Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE
COMMUNITY PLM2008 - 00396
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/8/2008
PARCEL: 2S 109AA -00200
SITE ADDRESS: 14035 SW 125TH AVE ZONING: R-4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: REINHART
Project Description: Replacing and repairing 200 ft. of rain drains and replacing (2) catch basins.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 0
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 200 ft
Owner:
FEES
STEVE & CI REINHART .
14035 SW 125TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/8/2008 $134.60
[TAX] 12% State Surch 10/8/2008 $16.15
Phone : 503- 780 -8057 Total $150.75
Contractor:
PRIME X CONTRACTING
6021 SE LOIS ST
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -519 -9981
PRI 503- 640 -4092
Reg #: LIC 122943
PLM 34 -492PB
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 : /.� /,, _ /! i Permittee Signature: ,e � -
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.
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Plumbing Permit Application
Building Fixtures and Nt FOR OFFICE USE ONONLY City of Ti e� Received Permit No.: _ Ad.
DateB � - . . _i y i
;� n 13125 SW Hall Blvd., Tigard, OR 223 Q ��t Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 WC. ` � P�� Other Permit No.:
n aB
T I G A R p Inspection Line: 503.639 �I 1; � te y:
te Ready /By: luri See Page 2
Internet: www.tigard- or.gov �`� O r(x�.�IC W Notified/Method: y Supplemental Information
TYPE OF WO� FEE* SCHEDULE
❑ New construction 0 ITemolition 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 (I) bath 249.20
❑ 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: 1403 5 SI...J 1 2 s ;k Ave Catch basin or area drain Z 16.60 , )i 1
City /State /ZIP: Tv. 5 area Ott -0 9wrt q7 2.2 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: R Footing drain (no. linear ft.: ) Page 2
c i .+ i tra �`t/ Manufactured home utilities 110.00
Cross street/directions to job site: (3 .„ w T iQ„( 4 . (2 5 t'4 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.: - "Z e2 Co
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
RLPari r tl! el I- °.., Ter OA C4 it p N Backwater valve 16.60
Clothes washer 16.60
- Dishwasher 16.60
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[8- PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: 54.,,v .i cr., R,ans heir Expansion tank 16.60
Address: 4 O3 5 y tti 12 54 k n ve Fixture /sewer cap 16.60
City /State /ZIP: -rr3 a,t a Dig C( Z 2 j Floor drain/floor sink/hub 16.60
Phone: (50j) 7•0 - S (75 7'
Fax: ( ) Garbage disposal 16.60
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❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Ce„t.}rt K 60,,,f $4.rue 1 r eftl Interceptor /grease trap 16.60
Contact name: 5 +�,,e ',era tk v.v Medical gas (value: $ ) Page 2
Address: $L 5 O Nu A e : k er r gal Primer 16.60
City /State /ZIP: -. a+ ,( G'/K, el 7 ZZ 3 Roof drain (commercial) 16.60
Phone: ( 03) 68 uf a 4 ci 3 I Fax: : (5 b3) b 7 O bh q Z Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: s �, A bp I re r't."e K Water heater 16.60
Address: ' t V �,' f �, Other:
City /State /ZIP: / w , � Subtotal att le_
/ Minimum ermit fee: $72.50
Phone: c9Q)) 5/ q G 7 $� p
1 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: r l ZZ qN 3 Plumbing Lic. no.: 311 I, 1j� Plan review (25 %of permit fee)
Authorized signature: -���i� 1 State surcharge (12% of permit fee) ir (�
nt ..
TOTAL PERMIT FEE MM. , 75 . .
Print name: 5 -N u G L ea f u r e I Date: ' O/a /c, B 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 12 /27/06 440- 4616T(I0 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
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Page 2 - Supplemental Information
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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 - 1 st 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' I 55.00 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' / 46.40 iir ct ) $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: $50,001.00 and up • $742.00 for the first $50,000.00 and $1.20 for
( yG each additional $100.00 or fraction thereof.
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Commercial 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 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 Isometric or Riser Diagram
Drinking Fountain
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
3" . -
-4
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 Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
\ Building \Permits\PLM- PermitAPP.doc 12/27/06
10/09/2008 07:23 5036782287 PAGE 01/01
L O i T. ur I IMAM)
COMMUNITY DEVELOPMENT
T I G `' ``" 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
I PORTANT PERMIT NOTICE
40) 6 Oti
PRIME X CONTRACTING pG o �11 �S
6021 SE LOIS ST G
HILLSBORO, OR 97123
• ermit #: PLM2008 - 00396
Dates Issued:
Parcel: 28 109AA -00200
Site ddress: 14035 SW 125TH AVE
Sub • ivis ion:
Lot:
Juri •. diction: R
oning; TIG
Proje Name: REINHART
Des ription: Replacing and repairing 200 ft. of rain drains and replacing (2) catch basins.
Your comps y has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing pe it to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Si • nature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW H:11 Blvd., Tigard, OR 97223, or you may fax the form to: 5 03.624.3681.
If you have a y questions please call 503.718.2433.
No plumbin. inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
•
STEVE & CI REINHART PRIME X CONTRACTING
14035 SW 125TH AVE 6021 SE LOIS ST •
TIGARD, OR 97224 HILLSBORO, OR 97123
hone #: 503 - 780 - 8057 Phone #: 503- 519 -9981
Reg #: ice- 640 -4092 122943
PLM 34 -492PR
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signatu.. of ' uthorized Plumber Name (printed)
, .
--- CITY OF TIGARD
BUILDING DIVISION
A . ,4,
- PERMIT #:
PLM2008
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/8/2008
Phone: (503) 639-4171 4 _ .'z' 1#
Inspection Requests (24 Hrs.): (503) 639-4175 .7.4k. 1 /
INSPECTION WORKSHEET FOR DATE:
10/912008 ' 7:01 PAGE: AM 25
SITE ADDRESS: , CLASS OF WORK: •
14035 SW 125TH AVE
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
REINHART
DESCRIPTION: Replacing and repairing 200 ft. of rain drains and replacing (2) catekbasins.
OWNER: - PHONE #: 503
REINHART, STEVE & CINDY
CONTRACTOR:
PRIME X CONTRACTING PHONE #: 503
Inspection Request Scheduled For: Date 10/9/2008 4 Pour Time:
Code # Inspection Description Confirm # Contact # Mes age
60/ 340 Storm drain 076468-01 L.. 503519-9981 Y
3 r I LA---‘,.....A.,, ,./.- e
Corrections/Comments/InstructionA: r)
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l a !ASS 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
fl FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: VC Date: 6/6 h
Phone #: (503) 718-
, .
- CITY OF TIGARD
BUILDING DIVISION A.
PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 - PLIV12008-00396
DATE ISSUED: 10/8/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 to■ --,.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
1W9/2008 7:01AM 26
SITE ADDRESS: CLASS OF WORK:
14035 SW 125TH AVE
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
REINHART
DESCRIPTION:
Replacing and repairing 200 ft. of rain drains and replacing (2) catch basins.
OWNER:
REINHART, STEVE & CINDY PHONE #: 603
CONTRACTOR:
PRIME X CONTRACTING PHONE #: 503.5199981
Inspection Request Scheduled For: Date: Pour Time:
10/9/2008
Code # Inspection Description Confirm # Contact # Message
335 Ruin c ain r . ) 076467-01 503-519-9981 N
•4C 0-) ( -5ar‘....:".
Corrections/Comments/Instructions:
t? - CeNe - a 4e v•V‘. 4.--y1
......
....,‘
i \ ,(12 )1 •
ir
/..
fi_
4 5--
- - 7
x PASS n PARTIAL APPROVAL CANCEL I I NO ACCESS
n FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: , Date: k0/4 /'ff
Phone #: (503) 718-