Permit CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit#: PLM2013 00340
T(CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/30/2013
Parcel: 1 S126CD00100
Jurisdiction: Tigard
Site address: 9925 SW GREENBURG RD
Project: Crescent Grove Cemetery Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: Replacing 300 ft.of rain drains.
Contractor: JACK HOWK PLUMBING/RESCUE ROOTER Owner: CRESCENT GROVE CEMETERY
PO BOX 2830 CRESCENT GROVE CEMETERY
CLACKAMAS,OR 97015 9925 SW GREENBURG ROAD
TIGARD,OR 97223
PHONE: 503-639-5347
HONE: 503-850-3100
FAX: 503-491-2932
FEES
Quantity Description Date Amount
300 If Storm and Rain Drain 09/30/2013 $137.58
Specifics: 1 12%State Surcharge- 09/30/2013 $16.51
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $154.09
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By . _ermittee Signature: IP 1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
5EP-21-2013(FRI) 10: 00 office staff (FRX)503 491 2932 P. 001/004
Plulnhillg Permit Appiica . .
Building Fixtures - r; S:. �.. ::: :';
>, t� ✓ _.. . f'OR..ON7?fC.,,,USE,"O�'CY.: . „
City ofTignt•d1 ( 2013 Rccelvc>l
P 0 2 Received 4/? /'3 Pnnnil N.,a 13125 SW HuII ftivl "firiud OR 972(' N .. fi+/ t 17� O13• "a
Plan Rcvicw
.,i ,- Phone: 503.639.4171 Fax: 503. 9S.1960 I}gdLiV: 011,er Prnml No.:
inspection Line: 503.639.4175 CITY OF TIGARD _ - - •-
„TIGARD pale Ready/By: halo BI Sec Page 2 for
- • IrlterneC www.Iigard-orgnv 1 Nplilied/Mc!Iod:
±�� ": , - 'i, t. .l ty , Supplemental Information
.���! �t �';�,),1F,ti',:irtirii�t!l3.t`J,e,-�Y':,a r, .i •r•-y `S'4�G".,1..' �,,�d(( ,�11'L,(1•�I'"",.14. ,fl"' 4F�7�y"II t�Q�aS�pr ,a •1 n'+
°,tVli lVir P,1+''G'_,,•.,:__.,.,.:�'i,:i��i °�1 Ni0..i , ii'4 , 145 ';; 4 'r�tV1j15;7F.J',',4.g.' PS �1;��i;,..: t .. ~7!41+1 f'.Ali ,F r hO°4rdl��t�i ':lti,ii ." e:). ;ll.rs_„'t
�' 6 %,-.. ,:.. ,�y„L . t ' ' -4 1. ,a .�: ,. .. , . ..r...+,,'11. 11
❑New construction ❑Demolition For special information useehccklist
- Description I Qty. Ea. Total
)Addition/nitcration/replacement ❑Other: , New 1-2-family dwellings(inclurla 100 ft.for each utility connection)
l ���s�„�i."1'.!:i�",��':..�•r.�Tlr' w ->,�v le.�^�"rc�, �y mv>��.:� 7 rr.. 1'
'.1`' �t1+�14' 1! .f6>,:yi ll0,766RtV!----i0�t1 fr 11 ' lifJ�t4J W tsCx 1 17�1�I i`.i:,'-0�1;7• SFR(I)bath 312.70
�I� 1� { �l'kY. , ,,,.A.,' 4 1 • ,.3,:.,.:.a ?..h ' �ist°t1!1♦l1'>i.
❑ 1-and 2-family dwelling jrCommercial/indtrstrial SFR(2)bath _ 437.78
❑Accessory building ❑Multi-family SFR(3)bath _500.32
❑Master builder Other: Each additional bath/kitchen
hen age.2 -
0her:
�, ,, .,,, ,:a,>r:;-,cnr,:,rr*--�z Ciro sprinkler( +s.1.It)
pa c 2
� � P
...t t1 P. k,r;� ,..,, l Eni u�, l ICi ;,� ��,�•r:i, ��I '* �a� !". ; -
��rt,
i':.yl iii:-.-. i. K t,,,..�i:G�fT,..,. ,11, ,..1,'y.,,_. .'re.., E .r,; !.1,1 4 rt:',',P,, � !:;,1 Site utilities:
Job site address: 99�s 99-407- 3/ r /!" Catch basin or area drain _ 18.76 -
City/State/ZIP: Drywell,leach line,or drench drain 18.76
Suite/bldg./apt.rut.: Project name: v� Canting drain(nu.linear ft.: ) -Page:2
Manufactured home utilities _ 50.03
Cross street/directions u,job site' 4//� r°` !r Manholes _ 18.76
Rain drain connector ill, /iO1 18.76 .
. ., • -, Sanitary sewer(no.linear IL: ) Page 2
• •- Shona sewer(no.linear tt.:") ,t/V Page 2 �A..
Water service(nu.linear ft.: ) Page 2 .
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no Bacldlow prevented 31.27 =
"' a T 1�lzS`h F xG 'S,.p1.5"'"' a." "114,p�[rgy]'Q°�}m.a� 1,,"t 7'i�a ti !`^ }� On. Backwater valve
• tti tG:YII,iffarH)..,J:T•' ;1 IES1-Y E1'l'n�iS 'Uiilrg,5!II ,1�1, li i I `11b4biyt'�1�.j`}�;; 12.51
(' Clothes washer 25.02
.ice/ // .. g' d,� f,
'>' -..).../7- ������� _ i Dishwasher 25.02
/ r! t� Drinking fountain 25.02
���.,. . ^
-Ejectors/s ump ump 25,02 RIM
t r1 v t �v .y lit•.` u 7 `17.7 t C rr� r ; s.1 xy Expansio rink 1251
.ta �`^1.-4�i �: is;: I t
Name: - ' y`J f j �` 40.., 7.7=7 .7--;;;;,,, Pixture/sewer cup . . 25.02
r &,,,:a,
Floor ge disposal inlc/lmb . 25.02 =
Address: /.// � �'�
� � �� Garbage disposal 25.02
�/�d�'"/•S ��i. Hose bib
Phone: �3 re'-.110111.r.4 25.02
•+ la maker
"a1 i /,M TV.. t i(1F41 '�"1 x -, ,r.Sr , 13191`∎ rJ�w0., 41 interceptor/grease tra 15.01
,la,s t aStriv ,m>7a:rl �xyerizz 1• u1�;r/_l:'kw- t'i lk °>\,5,4.z .t-get& I'd trap 25.02
..:.3 ui>,.o„,. ,, arc_
Business name:ARS dba JACK HOWK/RESCUE ROOTER Medical gas(value:$ ) IM Page 2 -
Contact name:JOYCE DENNIS . •
Printer 12.51
= .
- Roof drain(commercial) 12.51
•
Address:Y.O.BOX 2R30 Sink/basin/lavatory _ 25.02 I=
City/State/LIP:CLACKAMAS,OR 97015 Solar units(potable water) 62.54
Phone:(503)850-3100 • Fax::(503)491-2932 Tub/shower/shower pan . IS 12.51
E-mail •DENIVIS®ARS,COl41 Urinal 25.02 =
`i F ; %.,45;7 0igg iii ti�u #i.r t '„ otitl ik41,, .11,., ;Li Water closet 25.02
1.a M F r 1. l:•:,,., ua.11W.t? . tt.,, �_ .w ,• L . T R
Wales.hcoter 37.52
Businese,name:ARS dba JACK 110WK/RESCUE ROOTER Water piping/DW V 56.29
Address:P.O.BOX 2830 Other: _ 25.02
City/StatetZIP:CLACKAMAS,OR 97015 Subtotal riirai'
Phone:(503)850-3100 Fax:(503)491-2932 Minimum permit fee: $72.50 -
Plan review (25%of permit fee) f
CCD Lie.:127325 Pit• bing Lie,no.:34-16RPR l/
State surcharge(12%of permit fee) ''R,j,/ w•
Authorised signature: /
i.*Prr
TOTAL PERMI FEE i.04/1 ;, '
Print name:JOYCE DENNIS Date:�/ -�r This permit application ekpirr:if a permit is nal ot>tn,� A�;rl °fj m J t7
, _ after It has been accepted as cumpl. I '
P115.3-g6- 'nee ntcthodulu�ry;:et by Tri-Cuuniy IlnildinF Inds. .
,H,dldinglPenuiiArL NU•PermilApp. .l 01 4aa•ab16T(iu14/---.,W3:„..7
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5EP-27-2013(FRI) 10: 00 office staff (FAX)503 491 2932 P. 002/004
Plumbing Permit Application - City of'rigaal-ci • - •
. Page.2,-.Supplemental Information.-... ....,.
l+cc Schedule:
_ � �; Residential Fire Su �ressi_ovny.Systems: s
1C ':;1....,'r ti .N. jl a{K`' I�, 1.,'.,...,; 1i.,k:s�.1-lrc:,llt' '1 •T rink �t, i �t.�T-4i4'i li!'A4ii`7.17C�I,r '�h a.� .-•Y�h :-6tii'
Footing drain-I'100' 50.113 O to 2,000 _ $121!00
Footing drain-each additional 100' 37.52 2,001 to 1600 $169.6')
Sewer- 1st 100' 62,54 3.601 to 7 200 $233.20 _�-
7201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54 Medical
Water Service-each additional 100' Gas S stems
37.52 S�y�Vs7lC7 r� 0 !�����i�1'����1 ,err, ,�1 i. ��Nyrr�,n'.�FIiy1�"�rr"1 3f.t�:��t1's• '*
Storm&Ruin Druin-I st 100' fFJ Jul 6zsn �r ,,,,..�to$i G ;.�i.�e'mil'• n a+/"_t fcc$7 °f JL.',>.:':<>.is 11,"..?Yv t„'�11;
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Ruin Drain-each additional 100 r' � e r� ( $5,001.00 to$10,000.00 $72,50 for the first$5,000.00 and$1.52 for
tr ,i r each additional$100.00 or fraction thereof,to
'�-�'I-A"L and including$10.000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000,00 and$1.54 for
which no fee is specifically indicated 90.00/1ir each additional$100.00 or fraction thereof,to
(minimum charge- I2 hour) and including$25,000.00.
Inspections outside of normal business 90,00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum Charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fccs 90.00/hr = and including 350.000.00.
Additional plan review for revisions 90.00pr ' $50,001.00 and up . $742.00 for the first$50,000.00 and$1.20 for a
minimum charge- I2 hour) _ • -. • each additional$100.00 or fraction thereof,
Subtotal: _r .rs I. • , .
Commercial_Fixture Work:
Are you capping,adding or replacing fixtures? If"yes", f:', �' ��I ttrl y -+ �<t ✓i r yy;9 1� l" 1y d� i§m� 'i' S�'�'•
.'',, .1.a...1�.:��a,�d`���6�r 1��e�11f�IC•1,�1�,'t„i.4!!i�v��j;r.�J1�•��it-N-a���.lJ��.�?,�%��°�I
please indicate work performed by fixture_ Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
:.1 taiw t•v.,r7 r 71.S�. i lir E T4n�Nl 4 t,r.,7 t r l rr s;T ❑ Any new commercial building with water sery ice 2»
and
'ill r 0 7� ∎; r „!V. ''zwr �aia C7�f. Y7 ( Y greater,except systems designed and stamped by licensed i m.ra=, .v,...... ,.1 F' .rui�,i 415 0"u.,: •tiYl(i hc:111T:zru:al.
engineer.
Baptistry/Font •
Bath -TuWShower' .• . '. CI New exterior plumbing site utilities for any complex structure .
. -lacuzzl/Wirlpool • • , . as defined in OAR9)8 780-0040.
Car Wash -Each Stall • i ❑ Medical gas and vacuum systems for health care facilities.
Drive ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918-780-0040, •
Dishwasher, . -Commercial .
oomcstic Submit 2 sets of plans with any of the above.
Drinking Fountain •
•
EyeWEye Wash �- p,„...T.Te t ya7;t1;.wr ti: �`7tr T .4 ,"7 rr .i i rr« a. Ala+r 1'117.7
Drain/sink 2 (:y .1$:,,i .41p)"'3.g..Z'.*7)9.1S-4.4. -1'.cLllrt:t�! P. : ILT:n��
2
• Isometric or riser diagram is required for new buildings
-4" . that meet the II ualifications above.
Cur Wash Drain .
Garbage -Domestic
Disposal -Commercial
_ -Industrial Comments regarding fixture work:.
Ice Machikctfig.Drains •
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang
-Stall .
Sink -Bar/Lavatory
-Bradley ~i
-Commercial *Note: If the fixture work under this permit results in an
Service increase of sewer EDUs,a sewer permit will be issued and
3wimming_Pool Filter
Washer-Clothes fees assessed for the sewer increase must be paid before the
water Extractor ' r plumbing permit can be issued.
Water Closet-Toilet
Urinal -
Other Fixtures:.
weep://www.tigard-or,gov/city_lull/depattments/cd/doc/PLMF-PemtitApp7doe
SEP-27-2013(FRI) 10: 00 office staff (FAX)503 491 2932 , P. 003/004
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