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Permit CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00148 �� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/14/2005 PARCEL: 2S103BB -00900 SITE ADDRESS: 12515 SW 124TH AVE ZONING: R - 4.5 SUBDIVISION: BROOKWAY LOT: 009 JURISDICTION: TIG Project Description: Repipe water lines in house. Charging for 1 hour of inspection time. 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 HOLCOMB, FRED 12515 SW 124TH AVE Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 4/14/2005 $72.50 [TAX] 8% State Surchan 4/14/2005 $5.80 Phone : 503 -524 -8985 Total $78.30 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 -t forth in OAR 952 - 0001 -4 ! ! hrough OAR 952 - 0001 -0100. You may obtain copies of these rules or d� -stions to OUNG% calling :03-246-6:19 • 8/i i- 332 -2344. Issu =d By: / & 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. Plumbing Permit Application F0I2 OFFICE USE ONLY DateiBy. �__.' City of Tigard DateB / Permit No.: ' . or �� • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 /� ,p;�_�� ,: � Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 _a 1 � i Date Ready/By: �run ' El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method `! ,c, Supplemental Informat TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total k Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 4 1- 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: 1 5 J Z �� Catch basin or area drain 16.60 City / State/ZIP: T L/ 12 1 1` 9 - - 422 /j Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: 1 �7 Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: LN (tT 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 Back flow preventer Page 2 IW__ % _ . 1 % . 1 ,4 °_s s , P • Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 El, PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: ."-Re D 1_1 b L LD 1v] Expansion tank • 16.60 Address: I I s S1 124 - Ave. Fixture /sewer cap 16.60 City /State /ZIP: Tic061 je,n OR_ 772 Z'7" Floor drain/floor sink/hub 16.60 Phone: &3 ) S2_4 vjg5 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 Phone: ( ) I F ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: 1 L Water heater 16.60 Address: Other: Subtotal City /State/ZIP: O Minimum permit fee: $72.50 Phone: ( ) �� Fax: ( ) Residential backflow minimum permit fee: $36.25 7a .5 I Plan review (25% of permit fee) CCB Lic.: Plumbing Lic 5 �') / �'� State surcharge (8% of permit fee) 51 t Authorized signa �_� a •. . �, `� 7 • 2y) TOTAL PERMIT FEE 5°) Print name: ii ,6 - • ► . Date: M©!j 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\PLM- PermitApp.doc 12/03 440-4616T(l 0/02/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 700' 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 * . Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved Existing capped Comments regarding fixture work: Baptistry /Font Bath - Tub /Shower 2. - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic T 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 3 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 Z Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: - i.\Building\Pennits\PLM- PermitApp.doc 3/03 CITY OF TIGARD -t . BUILDING DIVISION PERMIT #: PLM2005 -00148 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2005 Phone: (503) 639 -4171 /�mu�oullny�u i '\ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/20/2005 TIME: 7:11AM PAGE: 52 SITE ADDRESS: 12515 SW 124TH AVE CLASS OF WORK: SUBDIVISION: BROOKWAY LOT #: 009 TYPE OF USE: PROJECT NAME: HOLCOMB DESCRIPTION: Repipe water lines in house. Charging for 1 hour of inspection time. OWNER: HOLCOMB, FRED, PHONE #: 503 -524 -8985 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 4/20/2005 Pour Time: • Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 004940.01 50:3- 524 -8985 N Corrections/Comments/Instructions: ' Atil /40 , -v - /--- e_ - i • Or ... C a," :r al PASS ❑ PARTIAL APQROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (°(/ Date: 6 i Phone #: (503) 718- , Inspections Required for: L 4/g 11 2'6105 so ✓ Code Inspection Description PASS Date By 1 ✓ Code inspection Description PASS Date I By BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground /slab cover __ 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service /reconnect . 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 — _ 1 220 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 _f 240 Exterior sheathing 245 Firewall 250' Roof nailing ELR - Restricted Energy Permit h 255 Wtr proofing basement walls 135 Low voltage 2_60 Tilt up panel 195 Misc. inspection: 265 Masonry 199 Electrical final _ 270 Reinforcing steel (rebar) 275 Framing _ MFG- Structure set -up MEC - Mechanical Permi — 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 3.10 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 I Misc. inspection: 205 Footing ■399 I 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 02/02/2005 CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00148 � •���` DATE ISSUED: 4/14/2005 "" " 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103BB -00900 SITE ADDRESS: 12515 SW 124TH AVE ZONING: R -4.5 SUBDIVISION: BROOKWAY LOT: 009 JURISDICTION: TIG Project Description: Repipe water lines in house. Charging for 1 hour of inspection time. 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 1 HOLCOMB, FRED Description Date Amount 12515 "SW 124TH AVE TIGARD, OR 97223 [PLUMB] Permit Fee 4/14/2005 $72.50 [TAX] 8% State Surchari 4/14/2005 $5.80 Phone : 503 - 524 - 8985 Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone: Reg #: r N This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes e and all other.applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is V 1 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.s t forth in OAR II 952 -0001- hrough OAR 952 - 0001 -0100. You may obtain copies of these rules ordiedq estions to OUNC.' 11 calling 03 -246 -6 9 8 - 332 -2344. a Issu d By: Per mittee Signature: 7 - � �'� � �, 4 _________ Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. e Z 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. Clti,