Permit •
Y ' a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00343
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/3/2007
PARCEL: 2S 104CA -03000
SITE ADDRESS: 13552 SW LAUREN LN ZONING: R -7
SUBDIVISION: HILLSHIRE LOT: 030 JURISDICTION: TIG
PROJECT: JACKSON
Project Description: Add water heater, shower, lay.
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:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GREG & ALI JACKSON
13552 SW LAUREN LN. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/3/2007 $72.50
[TAX] 8% State Surcha 8/3/2007 $5.80
Phone : 503- 970 -1475 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
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.
Issued By: _ _ . _ P_ermittee_Signature. _ 6
Call 503.639.4175 by 7:00 a.m. for an inspection that b siness 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 � , .
Permit No.: FOR OFFICE USE ONLY
Cl `J Date /By l 1a 0 6 ��`+ " (/� JL )
of Tigard
li
v 13125 SW Hall Blvd., Tigard, OR 9722 1 r 0 4 2007
-
Phone: 503.639.4171 Fax: 503.598. Plan Revie
Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175
�1 ov and -or. Date Ready /By: lnris • la See Page 2 for arm Internet www.tigard-or.gov g Notified/Method: Read /By. Supplemental 2 Information
T YPE OF W e" FEE* :SCHEDULE
❑ New construction ❑Demolition For special information use checklist.
Description Qty. I Ea. J 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
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: /35b2 dl ,1 z,,, 4 l Catch basin or area drain 16.60
Drywell, leach line, or trench drain 16.60
City /State /ZIP: %�� /02/ � '�Y`�'
Suite/bldg. /apt. no.: I Project roject name: J kSc�'l 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
l� 4 /an . _ A 0 -e-,: _ 0 ` .;` ■+ I at Backwater valve 16.60
i
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
0' PROPERTY OWNER I . ' ❑ TENANT
i Ejectors /sump 16.60
Name: G� - Al, 5 J ar, k Says Expansion tank 16.60
Address: j 3 552 J jJ Le-4f,, t Fixture /sewer cap 16.60
City /State /ZIP: T , Floor drain/floor sink/hub 16.60
il. /02/ 972
Phone: ( Jr63) 17a - /975 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
Sink/basi lavatory / 16.60
Phone: ( ) Fax: : ( ) Tu shower/ hower pan / 16.60
E -mail: Urinal 16.60
CONTRACTOR. Water closet / 16.60
Business name: O )/0 Z (Z-- Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 /7).
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
/ P. i - State surcharge (8 %f permiffee) - 5716
?C /
Authorized signature: �n l /� / �' _/(/(d-7,_ TOTAL PERMIT FEE 7 �y
. Print name: -/4i • �� Date: C3 `2 /'� 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 \Budding\Permits \PLMF- PermitApp doc 12/27/06 440- 4616T(10/02/ M/WEB)
L S .('5
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 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
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: $50,001.00 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 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"
- 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:
i' Building \Permits\PLM- PermitApp.doc 12/27/06
. . .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PI.,M2007 -003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 31312007
Phone: (503) 639 -4171 / ,
Inspection Requests (24 Hrs.): (503) 639 -4175 .�!�!i iL.
INSPECTION WORKSHEET FOR DATE: 12J3/2007 TIME: 7 :00AM PAGE: 45
SITE ADDRESS: 13(•;52 SW LAUREN LW CLASS OF WORK:
SUBDIVISION: t IILLSHIRE LOT #; 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Add water heater, shower, lay.
OWNER: JACKSON, GREG 8 ALISON PHONE #: 503-970.1475
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/31p007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 060626 -01 603- 381 -1428 Y
Corrections /Comments/ Instructions:
57'i 0 364'
Cart. fr
•
PASS PARTIAL_AP_P_R_QVAL ❑CANCEL
NO ACCESS
AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: AVV Date: I IV I,a7 Phone #: (503) 718-
CITY OF TIGARD t '
BUILDING DIVISION PERMIT #: PLM200I -00343
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 813/21007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 I I-
INSPECTION WORKSHEET FOR DATE: 11/28/.2007 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 13552 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLS} IRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Add water heater, shower, !ay.
OWNER: JACKSON, GREG & ALISON PHONE #: 503.970.1475
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1112612007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 060215.03 503- 381 -1428 Y
Corrections /Comments /Instructions: �* /�/�,,
`A! � A r LA 4-- J 1-Q �.rt/ �dk- �-V1 �`4 A - "" "V 6 1M i t i
C)
�- t �..�� e ✓ -4-� �. 1� ✓ � °e,.4 i ,� 120 dka j ,min
V ( ,nf 1 - E 1,0v)
PASS ❑ _ PARTIAL _APPROVAL ❑CANCEL ❑_NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c 6" /R k Date: I I i•0 ") Phone #: (503) 718-
CITY OF TIGARD ;w
BUILDING DIVISION PERMIT #: PLi12007 -00343
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/25/2007 TIME: 7 :00AM PAGE: 13
SITE ADDRESS: 13552 SW LAUREN LW CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Add water heater, shower, lay.
OWNER: JACKSON, GREG & ALISON PHONE #: 503.970 -1415
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/25/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 058284 -02 503 -381 -1428 N
Corrections /Comments /Instructions:
PASS fl PARTIAL APPROVAL I I CANCEL I NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: (TO t1M -J 1 Date: c ( 2:c - i 07 Phone #: (503) 718-
CITY OF TIGARD ,; r
BUILDING DIVISION PERMIT #: PLM2007- 00343
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2007
Phone: (503) 639 -4171 14, 1111li
Inspection Requests (24 Hrs.): (503) 639 - 4175!±x►
INSPECTION WORKSHEET FOR DATE: 9/21/2007 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 13552 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Add water heater, shower, lay.
OWNER: JACKSON, GREG & ALISON PHONE #: 503 -370 -1475
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact# Message
305 Plumbing underslab 056116 -02 503- 381 -1426 1°
Corrections /Comments /Instructions:
•
PASS n PARTIAL APPROVAL 0 CANCEL n_NO ACCESS
I I FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: �'`� ^'�— Date: 2:I 0 Phone #: (503) 718-
,