Permit C ITY OF T I GA R D PLUMBING PERMIT
i �� PERMIT #: PLM2005 -00060
DEVELOPMENT SERVICES DATE ISSUED: 2/16/2005
i
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 06707 SW PINE ST PARCEL: 1S136AD -04600
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Kitchen remodel. other fix. ice maker.
FEES
Owner:
Description Date Amount
BILL & JAN HETTICK
6707 SW PINE [PLUMB] Permit Fee 2/16/2005 $83.00
PORTLAND, OR 97223 [TAX] 8% State Surchan 2/16/2005 $6.64
Total $89.64
Phone : 503 452 - 1129
Contractor:
PARAMOUNT PLUMBING COMPANY
6019 SE 23RD AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97202 -0000
Phone : 231 -0794 FAX
239 -7516
Reg #: LIC 125438
PLM 26 -627PB
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 rules or direct questions to OUNC by lling (503)
246 -6699. �
Issued By: i� GGG�
(�� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
-_ . 'B cEIVED
Plunibine Permit A cation rOli (rrlc1.: !Isl.. (),!\I,,
City of Tigard FEB .1 r 2005 Received Permit No.:`7
13125 SW Hall Blvd., Tigard, OR 97223 ter. I r to �0'S f2)19.... 1 W/l, a 00 5 -0 04960
Plan Review
Phone: 503.639.4171 Fax: 503.598.
1�4tY OF TIGARD / /,u ' . I Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4 ♦ •� ��11LDING ()NISI ►1,�- o r„ ris: Notified/Method: C Supplemental Inf El See Internet: www.ci.tigard.or.us Information
�I✓t
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea- I Total
-0 4ddition/alterationheplacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
-0'1- 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
0 Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 6,7 Si.._) �e S / Catch basin or area drain 16.60
City /State/Z1P: ¶i 3 9 i f 0 9 '� 2 2 - 0 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: /-/e77;-.4 Footing drain (no. linear ft: ) Page 2
Manufactured home utilities I 110.00
Cross street/directions to job site: G9�
Manholes 16.60
Rain drain connector 16.60
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 Backftow preventer Page 2
4 76.4 II/ VC 04-1 od7C, i / Backwater valve 16.60
/1/41.J S L e! v. 6..e. 7 04,.. 6 e S g �` � Clothes washer 16.60
Dishwasher /• 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: 7 Fixture /sewer cap 16.60
City/State/ZIP: , Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal /• 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker / 16.60
Business name: fivx Ad 0 A,,,T P/ 4, ;,, 1 L� ...
Q Interceptor /grease trap 16.60
/�
Contact name: 7 .. / 44, c ,vi L ii Medical gas (value: $ ) Page 2
Address: 6.0 / cj j/ /f c_
.21' Primer 16.60
City/State/ZIP: /. 4.7 OK 5? Z GZ Roof drain (commercial) I 16.60
Phone: ( s °J) 0 2 J ^7 - 7 sit I Fax: : (€ 1 7 - ? r /,C Sinlc/basin / lavatory 16.60
Tub /shower/shower pan / 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: PA/ 4", a 4•,7 / � 4 ,2 7 f/ Water heater 16.60
Address: 6 5' ,sr .2 s / .. c. Other: I
Old S? 1 Subtotal ( .(9()
City/State/ZIP: / i .c . 2 Minimum permit fee: $72.50
Phone: (5'o3 ) 2 .2S 73 f.- Fax: ( S .2 a S - 7r/ L Residential backflow minimum permit fee: $36.25
CCB Lic.: /2 5 9J /' P umbing Lic. no. : . c- -c. 7 PA Plan review (25% of permit fee)
Authorized signature: /6 it 4J ' - / _ o& State surcharge (8% of permit fee) • (�
/ / TOTAL PERMIT FEE y . (o.5/ Print name: /n7ric C `✓oc,/v it, I Date: - /G- 0 C I 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 Bui !ding \ Permits \PLM- PennitApp.doc 17103 440- 4616T(10W071C0MAV®)
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
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 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:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub/Shower
-Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher -Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
c \BuildagTermits\PLM- Pcrmlwpp.doc 3/03
CITY OF TIGARD . .
_ .
BUILDING DIVISION PERMIT #: PLM2005-00060
11 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: : 2/16/2005
Phone: (503) 639-4171 A
,.. 4:10t oi
Inspection Requests (24 Hrs.): (503) 639-4175 ._-_,-0- - — lt
INSPECTION WORKSHEET FOR DATE: 3/18/2005 TIME: 7: 24AM PAGE: 23
SITE ADDRESS: 06707 SW PINE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HETTICK
DESCRIPTION: Kitchen remodel. other fix. ice maker.
OWNER: HETTICK, BILL & JAN PHONE #: 503-452-1129
CONTRACTOR: PARAMOUNT PLUMBING COMPANY PHONE #: 239-7516
Inspection Request Scheduled For: Date: 3/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 002209-01 503-784-1043 N
Corrections/Comments/Instructions:
(......
i .
/
r ---- .
...--------
t /
I
Q 'ASS 111 PARTI APPROV •p•-' 0 CANCEL
/ 0 NO ACCESS
El FAIL El CAL FO; - I ■ ' a 0 ADDITIONA EES ESSED
/
Inspector: Ar-, Date: '. I ° (CP - hone #: (503)
-