Permit � + yyI CITY OF TIGARD
,� PLUMBING PERMIT
" � ° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00044
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/6/2008
PARCEL: 2 S 104AA -90102
SITE ADDRESS: 12662 SW KAREN ST 10 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: JURISDICTION: TIG
PROJECT: BELLWOOD APT
Project Description: Units 10 & 11 Clothes washer (2)
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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
MOZINSKI, STEVEN P Description Date Amount
PO BOX 189
YAMHILL, OR 97148 [PLUMB] Permit Fee 2/6/2008 $72.50
[TAX] 12% State Surch 2/6/2008 $8.70
Phone : Total $81.20
Contractor:
PRO DRAIN & ROOTER SERVICE, INC
3300 NW 185TH AVE #213
PORTLAND, OR 97229 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -533 -0430
FAX 503- 715 -4989
Reg #: LIC 108504
PLM 26 -776PB
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.
/
Y
Issued By: / /i / Permittee Signatur•• j111 I "
I
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 RECEIVED . FOR OFFICE USE _ONLY
City of Tigard c Received
- 41 131 SW Hall Blvd., Tigard, OR 97223 Cr EB 6 2008 Date/13:,-
B Permit Na a � ���O9/
' 1111 Plan Revie , 7
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: J ® See Page 2 for
TfGAKD B Internet: www.tigard- or.gov
BUI.LDING Supplemental DI SIGN No tified Method / Iementallnformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 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 Multi- family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 12-6 6 Catch basin or area drain 16.60
City /State /ZIP: ?e, v-A-lai 1c.1 / Cj R ( 9 7 7.-a 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 10 4 I I Project name: &I.- .-) odd A i-S Footing drain (no. linear ft.: ) Page 2
P 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
Tax map /parcdl no.: Fixture or item
. Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
I✓,5-4c.11 %\J ,� .�,C c_1- c,*'1 -.1 LJ�S(, Backwater valve 16.60
y t s N S 1` Clothes washer 16.60 3 --s.
t v.
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
E33 APPLICANT 2 CONTACT PERSON Hose bib 16.60
Business name: i 0 n �o� r r Ice maker 16.60
CA ■ r . " J t ( ✓,' e _p Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: -3-306 N 1,J v (``A,, -�' 2 ( Primer 16.60
City /State /ZIP: IJ { - f - l a,,„ s 0 Q g -7 2/9 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (5b 3 ) 20 S - .-? 1 7 c Fax: : (y 71 S
yi k'\ Tub /shower /shower pan 16.60
E -mail: ta f QcA �` { -t- e.,,...„_,...,, - ( 0,,,, Urinal 16.60
J CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP:
Subtotal "S a Z O
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 / , s o
CCB Lic.: Plan review (25% of permit fee)
AO% Sb � Plumbing Lic. no.: 26 -'� 26 P1'
State surcharge (12% of permit fee) V - 70
Authorized signatu�r -e(. TOTAL PERMIT FEE I P. a7
Print name: / J c - {,.� Date: Z - 6 - S Thi 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.
1 \Bmlding\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 - li 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 $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: 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 Pool Filter 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 #: PLM2008-00044
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/6/2008
A 1\
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2J7/2008 TIME: 7:03AM PAGE: 7
SITE ADDRESS: 11662 SW KAREN ST 10 CLASS OF WORK:
SUBDIVISION: BFLLWOOD TERRACE CONDOMINIUM LOT #: TYPE OF USE:
PROJECT NAME: BELLWOOD APT
DESCRIPTION: Units 10 & 11 Cloths washer (2)
OWNER: IVIOZINSK.I, STEVEN P, PHONE #:
CONTRACTOR: PRO DRAIN & ROOTER SERVICE, INC PHONE #: 603-533-0430
Inspection Request Scheduled For: Date: 2/7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
39 Plumbing final 0641692-03 503-209-7779
Corrections/Comments/Instructions:
•
•
•
6 PASS 7 PARTIAL APPROVAL 0 CANCEL El NO ACCESS
7 FAIL CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: 615Vvr-A--/i"\---- Date: 2_ hoq Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: pi 13 44
,m200.000
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/60008
Phone: (503) 639-4171 -471401111t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/7/2000 TIME: 7:03Alvi PAGE: 9
SITE ADDRESS: 12662 SW KAREN ST 10 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: TYPE OF USE:
PROJECT NAME: BELLWOOD APT ,
DESCRIPTION: Units 10 & 11 Clothes livasher (2)
OWNER: MOZINSKI, STEVEN P, PHONE #:
CONTRACTOR: PRO DRAIN & ROOTER SERVICE, INC PHONE #: 503
Inspection Request Scheduled For: Date: 2/7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
315 Post/beam plumbing 064692-01 503-209-7779
Corrections/Comments/Instructions:
PASS fl PARTIAL APPROVAL LII CANCEL fl NO ACCESS
111 FAIL pi CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: aDA44A—A\\...—._ Date: r‘\ Phone #: (503) 718-
1
CITY ��'����U�������� ~ ' ` 1
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BUILDING DIVISION PERMIT #: PLk42U08'0O014
| 131258VVHeU|EUvd..Tlga�.ORQ7223 DATE ISSUED: 2/60,008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 °��W� AL
INSPECTION WORKSHEET FOR DATE: 2/7V2008 TIME: 7:03Atvl PAGE: 8
SITE ADDRESS: 12662 SW KAREN ST 10 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: TYPE OF USE:
PROJECT NAME: BELLWOOD APT
DESCRIPTION: Unit* 1D& 11 C|u1hwa washer /2\
OWNER: MUZ|NSN|. STEVEN P. PHONE #:
CONTRACTOR: PR0 DRAIN &ROOTER SERVICE, INC PHONE #: 503-53 3-0430
Inspection Request Scheduled For: Date: 2y7y2008 Pour Time: -
Code # Inspection Description Confirm # Contact # Message
320 P|unmhingvough'in 064692-02 603-209-7779 N
Corrections/Comments/Instructions:
.
LK PASS pi PARTIAL APPROVAL ri CANCEL ri NO ACCESS
| I FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: /FO Date:2 \ -1 Phone #: /503\ 718-
__ . '