Permit CITY TIGARD PLUMBING PERMIT
, let , DEVELOPMENT SERVICES PERMIT #: PL 18/200 00640
nl± 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/18/2005
PARCEL: 25111 BD -00407
SITE ADDRESS: 14940 SW 96TH AVE ZONING: R -3.5
SUBDIVISION: DARMEL NO. 3 LOT: 017 JURISDICTION: TIG
Project Description: Replace kitchen sink.
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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GARY SMITH Description Date Amount
14940 SW 96TH AVE
TIGARD, OR 97223 [TAX] 8% State Surchan 11/18/200: $5.80
[PLUMB] Permit Fee 11/18/200E. $72.50
Phone : NA Total $78.30
Contractor:
REAMECH
30330 SW GRABEL RD. REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97124
Phone : 503 969 - 6252
Reg #: /4 N6
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 -..'9 or 1- 800 - 332 -2344
Issued By: ' / 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.
Building Fixtures _ N.
Plumbing Permit A p i tit im FOR OFFICE USE ONLY •
City of Tigard Ki I �J ZOOS Date/By. I l (15f(D'S 0 Permit NoNj 2 , ,pp ‘, %
13125 SW Hall Blvd., Tigard, OR 9722 . Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 "61, (u ; . „ I D ate /B y: Other Permit No.:
hrr�
24- Hour Inspection Line: 503.639.4175.ITY OF TIGARD ■ W. i 1 Date Ready/By: f 0 See Page 2 for
Internet: www.ci.tigard.or.us BUILDING r)I\/Igir"' Notified/Method: I. l Supplemental Information
' TYPE OF WORK - FEE* SCHEDULE '
❑ New construction ❑ Demolition • For special information use checklist
Description I Qty. I Ea. I Total
,! Addition /alteration/replacement ❑ Other:
New 1 dwellings (includes 100 ft. for each utility connection)
• - CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
lit 1- and 2- family.dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JO.B'SITE INFORMATION AND LOCATION = Site utilities •
Job site address: (Y y y 0 51,t, y' .ft„ no, Catch basin or area drain 16.60
City /State /ZIP: f r 1` 9 0, I o / q 7 1-2-67 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
[ 11� g / Manufactured home utilities 110.00
Cross street /directions to job site:
` � � / �-, S « 7 "T / C''- - ` 6 Manholes 16.60
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 OF WORK - Back flow preventer Page 2
(V t 0 Cl & ((/ C. P` C / Pt A Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ❑.TENANT
/ Ejectors/sump 16.60
' Name: 5 `v / 1Yl Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ 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/basin/lavatory t ( 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR - Water closet 16.60
Business name: R e . I 'AK-, Water heater . 16.60
Address: 3 o33 c S' ( 6=.'v.N 6 e• / R I Other:
[ J
City /State /ZIP: 14 s di" &♦ �/ 7/ Subtotal
permit fee: $72.50
Phone: (So.) ?' q 67_ ca. Fax: ( ) 1 -oio Residential backflow minimum permit fee: $36.25
CCB Lic.: I ( 7 / `- (3 7 . !L / /oc Plumbing Lic. no.3 -- 3' ? p� Plan review (25% of permit fee)
T 7 State surcharge (8% of permit fee)
Authorized signature:
LLLff O.
q
TOTAL PERMIT FEE 36
Print name: /.., p /w- y ( 4 /^/ J, C' / i 01 Z Date: (/ ^( f -Q,,c 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.
is \Building\ Permits\ PLMF- PermitApp.doc 06/05 440- 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) To 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: • • " `i `.,'
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 101' 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 $10,010.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 fort • first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additi . al $100.00 or fraction thereof; to
(minimum permit fee $36.25) 27.55 and incl :mg $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379. s for the first $25,000.00 and $1.45 for
eac , dditional $100.00 or fraction thereof, to
Inspection of existing plumbing or includin • $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.Coinplex Structures-
Are you capping, adding or replacing fixtures? I' "yes ", • `complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure o system that meets any of the following criteria.
accurately report fixtures could result in increased se er fees*. Please check all that apply.
' Quantity by (Fixture) Work Perfor ed a Any new commercial building.
Fixture Type:' Repl.. e ❑ Any new exterior plumbing site utilities.
' ' Previous . Capped Added Existin ❑ 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 l l Any new residential building containing three (3) or more
- Domestic MI- dwelling units.
Drinking Fountain
❑ y NFPA 13 - multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" ubmit 2 sets of plans with any of the above.
3
4 „
/
O
Car Wash Drain / ometric or Riser Diagram -
Garbage - Domestic / — 0 Isometric o 'ser diagram is required for new buildings
Disposal - Commercial , -- . three (3) or m. e stories in height.
-Industrial -� •
Ice Mach./Refri:. Drains,/
Oil Separator (Gas Station) Comments regardin: fixture work:
Rec. Vehicle Dump Station
Shower -Gang •
-Stall
N...
Sink -Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor .
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 \Permits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION 6) PERMIT #: PLivi2006-00640
.,,, '
13125 SW Hall Blvd., Tigard, OR 97223 / DATE ISSUED: I itia$2.005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/18/2006 TIME: 7:01AM PAGE: 65 -
f
SITE ADDRESS: 14940 SW 98TH AVE CLASS OF WORK:
SUBDIVISION: DARMEL. NO 3 LOT #: 017 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Replace kitchen sink.
OWNER: SMITH, GARY PHONE #: NA
CONTRACTOR: REAMECH PHONE #: 503-969-6252
Inspection Request Scheduled For: Date: 1/18/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 025162-01 503-598-7610
Corrections/Comments/Instructions:
/ I PARTIAL APPROVAL CANCEL NO ACCESS
FAIL Ft CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
•
Inspector: Date: I / 1 0 4 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005•00640
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/18/2006
Phone: (503) 639 -4171 /a�aadiryi IlI l a �
Inspection Requests (24 Hrs.): (503) 639 -4175 L_
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 34
SITE ADDRESS: 14940 SW 96TH AVE CLASS OF WORK:
SUBDIVISION: DARMEL NO. 3 LOT #: 017 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: 1ep kitchen- smk-__.1)
OWNER: SMITH, GARY PHONE #: NA
CONTRACTOR: REAMECH PHONE #: 503 - 969
Inspection Request Scheduled For: Date: 11/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 022029-01 503.830 -2414 N
Corrections /Comments /Instructions:
•
G '
VA' PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
IL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: / Phone #: (503) 718 -