Permit A . CITY Of TIGARD PLUMBING PERMIT
w DEVE PERMIT #: PLM2006 -10014
� Iil / H BME r SERVICES 2CES - -4171 DATE ISSUED: 3/6/2006 . 6
PARCEL: 2S 102 B D -00702
SITE ADDRESS: 09870 SW MCKENZIE ST * ** ZONING: R -12
SUBDIVISION: MCKENZIE APARTMENTS LOT: JURISDICTION: TIG
Project Description: Replace 15' of sanitary sewer service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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: 15 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft'
Owner: FEES
HAP ARNOLD Description Date Amount
9870 SW MCKENZIE ST
TIGARD, OR 97223 [PLUMB] Permit Fee 4/1/2006 $72.50
[TAX] 8% State Surchari 4/1/2006 $5.80
Phone : 503 810 - 8933 Total $78.30
Contractor:
RESCUE ROOTER
PO BOX 1728 REQUIRED ITEMS AND REPORTS
WILSONVILLE, OR 97070 '
Contact # : ' PRI 503 685 - 9050
Reg #: LIC 127325
PLM 34 -168PB
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- 0 rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questionkto OUNC by
calling 5 3 -246 -6 9 or 00- 332 -2344.
Issued Permittee Signature: l lvc----■--,
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.
Building Fixtures
Plum bin2 Permit Application lsoR oFFIci.: Hsu ()Nix
City of Tigard Dffi vedr 3 / !', Permit No.: 14/6 ,0(p - /dal Ar
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 :11,,..; b,,,,-,,,,,...k/ Other Permit No.:
(l Date/By.
24- Hour Inspection Line: 503.639.4175 - , Date Ready/By. 4 ( J / 'j ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ( + 1 (W - 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
tjir1- 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: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
9 t
Job site address: _! q 7 0 c k ,P 14 z) r Catch basin or area drain 16.60
City /State/ZIP: 7 C'/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: et 9 Manholes 16.60
Rain drain connector 16.60 •
Sanitary sewer (no. linear ft.: f ) Page 2 �� j
Storm sewer (no. linear ft.: ) Page 2
Subdivision: • I Lot no.: Water service (no. linear R: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
tP L4cL- (g f oi% 5 , f- 1 (CL L Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
tf PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump . I 16.60
Name: 1 ,4 el p 4 r w 0 L Ci, Expansion tank 16.60
Address: CI 53 6 IM /[ e• •p n 2 r' t' Fixture/sewer cap 16.60
City /State/ZIP: `r , g Floor drain/floor sink/hub 16.60
Phone: (S'c3 ) 9/0 . ' 3 3 Fax: ( ) Garbage disposal 16.60
y-� Hose bib 16.60
'f' APPLICANT ❑ CONTACT PERSON
Ice maker I 16.60
P Business name: I ` Qs ,, -e K a r Interceptor /grease trap 16.60
Contact name: c jQ 14 4 5 P V Medical gas (value: $ ) Page 2
Address: , '7 7 o L C I - t° ti z /' a Primer 16.60
City/State/ZIP: ) .- y
Roof drain (commercial) 16.60
Phone: (5 ) ' ' O I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: k .& „ 1 P leG G/' e f Water heater 16.60
Address: l v . 'v 1 -1 �- , L SC h t; 1 I � Other: - I
1 1 7 7b 7d Subtotal
City / State/ZIP:
I l ` O L' U f (- � � � r ' Minimum permit fee: $72.50 50
7:03, S�
Phone: (5c ) 6 W S , qQ' 5 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 1. , Plumbing Plan review (25% of permit fee)
t 2 / g Lic. no.: / g �Q State surcharge (8% of permit fee) b ,
Authorized signature: , ?II / it TOTAL PERMIT FEE 7g, 7
Print name: 6 0 7 c ,,,,!s ," y Date: 3 , G .. C 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.
is\ Building \Pennin\PrMF- PennitApp.doc 06/05 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information y,
,
Fee Schedule: `E 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
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $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 Backfiow 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof; to
specially requested inspections - per hour 72.50 and including $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 Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing .
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply .
Quantity by (Fixture) Work Performed ❑ An new commercial buildin ` : . .
Fixture Type: Replace J ❑ Any new exterior plumbing site utilities - .
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities •
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
- 4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal . - Commercial three (3) or more stories in height.
- Industrial '
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower - -Gang
-Stall
Sink - Bar/Lavatory •
- Bradley
- Commercial • _
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued. ,
is\ Building \PeImits\PLM- PennitApp.doc 07/06/05
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CITY OF TIGARD 'Pt --(7 o6, too /1/4/
BUILDING DIVISION • - r PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �j�li•• •
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: —3/7 /6 4 TIME: PAGE:
SITE ADDRESS: g 7D � �J . �,, Q � C OF WORK:
SUBDIVISION: \�\ -6 ` --L1�LI % TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: 1 3 — ` ED 1 r
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
P L
C o rrections /Comments /Instructions:
/ ti fit —e--1e--/‘
C
•
CirrA-ss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
12 Inspector: Date: Phone #: (503) 718 41 zi