Permit CITY TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00407
..� II DATE ISSUED: 9/5/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 BD -00503
SITE ADDRESS: 14820 SW 98TH AVE ZONING: R -3.5
SUBDIVISION: DARMEL LOT: 002 JURISDICTION: TIG
Project Description: Connect existing house to sewer lateral. Septic tank is to be pumped, filled and inspected.
Reimbursement District fee paid this date.
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: SEWER LINE: 120 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
NORA/MARTY LOWERY
14820 SW 98TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 9/5/2006 $101.40
[TAX] 8% State Surcha 9/5/2006 $8.11
Phone : 503- 620 -5404 Total $109.51
Contractor:
MAC'S PLUMBING LLC
7262 SW NEVADA TER
PO BOX 19031 REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97219
Contact # : PRI 503- 849 -9531
FAX 503- 244 -6553
Reg #: LIC 75121
PLM 26 -670PB
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 y: ��) 60 6C4A Permittee Signature:
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 11SIi. OiONLY (,
City of Tigard Date /By. ► 6 ® � , lj Permit No.: I) !!� ! �v _66 6-7
Ill 'I 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C . Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit No.: c 5w2 /i67 X2/3
Inspection Line: 503.639.4175 Date Read /B � ° 10 See Page 2 for
T I C n K l7 Internet: www.tigard or.gov Notified/Method: � t C. Supplemental Informat
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition
' r For special information use checklist.
`. . V : Description I Qty. I 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
" Al- 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: / Std.) 1R - A Catch basin or area drain 16.60
City /State/ZIP: 71. )j q 7aaci Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: VV I Project name: Footing drain (no. linear ft.: ) Page 2
Cross street /directions to job site: q `, , Manufactured home utilities 110.00
l A�` /AA,' Aila oles 16.60
q..*.,. h •. ! M. . , , 1. aia draip connector 16.60
V Sanitary sewer (no. linear ft.: Page 2 /6/ , 4
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 (/�� Back flow preventer Page 2
ct_w 41 er ' K va later k ek 1tIoID.ieti9 ka Backwater valve 16.60
'-.I !; �/OP, -1- - Q1►Gt- ce ?Fe?c �Y .d f -f e_ s f tee f Clothes washer 16.60
d , ` r /a0 �,,,L Dishwasher 16.60
!7/� t . Drinking fountain 16.60
PROPERTY OWNER I 0 TENANT
4,---6, D S� Ejectors/sump 16.60
Name: a4) tJ0 ,..,,,, G tue Expansion tank 16.60
Address: r9 7 A Fixture /sewer cap 16.60
City /State/ZIP: ciel 17 9a9 Floor drain/floor sink/hub 16.60
Phone::o3) 10,0 Sq./05/ Fax: ( .-j-- Garbage disposal 16.60
❑ APPLICANT CI 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: in aC. k1. PI u w6 11,1 Water heater 16.60
1
Address: 7,2_4' a__ St, tU,vca 7j.T. - Other: Subtotal
City / State/ZIP: Po r + 1,„,,Q R emi CP
Imo° 1 Minimum permit fee: $72.50
Phone: 663) g T q• .. 95 3 ! Fax: ( ) a Residential backflow minimum permit fee: $36.25 /n/
G
CCB Lic.: 47 l oC_[ Plumbing Lic. no.: Plan review (25% of permit fee) -- 0
7/! tog State surcharge (8% of permit fee) S //
Authorized signal e: ,y�� TOTAL PERMIT FEE /69, 5/
Print name: //' / cti L 6 � e v c Date: Wd y This permit application expires if a permit is not obtained within
Y 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \PermitstPLMF- PermitApp.doc 04/06/06 4404616T(I0/02/COM/WFB)
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 - l a 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
CP 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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 thereol:, 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
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
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.
7 - � ° I� S u�
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 ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA I3 - 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 \Pennib\PLM- PermitApp.doc 07/06/05
l 1
CITY OF TIGi4RD;;; VO-no0(0,_boLoi Q
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 75alt
Inspection Requests (24 Hrs.): (503) 639 -4175 ,..'
INSPECTION WORKSHEET FOR DATE: ` /"f F7 TIME: PAGE:
SITE ADDRESS: 1 L A c5 q, c( 44 . : ' '''
CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #: .
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
360
Correction /Comments /Instructions:
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.PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: q),Al. . t
Date: / /o 7 7 Phone #: (503) 718- -"Z'''Y Ly