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Permit CITY TIGARD PLUMBING PERMIT � � DEVELOPMENT SERVICES PERMIT #: PLM2006 -00046 A! DATE ISSUED: 1/27/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114BB -00600 SITE ADDRESS: 10085 SW SERENA WAY ZONING: R -4.5 SUBDIVISION: PICKS LANDING NO.1 LOT: 005 JURISDICTION: TIG Project Description: Replace shower CLASS OF WORK: ALT 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: OTHER FIXTURES: TUB /SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES BEACH, STEVEN R + LISA D Description Date Amount 10085 SW SERENA WAY TIGARD, OR 97224 [PLUMB] Permit Fee 1/27/2006 $72.50 [TAX] 8% State Surcharl 1/27/2006 $5.80 Phone : 503 639 - 9878 Total $78.30 Contractor: STANDARD PLUMBING + HEATING PO BOX 19205 REQUIRED ITEMS AND REPORTS PORTLAND, OR 97280 Contact # : PM 246 - 3338 FAX 503 244 - 1279 Reg #: LIC 00007309 PLM 26 - 72PB 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 calling 503 - 246 - • or 1- 800 - 332 -2344. Issued By: 0 40 / _��_ ./ � Permittee Signature fze (� " 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 CC IVED Plumbing Permit AD>�a City of Tigard JAN Y _ 7- p� Permit No.: z ek,.� ? p 13125 SW Hall Blvd., Tigard, OR 97223 �A I� 2006 Plan Review p�l/ Phone: 503.639.4171 Fax: 503.598.1960 4y- Other Permit No.: 24- Hour Inspection Line: 503.639.4175 CITY OF TIGA` ,'IS'' " l i ly Date Date Ready Other ® See Page 2 for Internet: www.ci.tigard.or.us BUILDING DIV1 ='' Notified/Method Supplemental Information TYPE OF WORK FEE* SCH ULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. Total ddition/alteration/replacement ❑Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ++ CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 - 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: r � e s - Spa � "" Catch basin or area drain 16.60 / �D City /State/ZIP: / /� ©k q 7 7 1 L ( � Drywall, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: f I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to j • site: Manholes 16.60 . �: /. ,L . , � � 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 Backflow preventer Page 2 T t , AI h z� � c Backwater valve 16.60 /� � `�� 6' 5‘ Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 //�� Ejectors/sump 16.60 Name: %! 5,4 i2 £•,le ( Expansion tank 16.60 Address: I D 0 El. 5t 5 0 . A g • ,,A w Fixture /sewer cap 16.60 City /State /ZIP: T 05 /± d , 1y- (9 ,� '' 9 722. Floor drain/floor sink/hub 16.60 Phone: I , ( 5 „2 /_ P 3 � Q �T - Fe7k Fax: f ( ) Garbage disposal 16.60 A APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name:9 )1 N xs , ✓ I V& tf _y-,,,e Interceptor /grease trap 16.60 Contact name: t G A) 14 LTd Ad r Medical gas (value: $ ) Page 2 Address: AV . 4, r slay- Primer 16.60 City /State /ZIP: p 6/1 r, 40p p (e 9770 Roof drain (commercial) 16.60 Phone: ( 1 744... 333 Fax: : OR) 24iq‘• /L71 Sink/basin/lavatory 16.60 L0 Tub /shower /shower pan ( 16.60 / Li a. C E -mail: Doi() 9e $4t 4 7- , ZIFP Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: S v--,�r d 4, p( / y /' j t Water heater 16.60 Address: AO. di* pt 27,05- Other: City /State /ZIP: �1sr�T q� 'Z Subtotal /" '� f Minimum permit fee: $72.50 Phone: �) � > ? J . ? Fax: (3 ) ) 9'. /2 7P Residential back flow minimum permit fee: $36.25 CCB Lic.: ) 7 301 Plumbing Lic. no.: 72/3 Plan review (25% of permit fee) /3 A - 2_3 3 �/j State surcharge (8% of permit fee) di Authorized signature: g (�jJG TOTAL PERMIT FEE . Print name: rD 0 p q. a i . 4 � ro Date: / �/ V 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 \ Permits \PLMF- PermitApp.doc 06/05 440.46t 6T( 10/02JCOM/WEB) ,w4rie0 1 / - . 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 Back flow 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 (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ 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 - 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 ermit results in an Water Extractor p 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. i:\ Building \Pennits\PLM- PermitApp.doc 07/06/05 T . s CITY OF TIGARD , � BUILDING DIVISION PERMIT #: PI_M2006.-00046 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/77/2006 Phone: (503) 639 - 4171'' Inspection Requests (24 Hrs.): (503) 639 - 4175 �'f — INSPECTION WORKSHEET FOR DATE: 1/30/2006 TIME: /.01AM PAGE: 29 SITE ADDRESS: 10085 SW SERENA WAY CLASS OF WORK: SUBDIVISION: PICKS LANDING NO.1 LOT #: 005 TYPE OF USE: PROJECT NAME: BEACH DESCRIPTION: Replace shower OWNER: BEACH, STEVEN R + USA 0, PHONE #: 503 - 638 -9878 CONTRACTOR: STANDARD PLUMBING •F HEATING PHONE #: 246.3338 Inspection Request Scheduled For: Date: 1/30/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 025950-01 603- 246.3338 Y Corrections/Comments/Instructions: f / U / , / / / ,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: fr Date: i Phone #: (503) 718- ■