Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00159
TaGARI? 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/17/2008
PARCEL: 25111 CC -09400
SITE ADDRESS: 15720 SW GREENS WAY ZONING: R -12
SUBDIVISION: SUMMERFIELD NO.2 LOT: 121 JURISDICTION: TIG
PROJECT: BROWN
Project Description: Repipe entire condo.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SFA 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: ft
WATER CLOSETS: WATER LINE: 275 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JEFFREY M. BROWN
15720 SW GREENS WAY Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/17/2008 $147.80
[TAX] 12% State Surch 4/17/2008 $17.74
Phone : 503 -291 -9191 Total $165.54
Contractor:
AAPPLE PLUMBING
PO BOX 1543
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 936 -7461
FAX 503- 647 -2736
Reg #: LIC 104311
PLM 34 -308PB
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 rule ct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu d By: k 0 �i,�'i IL��L 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.
Pluming Permit Application
Building Fixtures ' ' ... 't ; OR OFFICE USE ONLY. F ' x b Fl r "w ' ,
I� c � t� 1 "i Received � 4 * ��,�,,
��' �w j j City Of Tigard d Permit No.: L t�C/v •a2 /59
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l q 13 125 SW W Hall Blvd., Tigard, OR 97223 Plan Re :
� C Other Permit No.:
Plan Review
a y Pho ne: 503.639.4171 Fax: 503.598.1960 Date/By:
�
p Date Ready/By: See Page 2 for
,1 Inspection Line: 503.639.4175 Internet: M�/a PP
lemeutal
?+.,;;.,y Internet: www.tigard- or.gov Notified/Method: Su Inform ation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. Total
*Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
l- 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: s Tao sc.,...) 6— freers L�R� Catch basin or area drain 16.60
City /State /ZIP: vi iL7 D 2 G -) ?-D—Li Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: swwyte,...6 CZ R DAZI VC-- Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) 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
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1 16.60
0 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: EK,h g ROiA/K) Expansion tank 16.60
Address: lc a O /ow 141 kii- t to a( a. Fixture /sewer cap 16.60
City /State /ZIP: Foy_Tha -y 4 p i, '' -1?-2-1 Floor drain/floor sink/hub 16,60
( 0)2, ) vZq j . q j
Phone: 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: ( ) Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: A ti � ic..._ Water heater 16.60
Address: 6 6d x l .(l i, Other:
Cit /State /ZIP: Ni Subtotal
y ``I U ) �p �� Z�
/ v Minimum permit fee: $72.50 go
Phone: (S ) .SD L- ctC (G Fax: ( ) • Residential backflow minimum permit fee: $36.25 ���
CCB Lic.: /6 y3 // Plumbing Lic. no.: 34 -3og Plan review (25% of permit fee) —6--
State surcharge (12% of permit fee) 17, 7 4'
Authorized signature:XLv � 7• i
ci// 7/o
TOTAL PERMIT FEE /4)5%
Print name: 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- 46t6T(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
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 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 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 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 ( 1 •
Drinking Fountain Isometric or Riser Diagram •
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic i ( Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall I
Sink -Bar/Lavatory 3 3
- 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 c�
Urinal'
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION V PERMIT #: PI_iVfZpflt$00Th9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ., • , R ;+ t2
Phone: (503) 639-4171 .
Inspection Requests (24 Hrs.): (503) 639 -4175 "'!� J �
INSPECTION WORKSHEET FOR DATE: 2J2 /2009 TIME: 7.03AM PAGE: 1
SITE ADDRESS: 15720 SW GREENS WAY CLASS OF WORK:
SUBDIVISION: Sl•1MMERFIELD No.2 LOT #: 121 TYPE OF USE:
PROJECT NAME: EiRf)WN
DESCRIPTION: ftepipe entire condo.
OWNER: BERMAN, JEFFREY PHONE #: 503 291 - 9191
CONTRACTOR: AAPPLE PLUMBING PHONE #: 503 - 936 -/4(31
Inspection Request Scheduled For: Date: 212&2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
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cr_ 320 Plumbing rough -in 080876-01 503-314-0341 N
Corrections /C ments /Instructions: 0
.:,/,.;./.(4/24/4.•ketA)44. ,....7,40...6
mas __2
0
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n '42 OC
Ii de . /3 q ❑ PASS ❑ PARTIAL APPROVAL V CANCEL ❑ NO ACCESS
4111 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
c y Inspector: Date: la #: (503) 718 -�