Permit .ten CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00386
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/1/2008
PARCEL: 2S109AA - 00600
SITE ADDRESS: 14275 SW 125TH AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: GEARHART
Project Description: Installing (1) sump basin, 100 ft. of sewer line and (1) sump pump. COMPLETING JOB STARTED
BY OTHERS.
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: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
OWNER INFO SUPPRESSED
14275 SW 125TH Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/1/2008 $88.20
[TAX] 12% State Surch 10/1/2008 $10.58
Phone : Total $98.78
Contractor:
RIVER CITY ENVIRONMENTAL
PO BOX 30087
PORTLAND, OR 97220 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 252 -6144
FAX 503- 288 -3658
Reg #: LIC 147355
PLM 26 -789PB
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 -00 100. 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
(PP I A I
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
. Builfling Fixtures O FOR OFFICE USE ONLY
Received
City of Tigard `� Date/By: Ar , 7 S Permit No.. A `'Y _'fk
• 13125 SW Hall Blvd., Tigard, OR 97 Plan Review
■ Phone: 503.639.4171 Fax: 503 ., Date/By: Other Permit No.: 1
Inspection Line: 503.639.4175 C� \ V ate Read By: l uris: 0 S ee Page 2 for
Pa
TIGARD P Y B
Internet: www.tigard- or.gov - . `Aotified/Method: Supplemental Information
TYPE OF WORK '` X.4' `�j�. FEE* SCHEDULE
❑ New construction ❑ DNton•.'` For special information use checklist.
. Description J Qty. I Ea. I 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
IEK 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: 1 ya15 3 W ` 1 I5 t " '41/ Catch basin or area drain I 16.60 WO 0
City /State /ZIP: 0 t n es 722,3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 1 10.00
Cross street/directions to job � site:
J �(, � r , ,� Manholes 16.60
1 4-- o 1' ��^" 5 f Z f / /ElO on) SH Rain drain connector 16.60
CA1 '(, Nos L s7' 1 `- N® � / �V/Manitary sewer (no. linear ft.: e) /17 Page 2 5 5, 00
et."( � V
,�+ L , v �� ��� /�� e ,„ sewer (no. linear ft.: ) Page 2
` Subdivision: �rO/ GU Y11 e•tG/ ! �hI
t no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: U S 7SS e . L t 7 L i b . . / '
Absorption valve 16.60
DESCRIPTION OF WORK p , Backflow preventer Page 2
R/ii�u I' d; LUX W, Do 1,16 . h y , A.0-ii 4 Backwater valve 16.60
We 4 / /a.,, U 4) y Clothes washer 16.60
r . We
/ ()y (J �, I , ( ,/� Dishwasher 16.60
[PROPERTY OWNER `/`/ ❑TENANTsy Drink fountain 16.60
Ejectors /sump / 16.60 6. &O
Name: 30\..lM 6EAtZ1...1A Expansion tank 16.60
Address: 1 n 5 5u3 125-M A vE, Fixture /sewer cap 16.60
City /State /ZIP: Q 1 tO 0 iz,.. 997-23 Floor drain/floor sink/hub 16.60
Phone: (505 Co Z - l� Z'� Fax: ( ) \! Garbage disposal 16.60
����
APPLICANT ❑ CONTACT PERSON Hose bib 16.60
` V t � � E. 1 M e Ice maker 16.60
` K �1 AJ v,�`
Business name: 'V
[7 ` Interceptor/grease trap 16.60
Contact name: y �j C, Medical gas (value: $ ) Page 2
Address: 1120 (� �� y�/� �� Primer 16.60
City /State /ZIP icTLAK.,0 02. 9 701 Roof drain (commercial) 16.60
Phone: (
2 � (44 52- ' � I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
(.��
E -mail: N.41 �} F+- 533 339 /55 Urinal 16.60
CONTRA R Water closet 16.60
Business name: /f4() UM , b f Ze)/'"il kt/y Water heater 16.60
Address: Other:
Subtotal B . ...C(J
City /State /ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 •
CCB Lic.: ! 4 7 Plumbing Lic. no.: 2 - ' Plan review (25% of permit fee) ■
Is State surcharge (12% of permit fee) /0.
Authorized signature: �y,� ,�G TOTAL PERMIT FEE a 6'73'1
Print name: L (� Date: I i p�EJ p This permit application expires if a permit is not obtkinc.,
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMF- PermitApp. doe 12/27/06 440- 4616T00/02/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 S,,(Y) 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
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
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 Isometric 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:
is\ Building \Pennits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
r _
BUILDING DIVISION PERMIT #: Pt..M200B-003136
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/1/200B
Phone: (503) 639-4171 • 14 11\
Inspection Requests (24 Hrs.): (503) 639
•
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
10/10/2008 7:00AM 50
SITE ADDRESS: CLASS OF WORK:
14 TH AVE 275 1-31A1 125
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GEARHART
DESCRIPTION: IrislaIling (1) sump basin, 100 ft. of sewer line and (1) sump pump. COIVIPLEBNG JOB STARTED
BY OTHERS.
OWNER: PHONE #:
OWNER INFO SUPPRESSED,
CONTRACTOR:. PHONE #:
RIVER CITY ENVIRONMENTAL. 503-252-6144
Inspection Request Scheduled For: Date: Pour Time:
10/1012008
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 076511-01 503-339-4989
Corrections /Comments / Instructions:
vi Aice, I Re ‘• cc in, 6, I I.
AA ve ; t.-/t-- •
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• •
•
O PASS 0 PARTIAL APPROVAL NI CANCEL LII NO ACCESS
• FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: db\-0..k,-M\\ Date: .) \ t)7, Phone #: (503) 718-