Permit ill CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00220
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/25/2007
PARCEL: 1 S134AC -02650
SITE ADDRESS: 11080 SW COTTONWOOD LN ZONING: R - 4.5
SUBDIVISION: ENGLEWOOD NO.3 LOT: 216 JURISDICTION: TIG
PROJECT: HAYNES
Project Description: Relocation washer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 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
KENNETH HAYNES
11080 SW COTTONWOOD LANE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/25/2007 $72.50
[TAX] 8% State Surcha 5/25/2007 $5.80
Phone : 971- 645 -8856 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
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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 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.
. /
- Permittee Si nature: i
Issued By: �_ .� ��kr ul�.. l
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 ApplicatinE—CEIVE r -, ,
F OR OFFICE USE ONLY .
City of Tigard MAY 2 5 2007 Received /
13125 S W Hall Blvd., Tigard, OR 97 _ r o ®
Date/By: 9.5 b '7 Permit No.: R114
v - 0 cZ�
i' I �1ul Plan Review
Phone: 503.639.4171 Fax: 503.598. Y960 Date/By: Other Permit N
Inspection Line: 503.639.4175 BUILDING DIVISION Date Read /B mr 5:
T I GA RD ard -or. ov Ready /By: Supplemental See Page 2 for
Internet: www.ti
g g Notified/Method: r Supplemental Information
TYPE OF `WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. Total
g Addition/alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY _ OF, CONSTRUCTION. . SFR (1) bath 249:20
e f 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350:00
El Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
. - JOB SITE INFORMATION. AND LOCATION Site utilities
Job site address: / /D S J 3 - 7 - Y V 14') Catch basin or area drain 16.60
City/State/ZIP: / / O 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Proj � Project name: AA" �� 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.: ) 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
hi r e‘J F11) Backwater valve 16.60
Clothes washer 16.60
1"0 C �� r Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER I ❑ TENANT°' '
—
Ejectors /sump 16.60
Name: ]�„� /' C- 7�4 (3 Expansion tank 16.60
Address: r �- / yoga s c_byw( L., Fixture /sewer cap 16.60
City /State /ZIP: 7–/( C 13 Floor drain/floor sink/hub 16.60
Phone: (/) /,j YS 6-)--6 Fax: ( ) Garbage disposal 16.60
, . y APPLICANT CI CONTACT PERSON Hose bib 16.60
• Ice maker 16.60
Business name: Owj\j 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: Sink/basin/lavatory 16.60
( ) Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: CONTRACTOR, Urinal 16.60
C ONTR, Water closet 16.60
Business name: al"). rte . Water heater 16.60 •
Address: Other:
City/State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 1 bing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee)
TOTAL PERMIT FEET g 50
Print name: f. ' " ` y¢ .', ; �� Date: ,x 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.
1:\ Building \Permits\PLM - PermitApp.doc 12/27/06 440- 4616T(I0 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
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 - 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
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Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", • Plan Review for Plumbing'Installations:
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quanti by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type:: Replace' greater, except systems designed and stamped by licensed
.Previous' Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR9.18- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash :Isometric- or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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 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:
i \Building\Permits \PLM- PermitApp doe 12/27/06
, -..c---.:--..: .. - .,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Nt_ l ra��7 -007 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: rt;7t'?d1t�7
Phone: (503) 639 -4171 Ak � j 1 l �1a
Inspection Requests (24 Hrs.): (503) 639 -4175 � X_ _
INSPECTION WORKSHEET FOR DATE: 10/15/2007 TIME: 7 :01AM PAGE: 43
SITE ADDRESS: 11080 SW COTTONWOOD LN CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.3 LOT #: 216 TYPE OF USE:
PROJECT NAME: HAYNES
DESCRIPTION: Relocation washer.
OWNER: HAYNES, KENNETH PHONE #: 971
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 057503 -03 971 - 545-8855 N
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Corrections /Comments /Instructions:
c ol , rc cf. L,G.., fr •
•
't PASS PARTIAL APPROVAL ❑ CANCEL NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q 1 \ W►'^.. Date: j6].ir1 /0 Phone #: (503) 718-
CITY OF TI.OARD .
BUILDING DIVISION. PERMIT #: PLM2007 -00220
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/25/2007
Phone: (503) 639 -4171 / N, l
•
Inspection Requests (24 Hrs.): (503) 639 -4175 .�' :_..
INSPECTION WORKSHEET FOR DATE: 7/18/2007 TIME: 7:01AM PAGE: 26
SITE ADDRESS: 11080 SW COTTONWOOD LN CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.3 LOT #: 216 TYPE OF USE:
PROJECT NAME: HAYNES
DESCRIPTION: Relocation washer.
OWNER: HAYNES, KENNETH PHONE #: 971 -615 -8856 c
CONTRACTOR: OWNER PHONE 525
Inspection Request Scheduled For: Date: 7/1812007 Pour Time: ' 7
Code # Inspection Description Confirm # Contact # Mes:. • - g
320 Plumbing rough -in 052254 -01 971 - 645.8856
Corrections /Comments /Instructions:
•
PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: f _ (_'` " Da te: c / � t Phone #: (503) 718-
CITY OFTIGARD • .
BUILDING DIVISION . ,_' PERMIT #: PLM2007- 00220
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2a120O7
Phone: (503) 639 -4171 4, 4 4 4 i b +Ic I
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7/1212007 TIME: 7:04AM PAGE: 35
SITE ADDRESS: 11080 SW COTTONWOOD LN CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.3 LOT #: 216 TYPE OF USE:
PROJECT NAME: HAYNES
DESCRIPTION: Relocation washer.
OWNER: HAYNES, KENNETH PHONE #: 971 -645-8856
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 0511380 -01 971 -645 -8856 Y
Corrections /Comments/ Instructions:
97-ba O ' - / /- '
,.- ....(610 /9/q
n PASS •, PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL F . ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Phone #: (503) 718- L
Inspector: pi Date: / D ( )