Permit C I TV O F TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00400
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/9/2008
PARCEL: 2S 103 BA - 00139
SITE ADDRESS: 12020 SW LYNN ST ZONING: R-4.5
SUBDIVISION: FIRELIGHT PARTITION LOT: 029 JURISDICTION: TIG
PROJECT: MARTIN
Project Description: Install residential backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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
KEVIN MARTIN
FIRELIGHT LLC Description Date Amount
PO BOX 1258 [PLUMB] Permit Fee 10/9/2008 $36.25
NEWBERG, OR 97132 [TAX] 12% State Surch 10/9/2008 $4.35
Phone : 503 -550 -6276 Total $40.60
Contractor:
HAMPTON PLUMBING CO.
411 S COLLEGE ST
NE WBERG, OR 97132 REQUIRED ITEMS AND REPORTS
NE
Contact # : PRI 503 -538 -5629
Reg #: LIC 160927
PLM 36 -102PB
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 •
these rule e ect questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss, ed By: t £ / • ,// / Permittee Signature.
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.
' c
Plumb Per mit Application .
Building Fixtures FOR OFFICE USE ONLY
City of Ti and Received Permit No I r
q 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: � 9 � � L�/r /�t5
Plan Review
. 17 • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read B ru ns: ® See Page 2 for
T I G A R D Internet: www.ti ardor. ov Ready /By: B
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement g Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
E 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: I S L yet A S-f- Catch basin or area drain 16.60
City/State /ZIP: " t:.clt cT(Z q 17:1-3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: � e t !'r ��' Footing drain (no. linear ft.: ) Page 2
�/ LGr✓ //� Manufactured home utilities 110.00
Cross street/directions to job site: Gf ® 4
� }} M anholes 16.60
l / 2- I / ® 4704 ,,-„t Ca--,re / 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
DES CRIPTION OF WORK Backflow preventer Page 2
..C 6 , c.4.-lie cliitek Cir,k/e Backwater valve 16.60
// vo Q, tock1, s\ouS_e., byJ)&4 Pa»/ In i /Ai Clothes washer 16.60
rr, t rr 1 cq. ! Dishwasher 16.60
❑ ' PROPERTY OWNER I ❑ 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 •
gy APPLICANT ®' CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: �� f LGG Interceptor /grease trap 16.60
Contact name: � ( ` ti , i ,
ii N Medical gas (value: $ ) Page 2
Address: l eD,BeA- /2 rer Primer 16.60
City /State /ZIP: ^le e_e j Roof drain (commercial) 16.60
Phone: (�,v3) bif ry I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: , I / Dvs P tui /tit, I _Water heater 16.60
Address: Other:
City/State /ZIP: Subtotal
Minimum permit fee: $72.50 3s/
Phone: 3 ) 3/f _ /7 l Fax: ( ) Residential backflow minimum permit fee: $36.25 •
CCB Lic.: /too q a'7 4 4 / I o Plumbing Lic. no.: ,,.3 - /Oa/ 6 Plan review (25% of permit fee)
Authorized signature: 7 ./j /,/ State surcharge (12% of permit fee) 9 ' f5
TOTAL PERMIT FEE q CG O
Print name: Date: f 9 oaf 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 \Permils\PLMF•PennitApp.doc 12/27/06 4404616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard id
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
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.
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 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- PermilApp.doc 12/27/06
, 1
CITY OF TIGARD . , - ,
BUILDING DIVISION s ' PERMIT #: PLM2008.00400
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2008
Phone: (503) 639 -4171 tix ;:ti il
Inspection Requests (24 Hrs.): (503) 639 -4175 ° __
INSPECTION WORKSHEET FOR DATE: 11/6/2008 TIME: 7:00AM PAGE: 5
SITE ADDRESS: CLASS OF WORK:
12020 SW LYNN ST
SUBDIVISION: FIRELIGHT PARTITION LOT #: 029 TYPE OF USE:
PROJECT NAME: MARTIN
DESCRIPTION: Install residential ackflow preven er f irrigation.
OWNER: MARTIN, KEVIN PHONE #: 503 - 550 -6276
CONTRACTOR: HAMPTON PLUMBING CO. PHONE #: 503 -53S -5529
Z y.g0
Inspection Request Scheduled For: Date: 11/6/2008 Pour Time: 4/0
Code # Inspection Description Confirm # Contact # Mes-..ge /A-.
395 Misc. inspection 077764 -01 503-899-5980 Y pik
Corrections /Comments/ Instructions:
. 7- , e.-e5■ — et.---
/ ia, (...,,,-1.s
b -e)- - /--€._ • - ; • �-< (> ` .
a 4- (1)2.. r-c.. J..
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ins
I� v� ��i ‘4‘
Inspector: /(,, 503 1
pec v l � Date: `C / Phone #: ( ) 718
CITY OF TIGARD - „, A
BUILDING DIVISION PERMIT #: PLM200B -00400
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2008
Phone: (503) 639 -4171 A �� �ll
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/17/2008 TIME: 7:00AM PAGE: 2
SITE ADDRESS: 12020 SW LYNN ST CLASS OF WORK:
SUBDIVISION: FIRELIGHT PARTITION LOT #: Q29 TYPE OF USE:
PROJECT NAME: MARTIN
DESCRIPTION: Install residential bacldlow preventer for irrigation.
OWNER: MARTIN, KEVIN PHONE #: 503-550-6276
CONTRACTOR: HAMPTON PLUMBING CO. PHONE #: 503.5 - 5629
Inspection Request Scheduled For: Date: 11/17/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 078154 -02 503. 899 -5980 N
Corrections /Comments/ Instructions:
& ilj g b fi lmisef •
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 14(1, : 1 V C. JA 1 _ 24� p Date: / Phone #: (503) 7 8
CITY OF TIGARD ''
A,
BUILDING DIVISION PERMIT #: PLM2008- 00400
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2008
Phone: (503) 639 -4171 /�� r�
Inspection Requests (24 Hrs.): (503) 639 -4175 _„' �'IL.
INSPECTION WORKSHEET FOR DATE: 11/17/2008 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 12020 SW LYNN ST CLASS OF WORK:
SUBDIVISION: FIRELIGHT PARTITION LOT #: 029 TYPE OF USE:
PROJECT NAME: MARTIN
DESCRIPTION: Install residential back low preventer for irrigation.
OWNER: MARTIN, KEVIN PHONE #: 503-560.6276
CONTRACTOR: HAMPTON PLUMBING CO. PHONE #: 503_538 -5679
Ins ection Re uest Scheduled For: Date: Pour Time: t
P q 11/1712008 fr
Code # /Inspection Description Confirm # Contact # Mes•.age
395 Misc. inspection 078154 -01 503 -899 -5908 Y
Corrections /Comments /Instructions:
V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (1( 1/ Date: 1 07 I hone #: (503) 718 - — 1