Permit •
C ITY OF TIGARD PLUMBING PERMIT
�i�► DEVELOPMENT SERVICES PERMIT #: PLM2006 -00236
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/8/2006
PARCEL: 1S135BD-00200
SITE ADDRESS: 09785 SW SHADY LN ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace catch basin.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
STAN NORED
16500 NW GARFIELD AVE Description Date Amount
CORVALLIS, OR 97330 [PLUMB] Permit Fee 5/25/2006 $72.50
[TAX] 8% State Surcha 5/25/2006 $5.80
Phone : 503- 689 -1702 Total $78.30
Contractor:
ROGERS EXCAVATING INC
PO BOX 6468
ALOHA, OR 97007 -0468 REQUIRED ITEMS AND REPORTS
•
Contact # : PRI 503- 649 -3899 •
Reg #: LIC 121907
PLM 34 -449PB
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 -6699 or 1- 800 - 332 -2344.
Issued By: ��� Permittee Signatur �i
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.
CL(/ a r
Bu>Ilding Fixtures •
Plumbing Permit Application EG ER! r
i // /" ( � �/ j a
a 13125 SW Hall Blvd., Tigard, OR 97223
City of Tigard Received Date/By. 7 . > e�r o ` b Permit No.: L// J
1111 3
MAY /" plan Review
II Phone: 503.639.4171 Fax: 503.598.1960 MA 200E Date/By. OtherPennitNo.:
Inspection Line: 503.639.4175 Date Read B t ° " 9 ® See Pa e tal 2 for
T I G n It 0 d-or. ov r pp}} p Y o
Internet: www.ti g
F� ,
g `,1 A Y �� 11 1lJf °1,�.lfled/Method: ?�E, Supplemen Information
TYPE OF WOIt nTN', f; T`TITTC1(31\ FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
,ddition /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 ,ommercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities /
Job site address: 1 7 8 5 j S w � e 1 L AA ,Q Catch basin or area drain / 16.60 /"�C
City /State /ZIP: 71 J q 64 , 0 /2 9 > *2 Z 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l Project name: R ,,, ej„„e_Ic Footing drain (no. linear ft.: ) Page 2
/� Manufactured home utilities 110.00
Cross street /directions to job site:
v "� r 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
- J-c
DESCRIPTION OF WORK Backflow preventer Page 2
1' (
CtC 4f C
D( n ( 6h-cf ( 6h- c 1 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
r Ejectors/sump 16.60
Name: /* /VQY`Q Q
�, � Expansion tank 16.60
Address: /65 Arc c o_ G�4 At) e.. Fixture /sewer cap 16.60
City /State /ZIP: 60,t%7(Q0/S / o e 9 7,-.3 0 Floor drain/floor sink/hub 16.60
Phone: (, v) b & 7- r? o r _ Fax: (5-((7) ir6.� _ O 7V ( Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ({ jij P,o-aex Interceptor /grease trap 16.60
Contact name: c�Zr� A Medical gas (value: $ ) Page 2
Address: /Co At. 6„44-T ` e-- ( J Primer 16.60
City /State/ZIP: ( ,/,.,rt.5ar s 0.2 y 7,�3 'CD Roof drain (commercial) 16.60
Phone: r (e g S'-/ ? Z I Fax: : ( )
Sink/basin/lavatory 16.60 •
/ Tub /shower /shower pan 16.60
E -mail: S-t ,�.i Z e l 3 To� <0 u , -c( Co vvl
Urinal 16.60
CONT OR -- Water closet 16.60
-, c ,
Business name: .�p(bg4 E' XCdi i> /47 , J( t Water heater 16.60
Address: PY) . L 41 Other:
City /State/ZIP: A Lill /i Qf L /''C�0-7 Subtotal
� Minimum permit fee: $72.50 , 50
Phone: (6L,7) ((L/C! _3 4-77---
7 , ' fax: ( ) / !t Residential backflow minimum permit fee: $36.25
CCB Lic.: 1 9.i 1o`) - 5 /AylQgt. . _Jlumbi ic.no.:5V'y4/8.)DiJ Plan review (25% of permit fee)
Authorized signature: Of - 7 // / 0P State surcharge (8% of permit fee) S &)
% G �`� TOTAL PERMIT FEE 7$. 3
Print name: j' j ) ,-Q„4.._ Date: s ZJ O 6 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- PemlitApp.doc 09/06/06 440 4616T(10/02/COM/WEB)
IV
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 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 ❑ 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 ❑ My new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain • ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
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 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 Extractor
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 \Permits\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: M2006-0029E,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2006
Phone: (503) 639 -4171 A:litIl PL
Inspection Requests (24 Hrs.): (503) 639 -4175 IL.
INSPECTION WORKSHEET FOR DATE: 12/11 /2006 TIME: 7:00AM PAGE: 26
SITE ADDRESS: 09785 SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: RAINBOW PARK
DESCRIPTION: Replace catch basin.
OWNER: NORED, STAN PHONE #: 503- GU'3.1702
CONTRACTOR: ROGERS EXCAVATING INC _ PHONE #: 503 - 649-3899
Inspection Request Scheduled For: Date: 12/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
345 Culvert/catch basin 040889-01 503.968.7230 Y
Corrections/Comments/Instructions:
■
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s /
I
(Q._ P SS El PARTIAL APPROVAL 11] CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: fi - I ,` " /)..e Date: \ ! V�e Phone #: (503) 718 -
1