ns`a °"T,i,,,�rr_srF'-r, Please FAX. BACK to • 503 - 4.91 -2932 Fee methodology set by 1'ri County Building Industry Service Board. r - SEP -i8 -2004 15:13 P.002 Plumbin Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: - Site Utilities Qty. Fee (ea) Total Residential Fire Suppression Systems: routing drain • 1' 100' S Ogr I'OOt e: Perm Fee: 55,00 0 - 2.00 Footing drain -each additional IOW , $115.00 .�� 46.40 OOi t o 3,600 $160,00 —__ Sc«cr li! ItIU' 55.00 3,601 to 7,200 $220.00 Sewer - each additional 100 7�U1 and greater $309.00 ---� Water Ser ice . X16.40 _ J Water Service - each additional 100' 46.40 - Medical Gas Systems: Storm & Rain Drain - 1st IOU' 55.00 Valuation: Permit Fee Sturm &Rain D r a i n - each additional IOU" 46 40 _$1.00 to $5.000.00 Minimum tee $72.50- `_____- b;s.UOLUU to $10.0(11100 $72 ;0 for the' t;rst $5,000.00 and $ I.$ each- Fixture or Item Qty. tee (ca) Total $100.00 or fraction thereof, to and Commercial Back Flow Prevention Device 464 incl 5 0 $10,000.0(1, I kflow Prevention Device r Residential c - $10.001.00 to $''S,UpU.n(I $148.50 for the first $l0,DU toF and $I.S,t for (minimum omit fcc $36.25. each additional $100.00 or fraction thereat; to Rain Drain, single family dvtelling 65 .2 5 — and mcludtn $25,000.00. $2, Ol1t,UU lv ° �SOAU0.00 $379,50 for [he first $25.000.00 and 1;1.45 for Inspection of existing plumbing or each additional $ 100.00 or traction thereof; to _ specially requested inspections - per hour 72,50 and includin $50,000,00. Subtotal: $50.001.00 and u $742.Q0 fur t he first $50,000.00 and $ 1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: Are you capping, adding or replacing fixtures? If " es" Plan Review for Plu mbiin I >nstallatjpus y > plan rev iew is required for any of fhe iollok ing, please indicate work performed by fixture. Failure to ?lease check all that apply. accurately re ort fixtures could result in increased sewer fees *. Any new commercial building with water service 2" and Quagtlty by (Fixture} Work Performed greater. except systems designed and stamped by licensed Fixture Type; Replace engineer, Previati, Ca ed Added ISxtatin� ID New exterior plumbing site utilities for any complex structure 8 :tist Rath —Tub/Show as defined in 0AR918 -780 -0040. Jacuzzi /R'hiripoul U Medical gas and vacuum systems for health care facilities, C Wash 1:aeh Stall ❑ Any multipurpose tire sprinkler system. - Drive Thru 12 Any complex structure as defined in OAR918- 780 -0040. Cuspidor /Water Aspirator - Dishmasher - Commercial - - Submit 2 sets of plans with any of tha above, - Domestic - I�rinking Founta;n IsQItlCtriC O r Eye wash — Riser Dia ram �(oor Dram /sink . z ' Isometric or rise diagram is required fo r new buildings — —_ that meet the qualifications above - C ar Wash Drain Garbage - Domestic Disposal contmcroial Comments regarding fixture work: - Industrial Icc Mach. /Refrig. Drains Oil Separatur(Gas Station) - Rec. Vehicle Dump Station Shower -Gang - Stall Sink -13ar /Lavatory - F3 — *Note: If the fixture work under this permit results in an - commeomme rcial – increase of sewer EDUs, a sewer permit will be issued and Sol VICC SNimm;ng Pool Filicr fees assessed for the sewer increase must be paid before the Washer - Clothes _ - plumbing permit can be issued. Water Extractor — — Water Closet - Toilet Urinal Other Fixtures ~' _ i.lauildinaTenn ir.et.M -Perms App.doe I 2t27/06 TOTAL P.002