Permit C ITY OF TIGARD PLUMBING PERMIT
�► PERMIT #: PLM2006 -00443
DEVELOPMENT SERVICES DATE ISSUED: 9/28/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109AD - 14300
SITE ADDRESS: 12927 SW TAKENA CT ZONING: R -7
SUBDIVISION: ARBOR SUMMIT NO. 2 LOT: 039 JURISDICTION: TIG
Project Description: 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
BRAD & SHE MCCOLLUM
12927 SW TAKENA CT Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 9/28/2006 $36.25
[TAX] 8% State Surcha 9/28/2006 $2.90
Phone : 503- 639 -2509 Total $39.15
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: Y44- /1 f - 6 (frtyL
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 I•'olz OFFICE USE: OiNLI
City of Tigard SEP 2 d 2006 i� ■ ► • ►
Permit 0• ,;! ■ / O�/
V 13125 S W Hall Blvd., Tigard, OR 972 31 OF TI GARD Plan Review
.11111 0 Phone: 503.639.4171 Fax: 503.59 D, Other Permit No.:
Inspection Line: 503.639.4175 1 INC DIVISION
T I G A It I..) Date Ready/By: Juri El See Page 2 for
Internet: www.tigard - or.gov • Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
. ❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
. A 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 41- 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: / 0241 Z 7 S(.-- T }<,V4 C *- Catch basin or area drain 16.60
City /State/ZIP: -RC 4Av d L 7 ZZ C f 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
Q / � Storm sewer (no. linear ft.: ) Page 2
• ' Subdivision: ,4 S) •et &T- I Lot no.: 3? Water service (no. linear ft.: ) Page 2 .
Fixture or item •
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK 1 c Backflow preventer , Page 2
_TNS/ / L , 14C- 4 6PRi)l1c�p . Backwater valve 16.60
6JJTF`44 Clothes washer 16.60
• Dishwasher 16.60 '
X PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: J� -4- SEI-0 (Ly4 / v l �.Q 4.4,0e/1" Expansion tank 16.60
Address: 1. 2 2 l k , --I-- Fixture/sewer cap 16.60
• • City/State/ZIP: TG b c ?72L4 Floor drain/floor sink/hub 16.60
Phone: ( ) 4 - 2 S o Q Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: A Interceptor /grease trap 16.60
Contact name: el 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 -
Business name: /41.44.6 Water heater 16.60
Address: Other:
�(/ '
City/State/ZIP: Subtotal Minimum permit fee: $72.50
Phone: ( ). Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: 5� X1_4 -4, � State surcharge (8% of permit fee)
TOTAL PERMIT FEE ' 3 9 ,15-
Print name: ER4a j f([, - I Date: g -2g-6C 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 \Pemits\PLMF- PamitApp.doc 04/06/06 440-46I6T(I0/02/COM/WEB)
•
•
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 too' 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 Back flow 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 fixture s 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
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
-Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918 780 - 0040.
Car Wash -Each Stall
- Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic Isometric or Riser Diagram
Drinking Fountain El Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink -2"
-3" -
-4"
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
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase of sewer EDUs, a sewer permit will be issued and
-Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
•
Water Closet - Toilet •
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 0922/06
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CITY OF TIGARD ��
BUILDING ' DIVISION PERMIT #: PLM2006-00413
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2006
Phone: (503) 639 -4171 1
Inspection Requests (24 Hrs.): (503) 639 -4175 - ` __.._
INSPECTION WORKSHEET FOR DATE: 7/2/2008 TIME: 7 :0'1AM PAGE: 41
• SITE ADDRESS: 12927 SW TAKENA CT CLASS OF WORK:
SUBDIVISION: ARBOR SUMMIT NO. 2 LOT #: 039 TYPE OF USE:
PROJECT NAME: MCCOLLUM
DESCRIPTION: Backflovu, preventer for irrigation.
OWNER: Iv1CCOLLUM, BRAD & SHEILA PHONE #: 503.639.2509
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/2/2006 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
399 Plumbing final 072121-01 503 -639 --2509 Y
Corrections /Comments /Instructions:
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PASS ' ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Crb Lvi.l -A I'll -- Date: "7 I ) 0 c) Phone #: (503) 718 - •
i•
. CITY OF TIGARD eLt9 2-db - 00103
BUILDING DIVISION C PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 .,._ DATE ISSUED:
Phone: (503) 639 -4171 . /I1
Inspection Requests (24 Hrs.): (503) 639 -4175 -
INSPECTION WORKSHEET FOR DATE: 1 o r TIME: p , PAGE:
V
SITE ADDRESS: \ 'i \ / c ` ' CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
a — ..N 4 /J -C.6' PHONE #:
CONTR ■ • R: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Cor rections /Comments Instructions: - b Q
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❑ PAS- ❑ 'ARTI' AP' - OVA ❑ ' ANCEL I NO A ESS
❑ • IL .CALL FOR INSPECT : • I A DDITIONAL _ S A ESSED 0
Inspector: \/15 � Date: b / ° Phone #: (503) 718
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