Permit ... CITY OF TIG , RD
PLUMBING PERMIT
1 ° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00292
u r
TIGAItD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/9/2007
PARCEL: 2S 103DB -00900
SITE ADDRESS: 13355 SW 110TH AVE ZONING: R -4.5
SUBDIVISION: MIRA PARK LOT: 005 JURISDICTION: TIG
PROJECT: CLARK
Project Description: Kitchen remodel
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: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
SCOTT E. CLARK
13355 SW 110TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/9/2007 $72.50
[TAX] 8% State Surcha 7/9/2007 $5.80
Phone : 503- 624 -7274 Total $78.30
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 m:•y obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
. 411141 S\
lss ed By: // l IL _4.I . Permittee Signature. _ 4 1/4 .
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 �,,/��'J
City of Tigard �y i 4 0 7 Permit No.: i, f{ Sao ( a?
11 4 1 II 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 H eW O t h er Pemtit No.:
Inspection Line: 503.639.4175
T 1 G �� 1t D Date ReadyBy. 1 El See Page 2 for
Internet: www.tigard - or.gov Notified/Method _ // LI Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
XAddition/alteration/replac,ement ❑ Other: 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
❑ Master budder Each additional bath/kitchen 45.00
❑er Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: \ S t z " h Ave Catch basin or area drain 16.60
City /State/ZIP: • \ (� 7 01Z 0011 , , Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: `� Project name: C(� e_i(. Footing drain (no. linear ft.: ) Page 2
7 Manufactured home utilities 110.00
Cross street/directions to job site: AR� S-� Manholes 16.60
� Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) 1 Page 2
Subdivision: Lot no.:
Water service
e (no. linear ft.: ) 1 Page 2
Tax map/parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
V a � , . I - I - Backwater valve 16.60
INN aACeik Clothes washer 16.60
Dishwasher 1 330ROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
C` or Expansion tank 16.60
Name: c <� lFi \1
Expansion tank 16.60
Address: \3'Z +c 5\ \\0�. t. Ay f Fixture /sewer cap 16.60
City /State/ZIP: - � ` ✓ A Q • ` 1 `7 vr,-� 7� Floor drain/Floor sink/hub 16.60
Phone: (S ) (off 7 a - ) 4 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 1 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City / State/ZIP: 2..f drain (commercial) 16.60
Phone:( ) Fax::( )
Sin /basin/lavatory 2 16.60
Tub /shower/shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: i ( )N E it✓ Water heater 16.60
Address: l/ Other:
Subtotal
City / State/ZIP: Minimum permit fee: $72.50 yy/ ')
Phone: ( ) Fax ( ) Residential backflow minimum permit fee: $36.25 /i `�
CCB Lic.: .11‘14 ` PI , ing Lic. no.: Plan review (25% of permit fee)
,. State surcharge (8% of permit fee) 6% g0
�t�jf
Authorized signature: TOTAL PERMIT FEE 7 g • 30
Print name: Date: 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 \Permin\PLM•PermitApp.doc 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 55,000.00 Minimum fee 572.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to 510,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fee Total additional $100.00 or fraction thereof, to and
Fixture or Item • ea ) including$10,000.00.
Commercial Bad 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 5379.50 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 5742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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.
-3"
4 w
car wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
-lndustrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
-Bradley
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:
i1 &rildng\Perrnib\PLM- PermitApp.doc 09/27106
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Pi.M2007- 00292
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/9/2007
Phone: (503) 639 -4171 ICI
Inspection Requests (24 Hrs.): (503) 639 =4175
INSPECTION WORKSHEET FOR DATE: 6/3/2008 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 13355 SW 110TH AVE CLASS OF WORK:
SUBDIVISION: MI RA PARK LOT #: 00F,, TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Kitchen remodel
OWNER: CLARK, SCOTT PHONE #: 603
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6.13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070737 -01 503- 624 -7274 N
Corrections /Comments /Instructions:
[X PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: w--A Date: , Ji J 07`1 Phone #: (503) 718-
6/3/20
Iinforr:lation Summary 7:26:27A
�"'�E`' Case #: PLM2007 -00292
Activity Hold Updated
Activity Description Date 1 Date 2 Date 3 Disp Level B Date
PLM1010 Application received 7/9/2007 RECD None BLD 7/9/2007
PLM 1020 Permit created 7/9/2007 DONE None BLD 7/9/2007
PLM 1030 Check for parcel tags 7/9/2007 DONE None BLD 7/9/2007
PLM1260 PLM signature on application 7/9/2007 DONE None BLD 7/9/2007
PLM 1280 Issue permit 7/9/2007 DONE None BLD 7/9/2007
PLM2320 Plumbing rough -in 9/26/2007 9/27/2007 9/27/2007 FAIL None ST1 9/27/2007
PLM1730 Case update (see note) 3/18/2008 DONE None BLD 3/18/2008
PLM2399 Plumbing final 3/25/2008 3/26/2008 3/26/2008 PART None STI 3/26/2008
PLM 1530 Permit expired by limitation 4/14/2008 DONE None RB 4/14/2008
PLM 1470 Return to "I" status 6/2/2008 DONE None HAP 6/2/2008
PLM2399 Plumbing final 6/2/2008 6/3/2008 None STI 6/2/2008
Tran ees Create Created
Fee Type Description Code Revenue Account No. Date By Amt. DI
PRMT [PLUMB] Permit Fee 245- 0000 - 431000 7/9/2007 BLD $72.5C
5PCT [TAX] 8% State Surcharge 100- 0000 - 207020 7/9/2007 BLD $5.8C
Name Case People Listing
Role Type Address Company Name Hold Primary
OWN SCOTT E CLARK None Y
13355 SW 110TH AVE
TIGARD, OR 97223
PLM OWNER None N
1 of 1
InfoSummary .
CITY ®F TIGAR® '
f
BUILDING DIVISION PERMIT #: Pl M2Otl7 07 92
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7191)03.1
Phone: (503) 639 -4171 ..�'„,„ r!
Inspection Requests (24 Hrs.): (503) 639- 4175�i''`�f I
INSPECTION WORKSHEET FOR DATE: 9/27/2007 TIME: 7 :00AM PAGE: 80
SITE ADDRESS: 13355 SW 110TH AVE CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: oos TYPE OF USE:
PROJECT NAME: Ct.ARK
DESCRIPTION: Kitchen remodel
OWNER: CLARK, SCoT1 PHONE #: 503 - 624-7274
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Mesage
320 Plumbing rough -in 056417 -01 503.5247274 N
Corrections/Comments/Instructions:
Co (4 A. er -I TA a `ei S 4 -/k Sv Al i e-4 -717
e..
0 AAA Lt 4. •t L - i z i / - L5 r 1 rt4t.e.f teci „,z -.„d -t= o its C,
❑ PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
@ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr3 L► ./L- Date: 1 1 27/D7 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00292
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 71912007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 - M
INSPECTION WORKSHEET FOR DATE: • 3/26/2008 TIME: 7:00AM PAGE: 38
SITE ADDRESS: 133551 SW 110TH AVE CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: 006 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Kitw:hon remodel
OWNER: CLARK, SCOTT PHONE #: 503- -624 -7274
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 3/26/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 06734 01 503 - 624 -7274 Y
Corrections /Comments /Instructions:
C e b-
PASS 71, PARTIAL APPROVAL n CANCEL n NO ACCESS
7 FAIL CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: cri) ‘ 1 l I Date: 312. 1VSb Phone #: (503) 718-