Permit C ITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00096
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/7/2008
PARCEL: 2S 102 BC - 01300
SITE ADDRESS: 10230 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: NO. TIGARDVILLE ADDITION LOT: 027 JURISDICTION: TIG
PROJECT: ZIGLINSKI
Project Description: Replacing water service.
CLASS OF WORK: ALT 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: 80 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ANTHONY & ZIGLINSKI
10230 SW WALNUT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/7/2008 $72.50
[TAX] 12% State Surch 3/7/2008 $8.70
Phone : Total $81.20
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 8 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 624 -4880
FAX 503- 624 -2173
Reg #: LIC 81837
PLM 26 -445PB
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: �� ✓ � •ermittee Signature:
)( C.-
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 Application
4
FOR OFFICE USE ONLY
Received
City of Tigard Date/By
g Permit No : r/ i 8 s -
7
C 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 FaX 503 598.1960 Date/By Other Permit No •
TI G A R D Inspection Line 503 639 4175 Date Ready /By Juris la 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
®' Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
0/ ' I- 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: 1 Q Z 3 0 S (,,j41-04".4.- d— c Catch basin or area drain 16 60
City /State /ZIP: T` e"...-A Drywell, leach line, or trench drain 16 60
Footing drain (no linear ft ) Page 2
Suite/bldg./apt. no.: I Project name / Zl I �A
J Manufactured home utilities 110 00
Cross street/directions to job site: --17,4 0,N.— -
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no. linear ft . ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft..k0 ) Page 2 S5
Fixture or item
Tax map /parcel no.: Absorption valve 16 60
DESCRIPTION OF WORK - Backflow preventer Page 2
F p (4_c-4._ (,J L•.I -t/ .S ,.C-4t...„ Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16 60
( � ►, `/
Ejectors/sump
tan k 16 60
16 60
Name: Y Ot�rTK; ti r /r'v,!(,� Expansion tank / Fixture /sewer cap 16 60
City /State /ZIP: Floor drain/floor sink/hub 16.60
( )
Phone: ( ) Fax: Garbage disposal 16 60
❑ 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
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: ( ) Tub /shower /shower pan 16.60
E -mail:
Urinal 16 60
CONTRACTOR Water closet 16.60
Business name: ru n eN p1V w►10 j , I k (,-, Water heater 16.60
Address: p o . 6 23° 75' Other
City /State/ZIP: / 19 riles -� D .� Subtotal SS '
ii `` Minimum permit fee. $72 50
Phone: ($ 03) &.2.4 C fry p Fax: (S 2)3 ) 6 2 - 1 Z - 173 Residential backflow minimum permit fee: $36 25 7 2 -'
CCB Lic.: O / 1? 37 Plumbing Lic. no.:24, - Y y W Plan review (25% of permit fee)
State surcharge (12% of permit fee) g' .7
Authorized si ^'\
TOTAL PERMIT FEE g 1 >.J
Print name: „„&„, U,.`41.--- Date: 3 Jr o, 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 \Budding\Permits\PLM- PermitApp doe 1227/06 440-4616T(10 /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
i
Water Service - 1st 100' ( 55 00 5 ' 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 $50,001 00 and up $742 00 for the first $50,000 00 and $1 20 for
Subtotal: 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.
Quantity 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
-Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -
Each Stall ❑ 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
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 \Buddmg\Permns■PLM- PermIApp doc 12/27/06
... ... •
CITY OF TIGARD
BUILDING DIVISION ' PERMIT #: PLM2008-00096
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 "'f
INSPECTION WORKSHEET FOR DATE: 5/30/2008 • TIME: 7:01AM PAGE: 1
SITE ADDRESS: 10230 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: NO. 1IGARDVILLE ADDITION LOT #: 027 TYPE OF USE:
PROJECT NAME: ZIGLINSKI
DESCRIPTION: Replacing water service.
OWNER: ZIGLINSKI, ANTHONY & PATRICIA PHONE #:
CONTRACTOR: E3RUNER PLUMBING PHONE #: 503- 624 -4880
Inspection Request Scheduled For: Date: 5/30 /2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070611 -01 503 -624 -4880 N
Corrections /Comments /Instructions:
C I e c-1"c ce,,i o �O -,(� ` ' fe .rav -J 3 12-1 l 0 6 HtS. El c 20 OF- 6 43
Ca f I ya.;14—,,1 9 i
ri f PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 1 1 \\ Date: 513 0/0Z Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION - ' ' PERMIT #: PLM2008 -00086
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/112000
Phone: (503) 639 -4171 At
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I I ..
INSPECTION WORKSHEET FOR DATE: 311W2008 TIME: 7:00AM i PAGE: 49
SITE ADDRESS: 10230 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION LOT #: 027 TYPE OF USE:
PROJECT NAME: ZIGLINSKI
DESCRIPTION: Replacing water service.
OWNER: ZIGLINSKI, ANTHONY & PATRICIA PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 603624 -4880
Inspection Request Scheduled For: Date: 3/10/2008 Pour Time: —
Code # Inspection Description Confirm # Contact # Message i
330 Water service 066374 -01 603-62.4 -4880 N
Corrections /Comments /Instructions:
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I W ' ` ( 7 0 )'--- V, et•iV. j
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❑ PASS Vi„PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED (4( Inspector: V Date/ / P hone #: (503) 718-