Permit •
CITY . OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -10031
�It... DATE ISSUED:
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S104DD -02700
SITE ADDRESS: 12859 SW RIDGEFIELD LN ZONING: R -4.5
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT: 024 JURISDICTION: TIG
Project Description: Fixtures for basement finish.
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: 3 OTHER FIXTURES:
TUB /SHOWERS: 4 SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MANDY MOCK
12859 SW RIDGEFIELD LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/4/2006 $149.40
[TAX] 8% State Surcha 4/4/2006 $11.95
Phone : 503 -524 -3549 Total $161.35
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: j_ 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.
1 'Win Fixtures
4
Plumbing Permit Appli' � r":;"� _ , � . u l� r c: � 1 0 -4 OSE ()NM ' . . 4'1
�� , i� Received City Of Tigard Perm N o.
Tigard, OR 97223 Date/By: 3 i1� Ok v� O- X 006 -- /ads'
13125 SW Hall Blvd., Ti
g� ! P lan Review
. Phone: 503.639.4171 Fax: 503.598.1960 1 20 - 0 - !'r ,� ;; i .• Dale/By Other Permit No.:
24- Hour Inspection Line: 503.639.4175I[�� Date Ready/By: ®
s: See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGA' b ' Notified/Method: Supplemental Information
TYPL KDIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
si Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF. CONSTRUCTION SFR (l) bath 249.20
El 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
- JOB SITE INFORMATION AND LOCATION . Site utilities
Job site address: AN)Sr 3 h ' pi z ... Catch basin or area drain 16.60
City /State /ZIP: T -' p Q 9 7,2 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: v I Project name: a&Sp Footing drain (no. linear ft.: ) Page 2
/� Manufactured home utilities ■ 110.00
Cross street/directions tto job site: 4/4 //, k/ 'o
A 6,4/6/ f /J�a( Manholes 16.60
ae, ]t / e / Caard t -10 Rain 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 IPTION OF / WORK" / Back flow preventer Page 2
C rr ie Q par /i t �/ gm' 4ODt / /l9r°ilpyd Backwater valve 16.60
0 Clothes washer 16.60
Dishwasher 16.60
- 6 OWNER I ❑ TENANT . Drinking fountain 16.60
� / Ejectors/sump 16.60
Name: H ! t'c Expansion tank 16.60
Address: 9 S/v UV F, P /( L Fixture /sewer cap 16.60
City/State/ZIP: 7 a r a/ 0 9 7�,73 Floor drain/floor sink/hub 16.60
Phone: (503 ) 1:24- ,..T_S y 9 Fax: (S'03) .5.2 y. ,3,r y 9 Garbage disposal 16.60
Hose bib 16.60
0 APPLICANT - ❑ CONTACT. PERSON
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/ba avatory) 3 16.60 1 7, go
Tub /shower /shower pan el 16.60 %, yo
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60 ,? , z,O
Business name: Water heater 16.60
Address: Other:
City /State /ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 N q
CCB Lic.: Plumbing Lic. no.: Plan review (25 %ofpermit fee)
ill_ State surcharge (8% of permit fee) f to qLj
Authorized signature: TOTAL PERMIT FEE 1 ( 3'
o
Print name: i Date: X/0),‘ This permit application expires if a permit is not obtained within
/40 fr
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Permits\PLMF- PenniiApp.doc 06/05 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard r
Page 2 - Supplemental Information
`Fee Schedule:. Residential Fire Suppression Systems:
Site Utilities: Qty. Fee(ea) Total Square Footage: Permit Fee:.
Footing drain - I a 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer 1st 100' 55.00 3,601 to 7,200 $220.00
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: Per F
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
a dditional $100.00 or fraction thereof Fixture or Item: Qty Fee (ea) Total 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 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
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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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 El Any new commercial building.
❑ An new exterior plumbing site utilities.
Fixtuee Type: Replace Y P g
. 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
Drinking Fountain dwelling units.
Eye Wash
❑ Any NFPA 13 -D multipurpose fire sprinkler system.
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 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- PetmitApp.doc 07/06/05
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: m200310031
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 916/2006
Phone: (503) 639 -4171 •I � I t�t,
Inspection Requests (24 Hrs.): (503) 639 -4175 4 .,4! : _
INSPECTION WORKSHEET FOR DATE: 9/28/200i6 TIME: 7 :02AM PAGE: 11
SITE ADDRESS: 12E159 W RIDGFFIELD LN CLASS OF WORK:
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT #: 024 TYPE OF USE:
PROJECT NAME: MOCK
DESCRIPTION: Fixtures for basement finish.
OWNER: MOCK, MANDY PHONE #: 5033.5243549
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
339 Plumbing final 037325 -01 503. 524-3M,49 N
Corrections /Comments /Instructions:
PASS I I PARTIAL APPROVAL ❑ CANCEL 1 I NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: v Phone #: (503) 718- ��3/
CITY OF TIGARD -
BUILDING DIVISION
PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 61'16I.:C
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: (;;r TIME: 1:03AM PAGE: €;1)
SITE ADDRESS: 1 iiJ '1h CLASS OF WORK:
SUBDIVISION: MOL3i\f N C.1. it 2 LOT #: 0'24 TYPE OF USE
PROJECT NAME: MOCK
DESCRIPTION: wIrtt
OWNER: IVIOCV.. PHONE #:
CONTRACTOR: OWNEk: Ta5� -?q-- 77 PHONE #:
Inspection Request Scheduled For: Date: €'i;:6; Pour Time:
Code # Inspection Description Confirm # Contact # Message
PiUMLifrp, f0T2i1 trf)1A6 1 fiO3 :;( .;;;; 1
Corrections/Comments/ Instructions:
PASS 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
fl FAIL fl CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: kl V 1/46 Date: 61 Phone #: (503) 718-