Permit •
CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00152
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/19/2007
PARCEL: 1 S134CB -13500
SITE ADDRESS: 12398 SW MILLVIEW CT ZONING: R - 4.5
SUBDIVISION: MILLVIEW LOT: 035 JURISDICTION: TIG
PROJECT: SMITH
Project Description: Kitchen remodel.
•
•
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: SF • WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: SR3.3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft •
WATER CLOSETS: WATER LINE: ft
•
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
SMITH, ALAN C + DEBORAH B Description Date Amount
12398 MILL VIEW CT
TIGARD, OR 97223 [PLUMB] Permit Fee 4/19/2007 $72.50
[TAX] 8% State Surcha 4/19/2007 $5.80
Phone : Total $78.30
Contractor:
ROBERTSON PLUMBING INC
PO BOX 1329
BORING, OR 97009 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 658 -5818
FAX 503- 658 -7106
Reg #: LIC 88717 •
PLM 3 -184PB
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:
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.
Flaw, bi.� Perm Applicat pL,, rt5t Rk T , -. -' - (y Fe 503 - & 5S -7 to G
,I,' L, RECEIVE E FOR OFFICE USE ONLY
City of Tigard Received
;� g APR 1 Date/By: Permit No.: FLIT 200- 00152
a 13125 SW Hall Blvd., Tigard OR 9 7223 j 2007 Pl Review
e Phone: 503.639.4171 Fax: • -503.598.1960 Date/By: Other Permit No.:
T 1 G n 1t D Inspection Line: 503.639.4175 CITY OF FIGARD Date Ready/By: Juris: 'El See Page 2 for
Internet: www.tigard- or.gov Rt ',WING DlvlsiO ,Notified/Method: Supplemental Information
TYPE OF WORK � FEE* SCHEDULE
❑ New construction v Demolition For special information use checklist
Description I Qty. I Ea. I Total
XAddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath • 249.20
( l- 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: 1.4.--51s, 5 V \ ; \j l� s ,, W c -71 Catch basin or area drain 16.60. .
City/State/ZIP: "–\-' ■ G p\---g J) c � 7 2-2-3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project 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.: ) Page 2
' ! Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
i Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2 •
e; C? C Ii Z Ai R y D 7, ( Backwater valve 16.60
Clothes washer 16.60 WC)
• Dishwasher r 16:60 1Ij
Drinking•fountain 16.60
r • Ejectors/sump 16.60
Name: p /15 5 7 i „j i Expansion tank 16.60,
Address: - " ` I
Fixture /sewer cap 16.60
City/State /ZIP: I Floor drain/floor sink/hub' 16.60
( ) ( ) Garbage disposal 1 16.60 . 1 G �
Phone: Fax:: � p
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON - 64 -
Ice maker • (( 16.60 I t r
Business name: Interceptor /grease trap 16.60
•
Contact name: Medical gas (value: $ ) Page 2 .
Address: i Primer 16.60
.City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory ( 16.60 I � p —
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
A CONTRACTOR Water closet 16.60
i n
Business name: RE (�4.•I( r saki z,Cfc� Water heater 16.60
S Address: 9 e O, g o X I ? � Other:
City/State /ZIP: P p. 1 � O :► I q eDo Subtotal (
-
�.f Minimum permit fee: $72.50
Y° uu Phone: (503) _ S � i � Fax: (5p GS 0 —'7 f jr) G Residential backflow minimum permit fee: $36.25 72. S�
. 1=11111 ��� Plumbing Lic. no.: „ . i `r Plan review (25% of permit fee) 5, g0
Authorized signature: p State surcharge (8% of permit fee) IC
`+ rAl..5, ow 7 TOTAL PERMIT FEE 1-g; 30
Print name: n et NIsJ; S R 6, R e� Date: ii .-/ &� �j This permit application expires if a permit is not :obtained within
t 1' 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(10 /02/COM/WEB)
•
• . ' : . }
Plumbing Permit Application - City of Tigard •
,Page ; Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l 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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
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.
Quandti 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 OAR918- 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
- 3" that meet the qualifications above.
-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 *Note: If the fixture work under this permit results in an •
- Bradley
- 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 #: PLM2 007 -00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/19/2007
Phone: (503) 639 - 4171 °,62 . .
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 6/21 /2007 TIME: 7:03AM PAGE: 25
SITE ADDRESS: 12396 SW MILLVIEW CT CLASS OF WORK:
SUBDIVISION: MILLVIEW LOT #: 035 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Kitchen remodel.
OWNER: SMITH, ALAN C + DEBORAH B, PHONE #:
CONTRACTOR: ROBERTSON PLUMBING INC PHONE #: 503 -65B -58113
Inspection Request Scheduled For: Date: 6/21 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 050666 -01 503.360.2129 Y
Corrections /Comments /Instructions:
P ' 114
6911/
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ) )/ 09) Date: - IA Phone #: (503) 718-
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: PLM2007 -00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/19/2007
Phone: (503) 639 -4171 ' II I
Inspection Requests (24 Hrs.): (503) 639 -4175 V F:_..
c
INSPECTION WORKSHEET FOR DATE: 6119/2007 TIME: 7:01AM PAGE: 83
SITE ADDRESS: 12398 SW MILLVIEW CT CLASS OF WORK:
SUBDIVISION: MILLVIEW LOT #: 035 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: Kitchen remodel. ■
OWNER: SMITH, ALAN C + DEBORAH B, PHONE #:
CONTRACTOR: ROBERTSON PLUMBING INC PHONE #: 503 -65 &5818
Inspection Request Scheduled For: Date: 6/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 050429 -01 503.380.2129 N
Corrections/Comments/Instructions:
Ai
Z e 7
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0\(
` j/ Date: / Phone #: (503) 718- 2 '13)