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Permit .ti 71 : CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00083 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/4/2008 PARCEL: 2S 103CA -00307 SITE ADDRESS: 13200 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: WILSON Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #30. Fees paid 3/4/08. 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES RONALD & D WILSON 13200 SW 121ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 3/4/2008 $72.50 [TAX] 12% State Surch 3/4/2008 $8.70 Phone : 503 -590 -1680 Total $81.20 Contractor: OWNER REQUIRED ITEMS AND REPORTS Contact # : PRI 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. --1111111111mith / Issued By: �` J `` , �` ' • mittee Signature: I � I//� /j/ 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. Plumbing.Permit Application Building Fixtures FOR OFFICE USE ONLY /` at M g B dd /3-7)- / ! r l c ,g J City of Tigard Date Permit No.: i gL V 13125 SW Hall Blvd., Tigard, OR 97223 - y Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: S'ct- 'J - � Inspection Line: 503.639.4175 Date Read /B Juris. HI See Page 2 for TIGARD Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK d . FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description Qty. Ea. 1 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 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: ' 7_00 , A Catch basin or area drain 16.60 City /State /ZIP: 776,4 i6 7.7_-23 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 1 Project name: (tir 'f id l Footing drain (no. linear ft.: _) Page 2 v Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: /a) ) / Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 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 G r c - 7 L eA-,s1\ - . / ,e:ser-- Backwater valve 16.60 Sr c. /a „ V-/ ` � / / _ y / " t Clothes wash er 16.60 / �° F At /g Dishwasher 16.60 7 � + ❑ PROPERTY OWNER .. I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: ki . = l� _ / d Expansion tank 16.60 Address: j 2 2 . , l i 2,14 tiQ il � Fixture /sewer cap 16.60 City /State /ZIP: & v � r -- t ( j) 972 Floor drain/floor sink/hub 16.60 v �� Fax: Phone: (03) 690 - /4,13(:) Fax: ) Garbage disposal 16.60 ❑ 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 Sink/basin/lavatory 16.60 Phone: ( ) I Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR • ' Water closet 16.60 Business name: CX _/�E Water heater 16.60 Address: Other: City/State /ZIP: Subtotal Minimum permit fee: $72.50 �j Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 V V. � CCB Lic.: i j P, bing Lic. no.: Plan review (25% of permit fee) j State surcharge (12% of permit fee) 3 7v Authorized signature: �� �j _ t' 1 4 . TOTAL PERMIT FEE 8 /. ?c Print name: �io L i , O Date: 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 12/27/06 440- 4616T(10 /02 /COM/WEB) X r q / /Q t 1 _l Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information - „„ Fee Schedule: Residential Fire Suppression Systems: Site Utilities ' Q . Fee (ea) T 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 Qty. .Fe (ea) Total additional $100.00 or fraction thereof, to and Fixture orItem. 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 and including $50,000.00. specially requested inspections - per hour 72.50 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 Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed • Fixture Type: , Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918 780 - 0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040. -Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic • . . Drinking Fountain Isometr or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. - 4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet _ Urinal Other Fixtures: i:\ Building \Permits\PLM -Perm tApp.doc 12/27/06 f _ lib ;xis .AF 077 ,;,, �. ' SEPTIC SERInCE 1 4 RO.BOX 1130 ,. WILSONVILLE, OR 97070 (503) 682-1929 FAX (503) 5704719 CUSTOMERS / ORDER i PHONE DATE ' ) 4 © ee NAME oe19' /o_f !, L .5V ,� ADDRESS J 7 I 2 � It/• /t Z I E A P ° 3 6-,p0 fir a 2 SSOL Y CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT 4 d QTY. DESCRIPTION PRICE . AMOUNT pE Lo ., L c A ... TAX RECEIVED BY TOTAL 3 e5 4 ., 0 All claims and r nods MUST be accompanied by this bill. T 800 - 226.6380 or nebs.c:om THANK YOU • CITY OF TIGARD ' .. BUILDING DIVISION PERMIT #: Pl ^M 008 0008 43125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 314/2008 r Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: t3/15/2610E3 TIME: 7:00A i PAGE: $ r' SITE ADDRESS: 1.700 SW 121ST AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: WILSON i DESCRIPTION: Con necting existing house to sewer. Septic tank to be pumped and filled. Reimbursement #30. Fees paid 3/4/0B. OWNER: WILSON, RONALD & DIANE PHONE # : 503 - 590 -1080 • CONTRACTOR: (` WNER PHONE #: . Inspection Request Scheduled For: Date: 81151008 Pour Time: Code # Inspection Description Confirm # Contact # Message ;. 399 Plumbing final 074240 -01 503 - 969-9540 Y . Corrections /Comments /Instructions: ,` Cart 9/1, • • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: CM�'�'I' ►��-- Date: CZ` \ Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT Pi.M:00310:;03 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3fC:.(}i8 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 3/19/: 008 TIME: 7: 01 AM PAGE: 28 SITE ADDRESS: 11285 S!°J CAJE:I...t.E PL CLASS OF WORK: SUBDIVISION: GENESIS NO. 2 LOT 037 TYPE OF USE: PROJECT NAME: JAME=S:3ON DESCRIPTION: f'eplacernOnt of ;hover V ah!e. OWNER: JAME:SON, PHYLLI:a PHONE 603-6,21-2013/4 CONTRACTOR: BCAVERT(Aq PLOW0INt.? INC PHONE 50-3,643-7619 Inspection Request Scheduled For: Date: 3/1912068 Pour Time: Code # Inspection Description Confirm # Contact # Message Plumbing final Ot;593~i)'f 50-3-602-34,15 y Corrections/Comments/Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: y Date: sc ' /OVOI) Phone (503) 718- CITY OF TIGAR® BUILDING DIVISION PERMIT P1.102008.00'033 13125 SW Hall Blvd., Tigard, OR 97223 / DATE ISSUED: 3/u./2008 Phone: (503) 639-4171ir.G. Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 3/7/2000 TIME: 7:OftAM PAGE: 63 SITE ADDRESS: 11;.85 S!'Y CK)E:LLE Pl- CLASS OF WORK: SUBDIVISION: C E.NE.SIS 1140. 2 LOT 037 TYPE OF USE: PROJECT NAME: JAlv1ESON DESCRIPTION: Replaceinont of shmver valve. OWNER: JAMESON, Pl- YLLIS PHONE 503.62'1-200)4 CONTRACTOR: BEAVERTON PLUMBING ING PHONE 503--CA-~~7619 Inspection Request Scheduled For: Date: 3/712008 Pour Time: Code # Inspection Description Confirm # Contact # Mes e 320 f'fumlaing rough -in 06622GU'i 5t13C13 76 19 Y Corrections /Comments, Instructions / ❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: -5/--~ /4 I V Phone#: (503) 718- 2-,zy CITY OF TIGAR® BUILDING DIVISION PERMIT 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 Vvy - _C-p > h INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: I / 1~~+l ~V 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 ~v L P [A- u Corrections/Comments/ Instructions: 1J r, 0P11 c" /~VM c- ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Phone (503) 718- CITY OFTIGARD BUILDING DIVISION PERMIT PLm2oog=oc)03 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 q 1 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 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 ~oiv e S~ 3 (21 2 0T3 Corrections/Comments/Instructions: PASS ❑ .PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ~ ^,~~~V'-' Date: S Phone (503) 718-