Permit PLUMBING PERMIT
OF � � � ITY � PERMIT #: PLM2006 -00355
fiR DEVELOPMENT SERVICES DATE ISSUED: 7/21/2006
-1., �
�J,P?,= 4T—;,r'" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 104AC - 03900
ZONING: R -25
SITE ADDRESS: 12647 SW 133RD AVE LOT: 183 JURISDICTION: R IG
SUBDIVISION: MORNING HILL NO. 8
Project Description: Backflow preventer for irrigation.
SF GARBAGE DISPOSALS: MOBILE HOME SPACES:
CLASS OF WORK: WASHING MACH: BACKFLOW PREVNTRS: 1
TYPE OF USE: SF
FLOOR DRAINS; TRAPS:
OCCUPANCY GS: R3 CATCH BASINS:
STORIES: WATER HEATERS: SF RAIN DRAINS:
FIXTURES LAUNDRY TRAYS: GREASE TRAPS:
SINKS: URINALS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MICHAEL STEFFEN Description
Date Amount
12647 SW 133RD AVE 7/21/2006 $36.25
PORTLAND, OR 97223 -4717 [PLUMB] Permit Fee $2 25
[TAX] 8% State Surcha 7/21/2006
Total $39.15
Phone : 503-521-1906 '10
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
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Contact # : � � �, ; , � j� '0 pi
Reg #: ( V A / 6 V'a
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a pp / cable laws. is w .All subject tot he
oneiin ac approved plans. Municipal
This permit mi w I State
expir if ok is not started with n days of
applicable laws. All work suspended be y the Ore
Usuanco, o tic ation if work C is en ter. Those rules are set forth0i days.
n OAR 952 001 -010 through OAR 952 - 0001-0100 You rules
may obtain of ion
Utility Nofic Center. Tse rul
these rules or direct questions to OUNC by calling 503- 246 -669 or 1- 800 -332 -2344.
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r� ! t
^� Permittee Signature: �, ., ,/� v r r
Issued By: l Pr , / .01... i �
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Call 503 - 639 -4175 by 7:00 a.m. for an inspectia at business day. i
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.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: PLM2006 -00355 REQUIRED ON GREEN INSPECTION CARD.
✓
Cod71 Inspection Description PASS Date By 1 ✓ Code Inspection Description PASS Date By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
_ 805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG Structure set-up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping •
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection: _
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan _
999 , Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 , Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill _ 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing X 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: _ 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I: \Building \Inspection Cards \Forms \AOP- InspCard- Blank.doc 12/09/2005
CITY OF TIGARD
PLUMBING PERMIT
ik DEVELOPMENT SERVICES PERMIT #: PLM2006 -00355
>+L` �=- DATE ISSUED: 7/21 /2006
�" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 104AC -03900
SITE ADDRESS: 12647 SW 133RD AVE ZONING: R -25
SUBDIVISION: MORNING HILL NO. 8 LOT: 183 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MICHAEL STEFFEN
12647 SW 133RD AVE Description Date Amount
PORTLAND, OR 97223 -4717 [PLUMB] Permit Fee 7/21/2006 $36.25
[TAX] 8% State Surcha 7/21/2006 $2.90
Phone : 503 -521 -1906 Total $39.15
Contractor:
OWNER
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: Permittee Signature: z„, /9
v
Call 503 - 639 -4175 by 7:00 a.m. for an inspectio at business day.
This permit card shall be kept in a conspicuous place on the job site until completion of th project.
Approved plans are required on the job site at the time of each inspection.
Building Fixtures
Plumbing Permit Applicata .- 1':,'5' x: 1. ,* ,tufb t't)It o,Fl lc �: *a0i�i c).-X-) , i t a
Q k ; City of Tigard 11 I L 21 20N Recei _ / . Permit N..: \. 1 0.9 / �
a 13125 SW HaII Blvd., Tigard, OR 97223�1v plan Rev - ,!
III Phone: 503.639.4171 Fax: 503.598.1960 ` ' ' ' • D Other Permit No.:
,• f 'J" c ^ 211 Inspection Line: 503.639.4175 Guy y o 1. � a Ready/By: ® See Page 2 for
fi,�ini-#irtgaic Internet: www.tigard- or.gov V , *, *. _ ,. , 1i I, otified/Method: Supplemental Information
• • TYPE OF r i' ' ` 1 " . FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
111I Description 1 Qty. 1 Ea. 1 Total
El Addition /alteration/replacement ti Other: Sprf t1F1e Y New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' • CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
f] 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El 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 2( j 7 5 w 133 ro4 Au Catch basin or area drain 16.60
City /State /ZIP: 17 0, Y di U ca 2.2_3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name:
Footing drain (no. linear ft.: _) Page 2
r Manufactured home utilities 110.00
Cross street /directions to job site: j 33 rd l ; Ao l W cA l AtA � -
�_ J Manhole 16.60
b Q'I' W &JL . ) 3 2 �Q g, 13 +~ Rath 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
DESCRIPTION OF WORK Back flow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
14 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
� �'(" L' Ejectors/sump 16.60
yr I
Name: I t ,kcs , I S�e -TT 1r` Expansion tank 16.60
Address: 1 2 uult.{ 7 5 (/V 133 ' f p t U .e- , Fixture /sewer cap 16.60
City /State /ZIP: 1-cal es r 4 l O 2 9 7 223 Floor drain/floor sink/hub 16.60
Phone: ( Ca l I Garbage disposal 16.60
($ 03) 5 l _ ) q p (p (5 5 2.1 �19 0 (P 15+ ) Hose bib 16.60
-
• ❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: (7uJ A.IZJv Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) 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: /� j Water heater 16.60
C/ ��f { Other:
Address:
Subtotal
City /State /ZIP:
Minimum permit fee: 572.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: 536.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:C Date: 7_ 2.1- Q( 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 omits \PLMF -Penn itApp.doc 04/06/06 440-4616T( 10/02/COM/WEB)
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: 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 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
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: $50,001.00 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 the food service area.
Dishwasher - Commercial ❑ Any 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 ermit results in an
Water Extractor p
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\Pennits\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD i./1 4 (
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Jagiglit 1 Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: l,I5 S. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: '' - `
_. WNR: .S ,S '4/ 0 L.. .a PHONE #:
CONTRACTOO y ... ,„ %4 s L , ( t PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
-Seq4 6 Ct. at • Ct AA) - -)2JS: C--t_ - "*"Lt■4,..-c
Corrections /Comments /Instructions:
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PASS A (-1":;#s- -1-- S T. S
El PASS P RTIAL APPR VA CANCEL � I No ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-