Permit C ITY OF TIGARD PLUMBING PERMIT
Al ' DE VELOPMENT SERVICES PERMIT #: PLM2005 -00358
A , 1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/8/2005
PARCEL: 2S 114AD -01900
SITE ADDRESS: 16622 SW 88TH PL ZONING: R -12
SUBDIVISION: WAVERLY ESTATES LOT: 018 JURISDICTION: TIG
Project Description: Irrigation backflow.
CLASS OF WORK: OTR 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CONNIE HAWKING Description Date Amount
16622 SW 88TH PL
TIGARD, OR 97224 [PLUMB] Permit Fee 8/8/2005 $36.25
[TAX] 8% State Surcharl 8/8/2005 $2.90
Phone : 503 268 - 1524 Total $39.15
Contractor:
JAMES R. DENNY
PO BOX 230024 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97281
Phone : 590 - 1945
Reg #: LIC 5942
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 503-246-66' or 1 -:00- 332 -2344.
Issued By: I ! / • 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 r-- 'ED
Plumbing Permit Application C l OR Oil 1( i I �l. ()vI.1
City of Tigard LOOS Received e/g/ e / / Permit NLm�j ... 61-3563' 13125 SW Hall Blvd., Tigard, OR 97223
Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 TIGARD may Other Permit No.:
=
24- Hour Inspection Line: 503.639.4> DING DIVI �� I Date/By. � D ate Read yBy. El See Page 2 for
g u �N Notified/Method s: Supplemental Information
Internet: www.ci.tiard.or.us Sl
TYPE OF WORK FEE* SC
❑ New construction ❑ Demolition For special information use checklist
Description 1 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
Sk- 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
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: t� 22_ , (J, 5-6- -)� Q� Catch basin or area drain 16.60
City /State /ZIP: -/ ` /we: 0 fa_ 9 '7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 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 Backflow preventer / Page 2
T Th L de IT e elI A) Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER l ❑ TENANT fountain 16.60
�� Ejectors/sump 16.60
D rii
Name: Ce_1 r Expansion tank 16.60
Address: I 6 (p 2 Z S W g _Q,a 1 -- _ Fixture /sewer cap 16.60
City /State /ZIP: / / y 'Z� Q / i Floor drain/floor sink/hub 16.60
Phone: (5' Z 8-_ ) c 2 Lf- Fax: ( ) Garbage disposal 16.60
❑ `APPLICANT / 0 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
Phone: ( ) I Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail: Urinal 16.60
; CONTRACTOR Water closet 16.60
Business name: 7,{41.0 De-4/1X Lee-) ot'srit/26 Water heater 16.60
Address: (')-(. W 23 oo 2 Other:
City /State/ZIP: - 7 - / - 4 ,./.,e 0 C.)iC . 9 7 • 2 b / Subtotal
Minimum permit fee: $72.50
Phone: (6'03) T 0 ,9G� Fax: ( ) Residential backflow minimum permit fee: $36.25 , 3p . ea.
S / 4 � a � Pl review (25% of permit fee)
CCB Lic.: T � Plumbing Lic. no.: /'
State surcharge (8% of permit fee) �v
Authorized signature:
D TOTAL PERMIT FEE 5
Print name: all -e1 l C5 R. _ j)(4 A ' 1 Date: - y 0_5 This permit application expires if a permit is not obtained wi (hin
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 06/05 440A616T(1o/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 - l" 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: 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
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: each 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 Then 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 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 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 \Petrnits\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD _ - T wu2 CL S 10G6 4
BUILDING DIVISION I PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 zni I DATE I S
Phone: (503) 639 -4171 ttk i
Inspection Requests (24 Hrs.): (503) 639 -4175 / Z 0
c/ Z ^7
INSPECTION WORKSHEET FOR DATE: TIME: 2 PAGE:
SITE ADDRESS: 1 1,6 W g L. _ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: l< P HONE #:
nYl rr1 ■ Z 6 g 1 . � 7 `f
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1p /' /6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
( ) PI ___c
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t/Luk-- Date: V A7 Phone #: (503) 718- 7Y 2-7
Label Number: PL S 40994 N
Contractor Name: GEO A MORLAN PLUMBING & HEATi Properly Owner: KONNI HAWKINS ` Installed By: ERIC OLSON -
Phone: 503- 274 -1444 Phone Number: (503) 268 -1524 Installer License: 315WB1 No
Fax: 503 -265 -0538 Job Addr : 16622 SW 88Th P ' • Install Type: 1 & 2 Family
Address: 2222 NW RALEIGH " - Ai) 97224 Issued Date: 3/9/2007 0
PORTLAND OR 97210 Work Description: WATER HEATER . Install Date: 4/15/2007
License: 26 -60PB Insp Rpt Sent: 5/2412007
CCB: 2734 • Comment: leap Rpt Rcva':
m
Supv Lie: I 2 • /3rd Pass/Fail .2
o
SupvReg: p'! ❑ C/ n r--
Do.
Metro #: to
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BCD 11 OR LABEL PROGRAM - MINOR LABEL TRACKING FORM AND INSPECTION REPORT . 'T'
Phone: 503-378-2804 Fax: 503-378-2799
JURLSDICTIOM TIGARD, CITY OF minor label # PL S 40994 , D
Contact log - Three contacts must be attempted within five (5) working days of receipt. 4
Date Time Initials Results x
61 Z 6 7 ) 1 ' ' C' • ‘ '-- - 1 .1%/1'■- i 6,X)...)L z 6 vv--
, 62/k/ et. I te li i .
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❑ No Contact ❑ Owner Denied •
• If the owner is unavailable or refuses the inspection, the jurisdiction must notify fhe Service Center within 10 working days.
In Approved Date Approved: /6
If the inspection is approved, the jurisdiction must send or fax a report to the Service Center within 5 wor days.
0
0
. .,-
❑ Inspection Failed Dale Contractor Notified of Failure: o
0
If the inspection fails, the jurisdiction must notify the contractor immediately. Contractors who wish to dispute the inspection results - •4—
must notify the Service Center within 10 days of notification by the jurisdiction. Contractors who accept the failure determination must
call the jurisdiction for a re- inspection and pay the jurisdiction's hourly re- inspection fee.