Permit - CITY OF TIGARD
PLUMBING PERMIT
,;, DEVELOPMENT SERVICES
PERMIT #: PLM2004-00378
_. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/20/2004
SITE ADDRESS: 12525 SW 112TH AVE PARCEL: 2S103AC -03300
SUBDIVISION: MCMICHAEL HEIGHTS ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: NEW 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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing house to sewer lateral, approximately 40' , reversing plumbing under the house. Septic tank
to be pumped & filled.
FEES
Owner:
Description Date Amount
JOHNSON, MICHAEL B + VALERIE L
12525 SW 112TH AVE [PLUMB] Permit Fee 8/20/2004 $117.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 8/20/2004 $9.40
Total $126.90
Phone :
Contractor:
NORTH'S PLUMBING
17120 SW SHAW
BEAVERTON, OR 97007 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 649
Insp existing /capped fixtures
Reg #: LIC 340 Final Inspection
PLM 34 -18PB
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 -001 : : e You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -• .99.
Issu d By: ) i 1 '1 ` ' / 4, C � - a, Permittee Signature: , .. , � \ IL./..:_
I
Call (503) . 9-4175 by 7:00 P.M. for an inspection needed the ne t business of
Building Fixture
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received d ^„ / Permit LM 0 i _0037
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: j art'
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / /Hoar, nM ;h' Date/By: Other Permit No.: �. 1 . 7
24- Hour Inspection Line: 503.639.4175 , � � runs:
. ., Date Ready/By: E;3 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
.a r L as y i tS^ .x, E .
_o t L . � � �_:. -. � � _ � � � 1 F
� E SCHED
❑ New 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)
.om 1 i,,J , . - 4 , v tt "4»'..t. , t w �h. ,, „. , SFR (1) bath ■ 249.20 -
Ill - 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
�. 4 , 4 t I; a a r' t t ,
. : ,te e: L L . u ,, 1t#
.' _ ', '1 Site utilities
Job site address: ta. 5 S...W , U. , a, \le' Catch basin or area drain 16.60
City/State/ZIP: 1 j , 4 ' OR Ct-7aa3 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:
I b (pck soc4k eye 1 -tnuf @ ( la's . < Errol Manholes 16.60
Rain drain connector / 16.60
Sanitary sewer (no. linear ft.: ' , 7 `e) ) Page 2 55. GU
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
" ° i� : r ' y t ®r A . = - Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
„:. , v , s -^:75 s° Drinking fountain 16.60
- > • -:- .S - Ejectors /sump 16.60
Name: I 1 CVI f l 6, . «t L. ZO k hSm h
L Expansion tank 16.60
Address: 1 5a S ,. 03 . t I AK .Ave, Fixture /sewer cap 16.60
City/ State/ZIP: T .1}Ypt b 9L7aa3 Floor drain/floor sink/hub 16.60
Phone: 61)-3)5q. - gg. I 7 Fax: 03 )59'S - 77 Garbage disposal 16.60
1 d 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
d ; a _ ,),, - Water closet 16.60
Business name: D I ( 6 a /t- f /, . Water heater • 16.60
Address: / 7/ / 4-,O Other: i� 1I,'IL��_ • a' • •
City /State/ZIP: �� i) .f.)/2. 9 70o 7 Subtotal
Minimum permit fee: $72.50 /
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 ,/_' / I
CCB Lic.: � a Plumbing Lic. no.: Gq / ir P,8 Plan review (25% of permit fee) _
Jf� 3 � State surcharge (8% of permit fee) 9 ,e/0
Authorized signature: / / TOTAL PERMIT FEE q C •
Print name: Date: This permit application expires if a permit is not obtaine w hin
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
is\ Building \Pemuts\PLMF- PermitApp.doc 12/03 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
°«.. ` ` g Et aaactage� Fee;
Footing 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 trQN� PF, >l tee:
$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
! O 1Prgokii g 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
, 1 �'i s u ► ° rre 1 erfu °`t d ��
Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
- Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Building \Permits\PLM•PermitApp.doc 3/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
NORTH'S PLUMBING
17120 SW SHAW
BEAVERTON, OR 97007
Plumbing Signature Form
Permit #: PLM2004 -00378
Date Issued: 8/20/2004
Parcel: 2S103AC -03300 k
Site Address: 12525 SW 112TH AVE
Subdivision: MCMICHAEL HEIGHTS
Block: Lot: 005
Jurisdiction: R-4.5
Zoning: TIG
Remarks: Connect existing house to sewer lateral, approximately 40' , reversing plumbing
under the house. Septic tank to be pumped & filled.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for
the plumbing permit to be valid, please have the appropriate individual from your company sign below and
return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building
Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
JOHNSON, MICHAEL B + VALER NORTH'S PLUMBING
12525 SW 112TH AVE 17120 SW SHAW
TIGARD, OR 97223 BEAVERTON, OR 97007
Phone #: Phone #: 649 -5544
Reg #: LIC 340
PLM 34 -18PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X 4 )- a 14 : — Al r u —
Signature of Authorized Plumber
If you have any questions, please call 503.718.2433.
i" / '
j UP \
1 i
°' ,psi . x,
. N'''')(1V. ihis)noe\ .-
, „,„).- g )
'IV
,---'----------1K-79' .
LAW) , .. ;1" )
d
i
1
Li
-- I Ldig,,2 ,
/ate, • _I v, iii Si
......< 0,
2
.,
y
ALVIN No. 1242 81/2" x 11" 35 °16' ISOMETRIC
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / � — S AM PM BUP
Location t! •S_c I Suite MEC
Contact Person 4t1!/1., aP 1 Ph ( ) 6 �� —SS� PLM 4 d 4 1 - 66 3 78
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors ' ( 4 S
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
410 -
Susp'd Ceiling �� �r� % �—
Roof
Other:
Final
PASS
PLUMBING FAIL �= = ._ / / p ,
Post & Beam
Under Slab
Water Service
Water Se
Rain Drains � !/ '
Catch Basin / Manhole
Storm Drain
Sho , er Pan j
PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line
ADA /�j
Approach/Sidewalk Date `v i/ � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL