Permit (157) CITY OF TIGARD MASTER PERMIT
1: COMMUNITY DEVELOPMENT Permit#: MST2019-00053
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/06/2019
Parcel: 2S 1036 B 10700
Jurisdiction: Tigard
Site address: 12110 SW 123RD CT
Subdivision: YE-OLDE WINDMILL Lot: 27
Project: Lee
Project Description: Remodeling (2) bathrooms.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $58,500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer 0
Tubs/Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0
Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 3 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 0
Owner: Contractor:
LEE,MARTIN L&CAROL A LEE TRUS DOUG ZIEBART CONSTRUCTION INC Required Items and Reports(Conditions)
12110 SW 123RD CT PO BOX 80402
TIGARD,OR 97223 PORTLAND,OR 97280
PHONE: 503-590-7341 PHONE: 503-307-4114
FAX:
Total Fees: $1,667.91
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 d. . •_suance, -, • work is sus%end-. for more the 180
days. ATTENTION: Oregon law requires you to follow the rules ..o.ted by the Oregon Utility Notificatio Center. Those rul-s are -et forth in OAR
952-001-0010 throe e' - 952-001-0090. Y(o -i iay'tSb!ahra-cep .!,the rules or dire t)questions to OUNC b calling 503.2 *.1987 or .800.332.. 44.
Issued By: /�,�/Alliiiiilla(` Permittee Signature: \
Call 5 /�5 by 7:00 a.m.for the next available inspection date.
This permit card sha �'.e kept in a conspicuous place on the job site until completion of the proj-ct.
Approved plans are required on the job site at the time of each inspection.
r.
BRildin2 Permit Application
:
Residential FOR OFFICcI. I,SI.0\1,1
Cityof Tigard 1 9 Received
Date/B •. ra �M
«•
q13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 6 .. Date/B : .. !A Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 ""J, Date Ready/By: Juris: WI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑Ne7 construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
- 'l-and 2-family dwelling 0 Commercial/industrial Valuation: $ 5(6/St 0
0 Accessory building 0 Multi-family Number of bedrooms:
IDMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12110 SW 123rd C t. New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST I
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
Remodel 2 Bathrooms —
Existing building area: square feet
New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: Martin and Carol Lee Type of construction:
Address: 12110 SW 123rd Ave. Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone:(503)590-7341 Fax:( ) New:
APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Doug Ziebart Construction, Inc. Structural plan review fee(or deposit):
Contact name: Doug Ziebart
FLS plan review fee(if applicable):
Address: PO Box 80402
Total fees due upon application:
City/State/ZIP: Portland, OR 97280
Amount received:
Phone:(503)307-4114 Fax::( 503) 245-5433
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Z b a l^t3@ CQmc a S t.n P t Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
Doug Ziebart Construction, Inc. and fire department access,along with the 2010 Oregon
Address: PO Box 80402 Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, OR 97280 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)307-4114 Fax:(503)245-5433 State surcharge(12%of permit fee): $21.60
CCB lie.: 96471 Total fee due upon application: $201.60
Authorized s tures This permit application expires if a permit is not obtained
O. g5::------ within 180 days after it has been accepted as complete.
Pres. Date: 2-11-19 *Fee methodology set by Tri-County Building Industry
Print name: Douglas Z Ziebart
Service Board.
I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist _ ,
One- and Two-Family Dwelling Folz OFI1CI: LSI ()NIA �.
City of Tigard
II/ Received
Permit No.:
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Associat
= Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGARD
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW les yo yi,1.
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ ■ _ ■
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 ❑
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity ❑ 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 0 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ 0 0
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if 0 0 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 0 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- 0 0 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing 0 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 ❑_
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
_ 20 Manufactured floor/roof truss design ietails. 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 0
architect licensed in Ore on and shall be shown to be a licable to the ro'ect under review.
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. 0 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 0
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Applicatio , . v...; 3 FOR OFFICE USE ONLY
City of Tigard ;,«) Received
g Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 -1--,)
I. Phone: 503.718.2439 Fax: 503.598.1960 ' 1--U .13. r¢e Z.i !g
Plan Review
Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: 10 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
t
'� OI+ WORK - a MMER AL FEE* SCHEDULE —USE CHECKLIST,
Mechanical permit fees*are based on the value of the work
D New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
` CATE &bRY.,OF ONSTR y CTION
� ,, '* =' ,..,m �: „* IDEI`( 'IAL£QUIPP NT•1sYSTf YIS FEES `
1`�--and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
' 'Iv
) OJB Sf fE INFORMATI N, Heating/cooling:
y
Qr ANII�.OLI'II�I!I ���
Air conditioning 46.75
Job site address: 12110 SW 123rd C t. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard, O R 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:
Heat pump 61.06
Duct work 23,32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
:* , 6 . S.:z. r '(1 OR �s [ Gas fireplace/insertentfo33.39
Remodel 2 Bathrooms
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
te, Other:
23.32
�x.. Environmental exhaust and ventilation:
Name: Martin and Carol Lee Range hood/other kitchen
equipment 33.39
Address: 12110 SW 123rd C t. Clothes
dryer exhaust 33.39
City/State/ZIP: Tigard, OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 3 23.32 Oct'
Phone:(503)590-7341 Fax:( ))) Attic/crawlspace fans 23.32
,J �...4 I / Q ACC PE Other: 23.32
. ,
Business name: Fuel piping:
Doug Ziebart Construction, Inc. $14.15 for first four;$4.03 for each additional
Contact name: Doug Ziebart Furnace,etc.
Address: PO Box 80402 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Port1and, OR 97280 Water heater
Phone:(503)307-4114 Fax::( 503)245-5433 Fireplace
Range
E-mail: zbart3@comcast.net Barbecue
CO * Clothes dryer(gas)
Business name: Supreme Comfort Heating & Air Conditioning Other:
Address: 9425 SW Commerce Circle #16 Subtotal
City/State/ZIP:W i l s o n v i l le, OR 97070 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)682-19$5 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 27.2.---,,) TOTAL PERMIT FEE
f'1( This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature. -
ii"------" Fee methodology set by Tri-County Building Industry Service Board
Print name: Douglas G. Zie rt, Pres. Date: 2-11-19
I.\Building\Permits\MEC_PennitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
'" •
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
TItaivaaatia41: wrnot Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\Buildineermits\MEC_PennitApp_040113.doc 2
Plue1 `mbing Permit Applicatiolc _:W,
Building Fixtures FOR OFFICE L SE ()NEN'
FEB 1
Cl of Tigard 9 i Received
`.1 g Permit No.:
II 13125 SW Hall Blvd.,Tigard,OR 9722(3" Date/By:
I Plan Review 11
Phone: 503.718.2439 Fax: 503.591.1t9.00 Date/By: Other Permit No.:
T I ,n R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
. 4 TYPE OF WORK _ FEE*SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
:ezi. C#EGORY op Ct TRUCri10 (1)bath312.70
SFR
and 2-famil SFR(2)bath 437.78
y dwellin g ❑Commercial/industrial
ElAccessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB S1TE INF)RMA11ON.AND LOCATION Site utilities:
Job site address: 12110 SW 123rd C t. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/state/ZIP: Tigard, OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
,<v. ° .� r Backwater valve 12.51
DE' l .,tu F ;r
,v ` ,'
"'' ' ' ' '"1"' Clothes washer 25.02
Remodel 2 Bathrooms Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-I''''X' ' t .'TY O ia - ' ANT 4, ;,,,,1 Expansion tank 12.51
Name: Martin and Carol Lee Fixture/sewer cap 25.02
Address: 12110 SW 123rd C t. Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:T i go rd, OR 97223 Hose bib 25.02
Phone:(503 )590-7341 Fax:( ) Ice maker 12.51
"' x.r. t . Interc tor/
r APPLICANT_ 7.3 w> C AC a N eP grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Doug Ziebart Construction, Inc. Primer 12.51
Contact name: Doug Z i e b a r t
Roof drain(commercial) 12.51
Address: PO Box 80402 Sink/basin/lavatory 3 25.02 7 S.oe
City/State/ZIP: Portland. OR 97280 Solar units(potable water) 62.54
Phone:( 503 307-4114 Fax::(503)245-5433 Tub/shower/shower pan 2_ 12.51 ZS'.'
E-mail: zbart3@comcast.net Urinal 25.02
-,51,,.., Water closet Z 25.02 '09
CONTRACTOR .,
t Water heater 37.52
Business name: Troy El 1 Elliott Plumbing Inc. Water piping/DW V 56.29
Address: PO Box 1958 Other: 25.02
City/State/ZIP: North Plains, OR 97133 Subtotal
Phone:( 503-390-5750 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: 152130 Plumbing Lic.no.: 34-402pb
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Douglas G. Ziebart, Pres. Date: 2-11-19 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.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Siteutilities '> Qty. ' 1'ee(ea) Total Square Footage: Perfbnit Fee:
Footing drain-1s'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: „Permit .'
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other i ispeetic"l i' s or Fees Fee ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accuratelyreportfixtures could result in increased sewer fees*.
kip, fo> 'lu I]xsta�ttl R ;4
Quantity by Fixture T re. Plan review is required for any of the following.
Fixture Type for ReplBeei Please check all that apply.
Work Performed: Capped Added Relocate
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
CW
C -Commercial
al 0 Any multipurpose fire sprinkler system.
Dishwasher:
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" yf� ;
t to it" i Diw' 'm
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Sery/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12110 SW 123RD CT, TIGARD, OR, 97223 May 31 , 2019 at 10:14:00 AM
Record Type: Record ID:
Residential - Master Permit MST2019-00053
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor