Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00519
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/27/2006
PARCEL: 1 S125DB -01700
SITE ADDRESS: 07140 SW TAYLORS FERRY RD ZONING: R -4.5
SUBDIVISION: SHADY DELL LOT: 017 JURISDICTION: TIG
Project Description: Water heater replace
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: 1 CATCH BASINS:
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
MEGAN SAGE
7140 SW TAYLORS FERRY RD. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 10/27/200€ $72.50
[TAX] 8% State Surcha 10/27/200€ $5.80
Phone : 5971- 219 -2766 Total $78.30
Contractor:
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 -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: bC Permittee Signature: .0 (791„00/4 fi ti.�
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.
w
Plumbing Permit Application oFrlcF �_isI o LV , 1�'
1�
a a ' City of Tigard �. Dat /ey 1 t , 7 (/ V / Permit No.: % /H 6 -�5 /q
" n 131 25 SW Hall Blvd., Tigard, OR 97223 r `► t I /
�� q p c Date/By: Review
X Other Permit
Phone: 503.639.4171 Fax: 503.598.19( UOv Date/By:
Y Inspection Line: 503.639.4175 TIGA D ate R ead B Ju ri El S ee Page 2 for
�� Ready /By: B
Internet: www.tigard or.gov ^a � v '`i ,y il Notified/Method: Supplemental Information
TYPE OF WO 990@0 v FEE* CHEDULE
❑ New construction Demolition For special information use checklist
Description I Qty. I Ea. 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
El 1- and 2- family dwelling ❑ Commercial/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: ' l I D 17 O vS - Catch basin or area drain 16.60
City/State /ZIP: 1 ar d / JS e 2 ( Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
. 1- I * ei- -ii-t, ID vs Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: SkevA.d,t `D PA.( I Lot no.: _
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
I €1 t- I n ( k �� Backwater valve 16.60
`�'" Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: ttt it Q 1 n y\ 4- 3� t( say, Expansion tank 16.60
Address: J V S a S a - 6- ) � Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
( f ) 2 - a c o G , Garbage disposal 16.60
Phone: F ax: ( )
❑ 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 drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Water hcatcr ` 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
.
State surcharge (8% of permit fee)
Authorized signatur
el aga AV TOTAL PERMIT FEE a 9
Print name: I Is " /f y� Sw5� Date: 10 Oc This permit application expires if a permit is not obtained within
`1 9 0 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I.\ Building \Permits\PLM- PermitApp.doe 06/26/06 440- 4616T(10/02 /COM/WEB)
.a 2 \ .--v -aon-
*t 7.oN
o P
moo
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
L\ Building \Permits\MEC- PermitApp.doc 12/30/05 2
s
CITY OF TIGARD ��yy��
BUILDING DIVISION, PERMIT #
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /
Phone: (503) 639 -4171 / iii 10/7- 2- e /
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: / 3.<7 IME: PAGE:
SITE ADDRESS: Z /4C® i t/ >% 2 / / ( CLASS OF WORK:
SUBDIVISION: ! LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: niwy remhdie6frejvv-------
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
S t j - C59 9 e 3 X
Corrections/Comments/Instructions:
r
0)
PASS I, 'ARTIAL APPROVAL n CANCEL NO ACCESS
FAIL law INSPECTION ADDITIONAL FE S ASSESSED
i/ / v
Inspector: Or Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT k�0�o bO /`�'
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: �, �-y
Phone: (503) 639 -4171 uA i #: /`i�
l • 1 Q7�'/`' /0 4
all /
Inspection Requests (24 Hrs.): (503) 639 -4175 ,,,,,t11' __..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ----/ 4Q (5 A' /Lt 3 ��' `LASS dRK:
SUBDIVISION: LOT # TYPE OF USE:
PROJECT NAME:
DESCRIPTION: C J / ep C1
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # essage
7 7 x 03 a4 ® 5
Corrections /Comments /Instr do :
O_____ / - Z .-/ 0, ----
,At‘ (97lar- - 14-e--7 -
®mss 0 sb nL ...04._ i ®c; AIJ - '
Adr _lacdAll711
li
W . , i I W � /�% it k
/
PASS n PARTIA , 'PROVAL n CANCEL ❑ NO ACCESS
AIL n C, 70 , I '► ION I J ADDITIONAL FEES ASS SED
4
Inspector: r ' Date: / 4 ` 6 4e #: (503) 7 e-