Permit 44,
4 - CI T Y OF TIGARD PLUMBING PERMIT
. COMMUNITY DEVELOPMENT PE
COMMUNITY PLM2008 -00148
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2008
PARCEL: 2S110BC -10000
SITE ADDRESS: 12494 SW WINTERVIEW DR ZONING: R -
SUBDIVISION: THORNWOOD PARTITION LOT: 001 JURISDICTION: TIG
PROJECT: BACKLUND
Project Description: Installing (2) lavatories, (1) shower and (1) water closet for bathroom addition.
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: 2 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ISSAC BACKLUND
12494 SW WINTERVIEW DR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/9/2008 $72.50
[TAX] 12% State Surch 4/9/2008 $8.70
Phone : 408 - 921 -1762 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
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 copi 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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Date/By: Ci of Tigard Permit No ��I' � --ON • 131 R eceived
K SW Hall Blvd., Tigard, OR 97223 Date/By.
.a : Phone: 503.639.4171 Fax. 503.598.19 r �� Plan Review Other P ermit No
T I G A It D Inspection Line: 503.639.4175 . N N(1 Date Ready/By. tuns. ® See Page 2 for
Internet www.tigard - gov �� Notified/Method Supplemental Information
TYPE OF W P 1 r ®k � LC �
RK `�X FEE* SCHEDULE
❑ New construction ❑ E v i � �\
1 For special information use checklist
gi \� Description j Qty Ea. I Total
Addition/alteration/replacement ❑ ( New 1- 2- family dwellings (inc ludes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
ii] 1- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
El Accessory building [I 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: / a1 i 4 S" w 3ii1 eiZ '/ Z G ;, DR . Catch basin or area drain 16 60
City/State /ZIP: 7SI., o R S 1 2 2 C' Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: / k f Footing drain (no. linear ft.. ) Page 2
Project name:
4/ 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
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
/ DESCRIPTION OF WORK Backflow preventer Page 2
QC4 1 de0; - >4‹1c ;4-:u\., Backwater valve 1660
Clothes washer 16.60
Dishwasher 16.60
M PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16 60
Name: TS 3 J( 8 cic k I U 0! II Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/ State/Z1P: Floor drain/floor sink/hub 16.60
Phone: (LW) cri i - I 1 C 'Z. Fax: ( ) Garbage disposal I 16 60
Q APPLICANT El PERSON Hose bib 16.60
^ Ice maker 16.60
(l
Business name: (V e - S Cq C bovc 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 d, 16 60 ?3. a D
Phone: ( ) J Fax: ( ) Tub /shower /shower pan
( 16.60 (6 D
E -mail: Urinal 16.60
CONTRACTOR Water closet • ( 16.60 /6,6,
Business name: � //i' o Water heater 16 60
Address: Other.
City /State/ZIP: Subtotal
Minimum permit fee: $72.50 .... sz
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee• $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) D .
Authorized signature:‘ „O/ TOTAL PERMIT FEE g l / �
/1 .
Print name: .. ".5 - SC C S C: C�L(C ! / U�+ c Date: t.I / �� I Q f' 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\PermitsWLMF- PermitApp doc 12/27/06 440-4616T(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
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
and including $50,000 00.
specially requested inspections - per hour 72.50
Subtotal: $50 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 fixtures 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 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.
-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
- Bradley *Note: If the fixture work under this permit results in an
- 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\Permiu\PLM- PcrmitApp doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -00148
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9/2008
Phone: (503) 639 -4171 4° 141411 (
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 519/2008 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 12494 SW WI NTER VIEW DR CLASS OF WORK:
SUBDIVISION: THORNWOOD PARTITION LOT #: 001 TYPE OF USE:
PROJECT NAME: BACKLUND
DESCRIPTION: Installing (2) lavatories, (1) shower and (1) water closet for bathroom addition.
OWNER: BACKLUND, ISSAC PHONE #: 40B- 921 -1762
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 519/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 06967E-01 503-598-7177 N
Corrections /Comments /Instructions:
•
K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 NS f Date: (.MD Phone #: (503) 718-
CITY OF TIGARD ,
,. A
1 BUILDING DIVISION PERMIT #: PLM2008 -00148
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9/2008
Phone: (503) 639 -4171 V11111'
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 7/29/2008 TIME: 7:01AM PAGE: 4
SITE ADDRESS: 12494 SW WI NTERVIEW DR CLASS OF WORK:
SUBDIVISION: THORNWOOD PARTITION LOT #: 001 TYPE OF USE:
PROJECT NAME: BACKLUND
DESCRIPTION: Installing (2) lavatories, (1) shower and (1) water closet for bathroom addition.
OWNER: BACKLUND, ISSAC PHONE #: 40B -921 -1762
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/29/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073395 -02 503 -598 -7177 Y
Corrections /Comments /Instructions:
Coa f.c. c J L,../L-.Q 8L--)
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (11A tb...,-a-- Date: 1 I tm Phone #: (503) 718-