Permit CITY TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00274
ma All 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/20/2005
PARCEL: 2S 104AA -04300
SITE ADDRESS: 12320 SW 127TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD LOT: 023 JURISDICTION: TIG
Project Description: Sewer line replacement approx. 50ft.
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: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BONNONO, DENNIS ROBERT AND Description Date Amount
CAROL LYN
12320 SW 127TH [PLUMB] Permit Fee 6/20/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchan 6/20/2005 $5.80
Phone : 503 - 590 - 5509 Total $78.30
Contractor:
Al DRAIN AWAY INC.
12511 NE FOURTH PLAIN RD. REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98682
Phone : 360 - 260 - 1368
Reg #: PLM 37 - 536PB
LIC 156455
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 ru :d are set forth in OAR
952- 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rul-s o d rect • eitions to OUNC by
calling 503-246-p-6§9 or 1- 800 - 332 - 2344.
Issued By: ,( L__\ Permittee Signature. A •-
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 •
e. -,I. \s �, C I�
Plumbing Pernfii . M ><o FOR OFFICE USE ONLY
o
City of Tigard e Received ( /�dl� g 6
Permit Noer t 0U66 ..6Yj�7
13125 SW Hall Blvd., Tigard, OI } L2 3� U ?NS ! Plan Revie.G
Phone: 503.639.4171 Fax: 503. 98.1960 G4rr $rmi Other Permit No.:
� (
24- Hour Inspection Line: 503.639.4175 g � D ate /By. D ate Re B r° ®See Pa e 2 for
Internet: www.ci.ti ard.or.us C ITY OF TIGARD Y y g
VI TON
Notified/Method: � 1 Supplemental Information
' BUI O WORK SCHEDULE
❑ New construction ❑ Demolition , special information use checklist.
• Description I Qty. I Ea. I Total
b,-Addition /alteration /replacement ❑ Other: • New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
.CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
NJ- 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: / 2 . 3 z S ( - 7 1 Catch basin or area drain 16.60
City /State /ZIP: f 4 Y CD („3 � 7 9 7 Z Z 3 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: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: , ra 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 Backflow preventer Page 2
iaf f G c---e _c- -ei-.) t?i - L l v i Le Backwater valve 16.60
Clothes washer 16.60 .
• Dishwasher 16.60
- ❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: N A- ruo } A1L Expansion tank 16.60
Address: 1 Fixture /sewer cap 16.60
•
. City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: (S7)) 6" - "5 Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
0 APPLICANT" '❑ CONTACT PERSON
(} Ice maker 16.60
Business name: '/ F / D . W - A a vl Interceptor /grease trap 16.60
Contact name: / Medical gas (value: $ ) Page 2
Address: t0 L c 7\ Z /o z 6 Primer 16.60
City /State /ZIP: V IA (6u (fi(/ �J a,- q 5, b g 2 _ Roof drain (commercial) 16.60
k)) C C) l -, r � ( 6() (C/t/ 1/ / 9 Sink/basin/lavatory 16.60
Phones i'iv' l S ( Fax: : > 7 7 tD.h
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: , ' tc--1 `--e Water heater 16.60
Address: Other:
City /State /ZIP:
Subtotal
Minimum permit fee: $72.50 /�
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 1
• CCB Lic.: /5 G t/5 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized si at r / / State surcharge (8% of permit fee) �'
�� -- --
�� _ TOTAL PERMIT FEE �g,'7
Print name: O 1. L �S-p//1 Date: & -2, This This permit application expires if a permit is not obtained within
l 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i.\ Building Wermits\PLMF- PeimitApp.doc 06/05 440-46I6T( I0 /02ICOM/WEB)
Plumbing Permit Application - City of Tigard %
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities : ,,Qty. Fe'e(ea) Total . Square Footage: : ._Permit.Fee: . .
Footing drain - I" 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
Fee.(ea) ' Total additional $100.00 or fraction thereof, to and
Fixture Or Item , Qty ota
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
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 "f ir-Complex Structures
Are you capping, moving or replacing existing fixtures? If A "complex structure" is defined as an installation of a plumbing
"yes ", please indicate work performed by fixture. - Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) WorkPerformed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
New Moved Existing Capped ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
• - 3 »
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Buildin g\Pennits\PLMF- PermitApp.doc 06/05
CITY TI AR
C OF G D
BUILDING DIVISION , " .> PERMIT #: PLM2005 00274
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2005
Phone: (503) 639 -4171 �o'mir�m4mlpupll���
Inspection Requests (24 Hrs.): (503) 639 -4175 ' _ __
INSPECTION WORKSHEET FOR DATE: 6/21/2006 TIME: 7 :11AM PAGE: 9
SITE ADDRESS: 12320 SW 127TH AVE CLASS OF WORK:
SUBDIVISION: BELLWOOD LOT #: 023 TYPE OF USE:
PROJECT NAME: BONNONO
DESCRIPTION: Sewer line replacement approx. 50Ft.
OWNER: BONNONO, DENNIS ROBERT AND PHONE #: 503 - 590 -5509
CONTRACTOR: Al DRAIN AWAY INC. PHONE #: 360- 260 -1368
Inspection Request Scheduled For: Date: 6/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 009782 -01 503- 252 -5500 Y
Corrections /Comments /Instructions:
ot,_(- Iler)17,e, J ` Ka e
r r\(' r r 1\
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: Date: / Phone #: (503) 718-