Permit C ITY O TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00138
..� l � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1 S13 006
PARCEL: 1 S136AD -04700
SITE ADDRESS: 06611 SW PINE ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Convert existing space into bathroom. Other fixture: ejector pump
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: 2 OTHER FIXTURES: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
HAYLEY & R HULTENGREN Description Date Amount
6611 SW PINE
TIGARD, OR 97223 [PLUMB] Permit Fee 4/14/2006 $72.50
[TAX] 8% State Surcharl 4/14/2006 $5.80
Phone : 503 347 - 9963 Total $78.30
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 ! i I , ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling . 1 3- 246 -669 • • r r s ! 332 -2344.
Issue. By: r Permittee Si nature:x
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 .
Plumbing Permit Application FOR OFFICE: FsE ONLY
City of T� and Received 1 Permit No
q 131 SW Hall Blvd., Tigard, OR 97223 Plan Review
I 00 /� a
III Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 DateBy.
T I G n It D Inspection Line: 503.639.4175 Date ReadyBy: r " ri ♦ _� El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: I G" Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description I Qty. [ 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 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
Job site address: ►P 6 i t ?Irv_ tot Catch basin or area drain 16.60
City /State/ZIP: co rl 1� &A d 0a_ C • Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: I Project name: 1�a-�/� f"O� Footing drain (no. linear ft.: ) Page 2
...T. 5 +0 P Q Q R. T � ( ' 1 Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
W T , I< r l o n 6 + 1. 1 C �� Rain drain connector 16.60
o vt Q me_ 't . (/ Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK WORK 1 Back flow preventer Page 2
Acklir9 a ba t% room i►H � e 4iS+ n Backwater valve 16.60
coo' »I! . - Clothes washer 16.60
Dishwasher 16.60
ROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump t. 16.60 16.60
Name: 1.10, tp w + , +�/, i i ji Expansion tank 16.60
Address: 6 t ` ( Ow 9 - n p !) t• v Fixture /sewer cap 16.60
City /State/ZIP: 1por-'t' lam d i Q Q 722_3 Floor drain/floor sink/hub 16.60
Phone: (50)347- 7- ci 4, 3 Fax: (503) 5T6 -8788 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 drai mmercial) 16.60
Phone: ( ) I Fax:: ( ) SinT ssi ay 2 16.60 3 .20
( Tub /shower hower pan 1 16.60 i (p. (oQ
E -mail: Urinal 16.60 ( -¢j- ->
R Water closet t 16.60 /4 O
Business name: Water heater 16.60
Address: Other
City /State/ZIP: Subtotal
Minimum permit fee: $72.50 .2: ,50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: JJ Plumbing Lic. no.: Plan review (25% of permit fee)
p^7� (Jy J /� _(6 State surc (8% of permit fee) .g go
Authorized signatur
i`^l -7 - ice( TOTAL PERMIT FEE 7g. 56
Print name: Date: 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: Building \Pamits\PLMF•PennitApp.doc 04/06106 440- 46I6T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
A.
Fee S • '' Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
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 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 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 td $50,000.00 I 4)79.50 for the first $23,000.00 and $1.45 for
•
Inspection of existing plumbing or r each additional $100.00 or *action thereof to
specially requested inspections - per hour 72.50 and includ t the $50,000.00 , $50,061.00 and pp $742.00 for the first $50,000.00 and $1.20 for
Subtotal:
each additional $100.00 or fraction thereof.
t ;e ,
• - . Q .. / + • .
I r I ,
• Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed t l ❑ Any new commercial building. •
Fixture Type: Replace b An y new exte p lu m b i ng site u ti l i t i es .
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition •
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car'Wash - Each Stall - , ❑ ,Plumb t% installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, includingaritercptors,
Cuspidor/Water Aspirator are being installed for the food service area. r
Dishwasher - Commercial ❑ Anynew residential building,containing,three (3) or more
- Domestic 4welling units. - . .
Drinking Fountain ' ❑ - Any NFPA 13 -D multipurpose fire.spri
• Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
ice Maeh./Refrig. Drains
..Oil$eparator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Statiop
Shower -Gang
' -Stall
Sink - Bar/Lavatory
- Bradley
-Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor *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 \Permits\PLM- PmnitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION t PERMIT #: PLM2006 -00138
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2006
Phone: (503) 639 -4171 a�, h ilii
Inspection Requests (24 Hrs.): (503) 639 -4175 - "__..
INSPECTION WORKSHEET FOR DATE: 7/5/2006 TIME: 7: NAM PAGE: 3
SITE ADDRESS: 06611 SW PINE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HULTENGREN
DESCRIPTION: Convert existing space into bathroom. Other fixture: ejector pump
OWNER: HULTENGREN, HAYLEY & REECE PHONE #: 503-347 -9963
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7 /5/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 032669-01 503-347 -9963 N
•
Corrections /Comments /Instructions:
, / C---Y / /
f
I \PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I �(� Date: �� Phone #: (503) 718 - Ll�/
CITY OF TIGARD ,
BUILDING DIVISION „ PERMIT #: PLM2O S.L0138
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2006
Phone: (503) 639 - 4171 /
Inspection Requests (24 Hrs.): (503) 639 -4175 _.' x-
INSPECTION WORKSHEET FOR DATE: 5/26/2006 TIME: 7:03AM PAGE: 2
SITE ADDRESS: 06611 SW PINE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HULTENGREN
DESCRIPTION: Convert existing space into bathroom. Other fixture: ejector pump
OWNER: HULTENGREN, HAYLEY 8 REECE PHONE #: 503-341 7-3963
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/26/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 030621 -01 503-347-9963 N
Corrections /Comments /Instructions: , ∎e
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El PASS 4ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 / ik - e—C Date: i # Phone #: (503) 718)
V