Permit C ITY OF TIGARD PLUMBING PERMIT
4 4, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00467
:.� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 005
PARCEL: 2S 2510 1026 B -02600
SITE ADDRESS: 10100 SW MOLLY CT ZONING: R -4.5
SUBDIVISION: MOORE'S MEADOWS LOT: 007 JURISDICTION: TIG
Project Description: (1) area drain.
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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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JODY BLAKELY Description Date Amount
10100 SW MOLLY CT
TIGARD, OR 97223 [PLUMB] Permit Fee 9/19/2005 $72.50
[TAX] 8% State Surcharl 9/19/2005 $5.80
Phone : 503 209 - 2207 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
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: � w Permittee Signature: '''"'"* JT�r
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.
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• Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard RE CE' - /,' V Received Pent No �Q� L
13125 SW Hall Blvd., Tigard, OR 97223 Date/By. /� �� al - � 1
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.:
24- Hour Inspection Line: 503.639.4175 SEP 1 9 i � ' .1 I i Dat�Y ,a.;
Date Ready/By: RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: '
' Supplemental Information
TYPE OF Q1(IOF TIGAMU FEE* SCHEDULE
BVI 1N G pMSIO special information use checklist.
❑ New construction )3emlltion N F or sP I
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement :i Other: (424u• 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: (t i OD 5 / (, ( G - Catch basin or area drain ( 16.60 /4, j _
City /State/ZIP: 7 i ,4g p e- 9722-3 Drywell, leach line, or trench drain 16.60
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Suite/bldg. /apt. no.: I Project name: . QL/,Je.7 U. ki.... - Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directtions job site: 5) 6�NZ 71
" g .t)FFJ will Jut Manholes 16.60
?4,01) c7011NSaN ST Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
. Storm sewer (no. linear ft.: ) Page 2
Subdivision: ptiv #46AWi I Lot no.: 7 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
F-E747./JE04 WALL/ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
gt PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
gt A L � Ejectors/sump
tan 16.60
Name: C/V Expansion tank 16.60
. Address: /t)`rjb SJ #4.p/...Ly. C£' Fixture /sewer cap 16.60
City/State/ZIP.-4/AP at., 9172 -23 Floor drain/floor sink/hub 16.60
Phone: (56) 2.17/ - Z�p7 Fax: (5fg ) Scw - p j9Q Garbage disposal 16.60
Hose bib 16.60
APPLICANT pitCONTACT PERSON
Ice maker 16.60
Business name: N
/q Interceptor /grease trap 16.60
Contact name: 7-0727d e(AI61.,Y Medical gas (value: $ ) Page 2
Address: &N M) Si, j M Cr Primer 16.60
City /State /ZIP: A1?4, 7723 Roof drain (commercial) . 16.60
Phone: (5 ) - 22 :: ) 5943 - Q390 Sink /basin/lavatory 16.60
� 47 F ax �� /� .1 r1 Tub /shower /shower pan 16.60
. E -mail: J Ak / j ( h'1 "/ , �M Urinal 16.60
1 �/ CONTRACTOR Water closet 16.60
Business name: A Water heater 16.60
Address: Other: •
City / State/ZIP:
Subtotal
Minimum permit fee: $72.50 �� . Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
Plan review (25% of permit fee)
CCB Lic.: Plumbing Lic. no.:.
State surcharge (8% of permit fee)
Authorized signature: . TOTAL PERMIT FEE 1 ,.7
Print name: Jo 1 ape I Date: ///3/0< 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.
is\ Building \Penniu\PLMF- PennitApp.doc 06/05 440-4616T(10/07JCOM/WEB)
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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 u $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more. new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
-Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: _ plumbing permit can be issued.
is\ Building \Perrnits\PLM•PermitApp.doc 07/06/05
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F
CITY OF TIGARD
BUILDING DIVISION PERMIT #: I'1_MOf) &0Q4(i7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9119/20()
Phone: (503) 639 -4171 iityVe
Inspection Requests (24 Hrs.): (503) 639 -4175 __.,
INSPECTION WORKSHEET FOR DATE: 5/23/2005 TIME: 7:03AM PAGE: 8
SITE ADDRESS: 10'100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT #: 007 TYPE OF USE:
PROJECT NAME: BLAKELY .
DESCRIPTION: (1) area drain.
OWNER: BLAKELY, JODY PHONE #: 503-209-2207
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
345, Culvert/catch basin 030419-04 503- 201.2207 N
Corrections/Comments/Instructions:
C4 ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL 0 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1LC l Dat Phone #: (503) 718- /
CITY OF TIGARD -.
BUILDING DIVISION PERMIT #: PLM20I.15.00167
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9
Phone: (503) 639 -4171 Q - _ i i ,
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I � ..
1
INSPECTION WORKSHEET FOR DATE: 5/18/2006 TIME: 7 :01AM PAGE: 3
SITE ADDRESS: 10100 SW MOLLY CT CLASS OF WORK:
SUBDIVISION: MOORE'S MEADOWS LOT #: 007 TYPE OF USE:
PROJECT NAME: 13LAKELY
DESCRIPTION: (1) aroa drain.
OWNER: BLAKELY, JODY PHONE #: 503. 209 - 220/
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/18 /2006 Pour Time:
Code # Inspection Description Confirm # n _ Message
346 Culvert /catch basin 030138-01 603- 209-2207 Y
Corrections /Comments /Instructions: 1
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. (7PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /4 -- Date: Y t (1 Phone #: (503) 718-