Permit •
CITY TIGARD PLUMBING PERMIT II
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00524
`! � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 2 S 115AA -09500
SITE ADDRESS: 16240 SW 108TH AVE ZONING: R -25
SUBDIVISION: SWARTWOOD PARTITION LOT: 002 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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
SWARTWOOD Description Date Amount
16260 SW 108TH
TIGARD, OR 97224 [PLUMB] Permit Fee 10/6/2005 $36.25
[TAX] 8% State Surcharl 10/6/2005 $2.90
Phone : 503 639 - 9203 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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: ,,e. / ✓ _L 4,) Permittee Signature. 4_rair‘ :i c.
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
REC
EIVED
ppl tioi i 2005 ' ; .
FOR OFFICE USE ot��l;�'�,
Plumbing Permit A
City of Tigard Received `v e /
1 SW Hall Blvd., Tigard, OR 2
iTY s 616 Permit No.: /�J'1�� --66,6
OF �1G.� Plan Review
Phone: 503.639.4171 Fax: 5 9 7�T DI VI 1 %;.,, Date/By:
Other Permit No.:
24- Hourinspection Line: 503.639.4 � � I .; . '�iI Date/By.
Date ReadyBy: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK _ FEE* SCHEDULE
- construction ❑ Demolition For special information use checklist.
Description I 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
at. 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: 1 G Z 2/ ( S GO 1 0 P 7 A-
Catch basin or area drain 16.60
City /State /ZIP: ` 7 t (7 ? 7 2 Z Drywell, leach line, or trench drain 16.60
ey Suite/bldg. /apt. no.: / " atleela 0 01 pet4_7<> d�
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: 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 •
r- e - -)a- eV J Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT" Drinking fountain 16.60
-^��- Ejectors/sump 16.60
Name: a e__ .e._ 'i,l') (�sr - t A) Q - d - 4 Expansion tank 16.60
Address: / & G Q S 0 / 0.- g fr, Fixture /sewer cap 16.60
City /State /ZIP: 17 / a C) , ' 7 2 Z y Floor drain/floor sink/hub I 16.60
( 3 ) 6 3 9 _ 9 - ZO 3
Phone: 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: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower %shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: � A ,.� Water heater 16.60
. Address: ` Other:
City /State/ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 (/p. a'
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signatur ` �Q� State surcharge (8% of permit fee) �,+ 90
='�1� Zt✓_ � �r,c TOTAL PERMIT FEE 3 ■ i 5
Print name: L7 C� .. 10 4,----fvoc-04 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 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) 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
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
. and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 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 .y
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.
❑ Any new exterior plumbing site utilities.
Fixture 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 - dwelling units.
Drinking Fountain
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
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 \Pctmits\PLM- PerrnitApp.doc 07/06/05
•
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: P114005-00624
13125 SW Hall Blvd., Tigard, OR 97223 &Air
DATE ISSUED: 1CV6/200t:,
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/24/2006 TIME: 6:68AM PAGE: FA
SITE ADDRESS: 16240 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: SWARIWOOD PARTITION LOT #: 002 TYPE OF USE:
PROJECT NAME: SWARTWOOD PARTITION
DESCRIPTION: Backflow preventer for irrigation.
OWNER: SWARTWOOD, PHONE #: 503-639-9203
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 026575-01 503-639-9203
Corrections /Comments / Instructions:
•
ASS Ei PARTIAL APPROVAL 0 CANCEL El NO ACCESS
El FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: v-( Date: Phone # (503) 718- I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2004 -00134
13125 SW Hall Blvd., Tigard, OR 97223 • ` DATE ISSUED: 5/26/2004
Phone: (503) 639 -4171 Aaaojvd
Inspection Requests (24 Hrs.): (503) 639 -4175 ''I'-
INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7:05AM PAGE: 65
SITE ADDRESS: .16240 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: SWARTWOOD PARTITION LOT #: 002 TYPE OF USE:
PROJECT NAME: SWARTWOOD PARTITION
DESCRIPTION: New SF
OWNER: SWARTWOOD, PHONE #: 503 - 639 -9203
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 017723 -01 503-639-9203 N
Corrections /Comments /Instructions:
/)
( 34 PASS " PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ( - CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: OTA ,% Date: // / Phone #: (503) 718 -
CITY OFfIGAR
BUILDING DIVISION PERMIT #: PLM200S -p0524
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/6/2006
Phone: (503) 639 -4171 ia i
Inspection Requests (24 Hrs.): (503) 639 -4175 AL
INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7:05AM PAGE: 66
SITE ADDRESS: 16240 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: SWARTWOOD PARTITION LOT #: 002 TYPE OF USE:
PROJECT NAME: SWARTWOOD PARTITION
DESCRIPTION: Backflow preventer for irrigation.
OWNER: SWARTWOOD, PHONE #: 503 - 639 -9203
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 017722 -01 503-639-9203 N
Corrections /Comments /Instructions:
1
4l
c.
/ ,;'
y ,
,. . - 0111111P- --/.-
•
4"1,SS 56 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL : LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector/ de Date: I D, 1 1 Phone #: (503) 718-
Inspections Required for: PLM2005- 005.24
✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG- Structure grading/footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors _ 199 Electrical final
•
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG Structure set-up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 _ Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 325 RP/backflow preventer
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing X 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection _ 599 Final inspection
I: \Building \IVR \InspCard- AOP.doc 06/17/2005
CITY TIGARD • • PLUMBING PERMIT
'i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00524
I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 2S115AA -09500
SITE ADDRESS: 16240 SW 108TH AVE ZONING: R -25
SUBDIVISION: SWARTWOOD PARTITION LOT: 002 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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
SWARTWOOD Description Date Amount
16260 SW 108TH
TIGARD, OR 97224 [PLUMB} Permit Fee 10/6/2005 $36.25
[TAX] 8% State Surchan 10/6/2005 $2.90
Phone : 503 639 - 9203 Total $39.15
Contractor:
OWNER 3
REQUIRED ITEMS AND REPORTS
Q
Phone:
Reg #: o
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: f✓ /d..G4/ZjJ___, Permittee SignaturQ� -��t ,,,- ,�,, -Gr
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.