Permit C ITY OF TIGARD PLUMBING PERMIT
°= COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00189
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/6/2008
PARCEL: 2S 103RD -01200
SITE ADDRESS: 12630 SW 121ST AVE ZONING: R -4.5
SUBDIVISION: NIX PARTITION LOT: 001 JURISDICTION: TIG
PROJECT: NIX PARTITION
Project Description: 480' of water service for two future lots.
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: ft
WATER CLOSETS: WATER LINE: 480 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
LOY NIX
12630 SW 121ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/6/2008 $240.60
[TAX] 12% State Surch 5/6/2008 $28.87
Phone : 503 -590 -4810 Total $269.47
Contractor:
POWER PLUMBING CO
P 0 BOX 19418
PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 244 -1900
FAX 503- 244 -8825
Reg #: LIC 52378
PLM 34 -150PB
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 o.• ain copies of
these rule irec .. estions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issu d By: Permittee Signature: , t /
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.
Plumbing Permit Application
Building Fixtures . , FOR OFFICE USE ONLY
City of Tigard Received Permit No.: I
a 13125 SW Hall Blvd., Tigard, OR 97223 Date /By: ����� p i / /� 0 ^ (�V
1 11 , - Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
y
Inspection Line: 503.639.4175 Date Ready/By: y /B 1 s: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description j Qty. Ea. 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
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
Accessory building SFR (3) bath 399.00
❑ ry g ❑ Multi- family
❑ Master builder III Other: Each additional bath/kitchen 45.00
Fire sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / of , 5 , tom 19, ii of_ Catch basin or area drain 16.60
City /State /ZIP: f / iiP= Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: I pq 2 % / 1 D I Footing drain (no. linear ft.: _ ) Page 2
X 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 de(' t' P
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
. DESCRIPTION OF 'WORK Backflow preventer Page 2
�� • ` n
1.- P � , L '� � 02_ # rC.0 j Backwater valve 16.60
.7--, Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: /1 • .. Expansion tank 16.60
Address: / '36 5 "} / z/ Fixture /sewer cap 16.60
City /State /ZIP: ---)-:(;.,--e7 `-Z O / Floor drain/floor sink/hub 16.60
Phone: () 5q - / 6 Fax: ( ) / Garbage disposal 16.60
❑ APPLICANT ❑ 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
Sink/basin/lavatory 16.60
Phone:
( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail:
AMP I Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: -- - = ;r��� Water heater 16.60
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Address: , r !q '
P C7 ! g Other:
City /State /ZIP: '1 J L . / 3 0 2 9 7A0 Subtotal
Minimum permit fee: $72.50 �'/ (pt Phone: (5 ) , cF 1_
Y`9QD Fax: ( ) Residential backflow minimum permit fee: $36.25 f/`T�
Plan review (25% of permit fee)
CCB Lic.: _ Pluming ic. no.:
�� State surcharge (12% of permit fee) 0 2,.8 ,V
Authorized signat . t 0 . TOTAL PERMIT FEE , �� ��
Print name: /
..... Date: 5-ArgLRi This permit application expires if a permit is not obtaiif *ithi �7
A
- 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 12/27/06 440- 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
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 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 Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture, Type: Replace engineer.
Previous Capped Added Existing, ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool • ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service • fees assessed for the sewer increase must be paid before the
Swimming PoofFilter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i \Building\Permits\PLM- PermitApp.doc 12/27/06
• - • -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008-001f39
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 51612008
Phone: (503) 639-4171 Aili
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/12/2008 TIME: 7:01AM PAGE: 28
SITE ADDRESS: 12630 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: NIX PARTITION LOT #: 001 TYPE OF USE:
PROJECT NAME: NIX PARTITION
DESCRIPTION: 480' of water service for two future lots. Future lot addresses: 12610 & 12590 SW 121st Ave.
OWNER: NIX, LOY PHONE #: 503-590-4810
CONTRACTOR: POWER PLUMBING CO PHONE #: 503-244-1900
Inspection Request Scheduled For: Date: 5/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Miter service 069696-01 503-590-3028
PeAL
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Corrections/Comments/Instructions:
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C o kiLit ( .- re) t.A.) 04..,-+eve (.■-) e,s-) VG, ; Peiv-Ad-r` c-3 ire- . ./CrtA-e-rA.
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14 PASS 0 PARTIAL APPROVAL El CANCEL ri NO ACCESS
0 FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: (31\evr.A-4 Date: (g) 17) Phone #: (503) 718-