Permit CITY OF TIGARD
PLUMBING PERMIT
,, , I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00130
:��I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/30/2005
PARCEL: 1 S 134CA -00503
SITE ADDRESS: 11205 SW 119TH AVE ZONING: R -4.5
SUBDIVISION: PANORAMA NO.2 LOT: 014 JURISDICTION: TIG
Project Description: Bathroom remodel.
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: 2 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
STRICKER, PAUL KAND TERESA J Description Date Amount
11205 SW 119TH
TIGARD, OR 97223 [PLUMB] Permit Fee 3/30/2005 $72.50
[TAX] 8% State Surcharl 3/30/2005 $5.80
Phone : 503 - 590 - 9272 Total $78.30
Contractor:
GEORGE DAVIDSON CONSTRUCTION
2265 NW 113TH AVENUE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97229
Phone : 503- 641 -2771
Reg #: LIC 136682
PLM 34 -357PB
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 or 1 0 2 -2344.
Issu G „./444 ii Permittee Signature: 6t-vPa 1W �
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
Plumbing Permit Application - .. .FOR OFFICE USE'. ONLY
City of Tigard Received / A �/ C
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: / Permit No. L �a�s �60,
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / GeNl l � rl +'� Date/By: • Other rm t No.:
24- Hour Inspection 64
ection Line: 503.639.4175 .� I .
p � � Date Ready /By: rt B See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: ' I
Supplemental Information
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,FEE S .CI3EDIIJSE
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. ,,.:�._ <,�a.E,�: -.`��' , A4, u"r.'ax:�;u�m�::.� �.�%t:.., e:, < ^a. <;�� »r.:,,,:.,: ,...,.c. ., .
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. Ea. Total
2 Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
;r '= a e $m:-4 ' ',, : -4,.m '.ar':: 't`sa i ° awi." ,te. .* , r r, •3• r mss"' „..:... ,,.::�a
.'' M1`k »_ "" 'r SFR I bath 249.20
rata ti fkl � T 92#, ; 9NSC ST RY, ®1: -. 1.MV �t ' : ,1 ()
'?�?,c�.`�€, . .. ae..A d,,. _.<. ".m�.�ss�'- a,��:a�;.„ n,.>.,- �,cw.�,c wz�au.t_ � .��', . ,,,a; �.n��z.�m.a�:.T�
PI: 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:
._ �ri, 'rrrk 2 ; w . a Fire sprinkler (_ sq. ft.) Page 2
r� " JOB STl'�E� 1341 P P TiIOIO AND �LO(�A ilia ""
ice" _�_�s � m. '�'N �Qs.� ..ws��� ..�s�`+ � �� :�.��� �� �. � �� Site utilities
Job site address: /1 ws S kJ 1) ei Catch basin or area drain 16.60
City/State /ZIP: -, ger- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: sme egszcv(i 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 '
Sanit 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.:
. ,�. . t .;_ ,; v ,r : ,. ,. a « _.';,.:. 4 - ..; : a; A bsorption valve 16.60
o ,. "° - {s , ° °irxp + , .�,. ° ° � tl , "�.x �. -'v nd> f „� " i ` °;�,Yw,FUa"." .
, , „ ,',,, iff l rel5 C&IPT a?;OF •151ii :� : ^.�� ~; g:.: 4; , "'z �`,r`` r ,' ; 1),,-
W, , I2 2'54 e,�'' .. r., . a v .. g. .a k . ,l � ..' Backflow preventer Page 2
l
n - OJ Z Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
�< t ., - _ ** co Drinking fountain 16.60
� tr � 1k ,° * : TENANT y ° = 4
.PS . ,vf" �° " "'€ 7= ` '. ,, wko 41,, ;" ° Ejectors /sump 16.60
Name: t,S-1 r. ki, L greitizerL Expansion tank 16.60
Address: I/ 2,07 9 ) 7 Fixture /sewer cap 16,60
City/State /ZIP: re Der Q 7 2 2 7 Floor drain /floor sink/hub 16.60
Phone: ( ) D 9 2.7 Z Fax: ( ) Garbage disposal 16.60
r� ` , r _ Hose bib 16.60
'k A �F� . a ,, t ,., ,C A' , T � . 4 - .1- o ,,e i t �w , !�CON�I'ACT EIt80iY
' 4' ' � 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
Sink/basin /lavatory 2 16.60
Phone: ( ) Fax:: ( )
Tub /shower /shower pan / 16.60
E -mail:
r; y ny * ace °: Urinal 16.60
1 ., - #. RACY OI2 ll.i .-
°, � ",u�.' . -_�' .' i �.?�,.�f ��,: �k���'•rwr � ..r..;�.� x�r1 _ :���� Water closet J 16.60
Business name: 60„,,,m, /, ADA, T 1,44. Water heater 16.60
Address: Z /� f f i/ gilt( Air Other:
City/State /ZIP: 140Vr ogr 9722Cj Subtotal
Minimum permit fee: $72.50 �' 9)
Phone: ( ) 913 6 1 /366 /) Fax: ( ) 503 4 N34433 Residential backflow minimum permit fee: $36.25
CCB Lic.: ' 34,6i Z Plumbing Lic. no.: 34,/- ?S 7
Plan review (25% of permit fee)
State surcharge (8% of permit fee) - CO ` C- Authorized signature: TOTAL PERMIT FEE 7g .
Print name: Gi C tett d^,f Date: 3 -30 -05 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:\ Buil ding\Permits\PLMF- PernutApp.doc 12/03 440- 4616T( 10 /02 /COM/WES)
Plumbing Permit Application - City of Tigard r
Page 2 - Supplemental Information r.
Fee Schedule: Residential Fire Suppression Systems:
te a,,- r ,, <: . :< s ... .:
.' .ti � ' . , ,. . - Tee(ea at - warm
, f _ _.
Site ilnnes r h g e wAtoMkrm�t F ee - -.
., ,.i' ,.c.k -'. '` - `'�� .- as2 � " - 4 ",;3 _. `» ,.d.;.., ,. IS VP :' r :z, g,W ,ee''�2t.
Footing drain - 1 s ` 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 _ °, ..,_-
aIuaton ' .,. P4ermif 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 $1.52 for each
ti*�- ' y� Fe e1a f do t'117$ additional $100.00 or fraction thereof, to and
��IX ALe4RI r Item V'' �� _; . ,, .. .� -t _- -s 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 * .
°� R Qu.0114 Prijiau e) t Y4t1 'erfoi'�r44
k txtureYPe v ro, '
Repae
, �Mevea � Ex,stm' Eappeax Comments regarding fixture work:
* x „=_: r,',/ Vi e - . �� s � � . 4�
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"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
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:
is\ Building \Pemtits\PLM- PermitApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006 -00130
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2005
Phone: (503) 639 -4171 mnoti if i
Inspection Requests (24 Hrs.): (503) 639-4175
WORKSHEET FOR DATE: 4/21/2006 TIME: 7:08AM PAGE: 27
SITE ADDRESS: 11205 SW 119TH AVE CLASS OF WORK:
SUBDIVISION: PANORAMA NO.2 LOT #: 014 TYPE OF USE:
PROJECT NAME: STRICKER
DESCRIPTION: Bathroom remodel.
OWNER: STRICKER, PAUL K AND TERESA J, PHONE #: 503 -690 -9272
CONTRACTOR: GEORGE DAVIDSON CONSTRUCTION PHONE #: 503 -641 -2771
Inspection Request Scheduled For: Date: 4/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 006066 -01 603 - 313-0014 N
Corrections /Comments/ Instructions:
•
•
•
JX, PASS ❑ PARTIAL APPROVAL ❑ CANCEL . ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Q��� "( Date: g/ 2 // 5 Phone #: (503) 718-