Permit a CITY OF TIGARD PLUMBING PERMIT
°• COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00015
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/23/2007
PARCEL: 2S 103C B - 02900
SITE ADDRESS: 12245 SW MARION ST ZONING: R -4.5
SUBDIVISION: WILLAMETTE NO.2 LOT: 033 JURISDICTION: TIG
Project Description: Line work for connection sewer to lateral. Septic system to be pumped and filled or removed.
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: 125 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JOHNSON, H DALE AND
GRACE V TRUSTEES Description Date Amount
12245 SW MARION [PLUMB] Permit Fee 1/23/2007 $101.40
TIGARD, OR 97223 [TAX] 8% State Surcha 1/23/2007 $8.10
Phone : 503 -590 -3303 Total $109.50
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: Permittee Signature: t A e d ,.. / , , . , ,,&
/•
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 ADnlicatioAECE VED roR (_)race USE ONLY
ity of ;� v 1 SW Hall B Tigard, OR 9722} 2007 )' 3/D 68 Permit No. � N,� 7/y��L /5
Plan Revie iii r
Phone: 303.639.4171 Fax: 303.398.1 °the` Permit se n *aaz9
T !GA R D Inspection Line: 503.639.4175 GM l� ®r 71(�di�®
Date/By-
y/gy. ltvi/ la See Page 2 for f
Internet: www.tigard-or.gov BUILDING DIVISION 1 6ed/Mr+htit• J Supplemental information
TYPE OF WORK - FEE' SCHEDULE .
❑ New construction ❑ Demolition For speda!luforutadon use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New I- 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 Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: L Aa (4S SW )) _�� Catch basin or area drain 16.60
City/State /ZIP: 1 ( Drywall, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: oject 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 : /LS) / 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
• DFSCRIPTION OF WORK Back flow preventer Page 2
-
0A C� /k�^ �Cr&( at, Backwater valve 16.60
c�J 1 OK l i(� . /110 1 .9 atiA aQ Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER El TENANT Drinking fountain 16.60
�L Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: 1,2-2-4 S S Fixture/sewer cap 16.60
City/StatelZIP: - - ci 7.-.a. 3 Floor drain/floor sink/hub 16.60 -
Phone) . I I. 3 3 o 3 Fax: ( ) Garbage disposal I 16.60
CI 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
Phone: ( ) • I Fax: : ( )
Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60 I
Business name: Water heater 16.60
Address: Other:
City/State/ZIP:
- Subtotal 01, 4b
- Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential badkflow minimum permit fee: $36.25 I
CCB Lic.: am , b'� g Lic. no.:
Plan review (25% of permit fee)
� State surcharge (8% of permit fee) g. 10
Authorized signs % 4-� ` ,, ,, / ' Oq. eh
i i t_ . L /�Y� -� l� V TOTAL PERMIT FEE .7 V
Print name: }, TA L 6 < ) D SD Date: / - Thb 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: \&rild'mg\Pamib\MAI- PamitApp.doc 06/26106 «0.4616T(10e2/COM/W®)
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 55.00 0 to 2,000 S115.00
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
rj�S 7,201 and greater $309.00
Sewer - each additional 100' 46.40 y(G
Water Service -1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm &Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$ 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 Bad 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: /0/.1/12 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
/D /.Tv 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
QaaotltY 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 Comments regarding fixture work:
Garbage -Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
-Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal -
Other Fixtures:
i:\&dlding\Permiu\PLM -Pe mitApp.doc 09e22/06
,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 000"15
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/23/2007
Phone: (503) 639 -4171 j1l +�
Inspection Requests (24 Hrs.): (503) 639 -4175 P _
INSPECTION WORKSHEET FOR DATE: 1/226/2007 TIME: 7:00AM PAGE: 12
SITE ADDRESS: 12245 SW MARION ST CLASS OF WORK:
SUBDIVISION: WILLAMETTE NO.2 LOT #: 033 TYPE OF USE:
PROJECT NAME: JOHNSON
DESCRIPTION: Line work for connection sewer to lateral. Septic 1stem to be pumped and filled or removed.
OWNER: JOHNSON, H DALE AND, PHONE #: 503 - 590-3303
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/26/2007 ef Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 042586-01 503780 -4734 V 4pi'aift
Corrections /Comments /Instructions: J✓
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lild PASS PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � ^(� Date: L / `� 7 /`) 7 Phone #: (503) 718- 7.-fz-f
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00015
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:' 1/23/2007
Phone: (503) 639 -4171 AA\ q �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/26/2007 TIME: 7 :00AM PAGE: 01
SITE ADDRESS: 12245 SW MARION ST CLASS OF WORK:
SUBDIVISION: WILLAMETTE NO.2 LOT #: 033 TYPE OF USE:
PROJECT NAME: JOHNSON
DESCRIPTION: Line work for connection sewer to lateral. Septic system to be pumped and filled or removed.
OWNER: JOHNSON, H DALE AND, PHONE #: 503 - 580.3303
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # essage
320 Plumbing rough -in 042585.01 503780 -4734 Y
Corrections /Comments /Instructions:
•
6C
❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �'' l/� Date: 1 1 `A ('7 Phone #: (503) 718- Zi L `I
CITY OF TIGARD AA BUILDING DIVISION P r # �G� � 0 � 1 �
13125 SW Hall Blvd., Tigard, OR 97223 k `1 DATE ISSUED:
Phone: (503) 639 -4171 1 I i
Inspection Requests (24 Hrs.): (503) 639 -4175 "I I
INSPECTION WORKSHEET FOR DATE: '/ k /6 TIME: PAGE:
SITE ADDRESS: 122i c V AI CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments /Instructions: /� 1 />
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tAlJciA-J742 4 AS - k U ( liy
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SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: I P i1 Phone #: (503) 718 / z- Y '
P.
5036522333
GSE INC
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JOB INVOICE !
Jan SO 07 08:17a
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CUSIOVERS OROEP NO DATE ORDERED
7-25.-07 i
ORDER TAM ,.1,
DA7E .140•..:ISED
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TOTAL Mill
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