Permit C ITY OF TIGARD PLUMBING PERMIT
i� DEVELOPMENT SERVICES PERMIT #: PLM2006 - 10019
I ' DATE ISSUED: 3/7/2006
I "•' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 CB -02300
SITE ADDRESS: 14885 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: MURDOCK HILL LOT: 004 JURISDICTION: TIG
Project Description: Repipe and add fixtures, ice maker
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
MARILYN WEBER
14885 SW 100TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/1/2006 $166.00
[TAX] 8% State Surcha 4/1/2006 $13.28
Phone : 503- 968 -3204 Total $179.28
Contractor:
ABC CONTRACTING
11945 SW PACIFIC HWY. #306
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 620 -4757
FAX 503- 620 -4790
Reg #: LIC 162558
PLM 26 -786PB
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: /�Gfit,.2 /f4.G4, 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.
•
ding Fixtures
� iVE® 111 1 " ". " .rt " ' ,1
Albin. Permit Ai t I' k� r * i I O12 7 I IC"L.7 O \ I 1 7 r. Al
` ity of Tigard pp pp �} Received
- Permit No.:P
13125 SW Hall Blvd., Tigard, OR 97223 MAR �" Date/By ,e 1i� of -/001 A*
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 r /bran Other Permit No.:
' 24- HourinspectionLine: 503.639.4175 CIT O F TIG ar '� fll'. Date/BY BUILDI DI`J "' e`'? A DateReadyBy: Jun ® SeePage2for
Internet: www.ci.tigard.or.us . Notified/Method Supplemental Information
TYPE OF WORK FEE* SC EDULE . -
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 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
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
12 Accessory building ID Multi-family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities
i
Job site address: i g 8t c„,,,,) to u 4- h Jb ac Catch basin or area drain 16.60
City /State /ZIP: 7%, VA,r) ❑ Y e °kit 1 ' Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ( Project n e: �.k1(x, Footing drain (no. linear ft.: ) Page 2
Cross street /directions to job site: Manufactured home utilities 110.00
j ��f.l�, I J ,' �oc� pp�
tc S Manholes 16.60
.3 lW-► K (jJ C ' 4 t 2. p L s tt+v•� t ° J k (K) Rain drain connector 16.60
" � C l C C , - t L , (3N.., / t c ) r ) To l t. t i. - ... &. /H-70 Sanitary sewer (no. linear ft.: _) Page 2
� J t,j c t.,.3 S l� ,\„,.., ;4 �4. , cd _ 140 w Gs Storm sewer (no. linear ft: _) Page 2
Subdivision: 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
CC. - co l^ c W 4�/ ° fi
• r y4i 4 1 ti. 4() Backwater valve 16.60
Clothes washer r 16.60 iL, L
Dishwasher ( 16.60 `1, t D
PROPERTY OWNER I ❑TENANT. Drinking fountain 16.60
Ejectors/sump 16.60
Name: l ' - i \ P . i 1y \ f c be. r Expansion tank 16.60
Address: , 295 Sw 100 Fixture /sewer cap • 16.60
vr`. ,A
City /State/ZIP: --r , a 0 i Lq cbo Floor drain/floor sink/hub 16.60 ( L1,O ," Phone: 9 Fax: 1 Garbage disposal 16.60
❑ APPLICANT , ` t X,CONTACT. PERSON ' Hose bib 16.60
Ice maker 16.60 I b 4,0 i
Business name: C, C c ■ vG LL 6 Sf J J C S Interceptor /grease trap 16.60
Contact name: ' C, Fl-.r 5 i Medical gas (value: $ ) Page 2
Address: ltgc-k5 , QL;4 C \ \ �Q P r i mer \ 16.60 k (a r
J Z R oo f d ra i n commercial f 16.60 City /State /ZIP: J t '(` `+ ��/ 1 ( D, \ 0 ! 11 1- 16.60 . �3 �U
Phone: (2)051 L. 6 13Z. Fax: : (5-03) Z d --- I-H R0 Sink /basin /lavato \ J 1��7
Tub /shower /shower pan 1
16.60 . \4, btu
E -mail:
Urinal 16.60
CON'T'RACTOR Water closet 1 16.60 • (4 ,, (, 0 ,
Business name: l., 0 +V r5. C -
H 0 ( 5 u 1 LJ
Water heater Ct. J �,Uto t ;n1 I 16.60 l� f j a,/
Address: 1 I /� y Other
Ct t,T+� 5w �1
t��C -t. �c'L l�(x.� - Subtotal =
City / State/Z - 1
City / State/ZIP: 1 Q t) q ?•Z�
( ! � Minimum permit fee: $72.50 r X3 ( ,,
Phone: 0 Z.u . • - u� 5 7 Fax: ( "e ,) -6 Ltd - t-f 7 ej7 Residential hackflow minimum permit fee: $36.25 itat .ea
CCB Lic.: `b25-5 8 Plumbing Lic. no.: 76_ 7136pi Plan review (25% of permit fee)
State surcharge (8% of permit fee) /3,eS" 1
Authorized signature:
, �v~ "? ", C 2 6 z ' TO TAL PERMIT FEE / 79.x 0
Print name: ? t> C \ G . t %d t .. a_ Fa 7 Date: '3 -G, - -t) E, This permit application expires if a permit is not obtainea wrrnrn
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building industry Service Board.
i:\ Building \Perrnits\PLMF- PennitApp.doc 06/05 440- 4616T( I0 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Pee Schedule:
., Residential Fire Suppression Systems:
Site Utilities - ' ' Qty'.. Fee (ea) Total Square Footage: Permit- Fee: -. : I ll-
Footing drain - I" 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 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
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: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed El Any new commercial building.
Fixture Type::' Replace ❑ Any new exterior plumbing site utilities.
• Previous Capped Added Existing - ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food 'service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher -Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 - multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2",' Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain Isometric Or Riser Diagram.
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height. •
- Industrial
Ice Mach./Refrig. Drains
' Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang -
-Stall
Sink - Bar/Lavatory •
- Bradley
-Commercial
- Service
Swimming Pool Filter
washer Clothes *Note: If the fixture work under this ermit results in an
Water Extractor p
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: - plumbing permit can be issued.
is\ Building \Permits\PLM- PermitApp.doc 07/06/05
�PL/'j'I
CITY OF TIGARD - _.
BUILDING DIVISION PERMIT #:� —
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 w A i , ,�
Inspection Requests (24 Hrs.): (503) 639 -4175 ,..„. °Tf L
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
y8�
/ SITE ADDRESS: At ` D 0 ` 44).-e...- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 --3-6 co Pour Time:
Code # Inspection Description Confirm # Contact # Message
fraiC , -b , T. p -8/ o(3)__
Corrections /Comments /Instructions: y
eP
Y J � . ctix_e_aoi
.---------
Cck) / i.,, 1i✓v t c... -Jo . ✓. 141 11 c 0✓ S 41, we/ _ . -- Fu. - 6 Lf*-.; 4 a .---z_
n PASS lk PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cp1,►.4,..j 1' ..- Date: 2 / 1 i) 0 ( Phone #: (503) 718-
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
q
• •
•
January 23, 2007 •
TIGARD
Contractor ABC Contracting Service
Address 11945 SW Pacific Hwy STE 306
City, State, ZIP Tigard OR 97223
Site address: 14885 SW 100th Ave Owner: Marilyn Weber
Permit # PLM2006 -10019 Notice n Expired g Last inspection 3 /W l0 �p
OAR 918- 785- 0212(1)(a) states that all persons who take out a plumbing permit shall
request an inspection within 24 hours of completion of any plumbing intended to be
covered or concealed and (b) request a final inspection within 24 hours completion of
all plumbing for the job site covered by a particular permit.
Failure to comply with the above provisions will be subject to enforcement action as
a violation of TMC14.04.090, paragraphs 1 through 8, and as constituting a Class I
Civil Infraction subject to penalties of up to $250.00 per day, per violation.
If this letter has been sent as a notice, you will be allowed ten working days from the
date of this letter to call for final inspection. After that date, the permit will be
expired by limitation.
If the permit mentioned above has been expired by limitation, you may apply within
ten days of the date of this letter for re- instatement for purpose of final inspection
(one). The fee for reinstatement will be the amount of the permit or $62.50,
whichever is less and will be valid for fifteen working days.
A backflow assembly test report will be required for all permits that include a
backflow assembly. A copy must be provided at the time of the final inspection.
Call Jeanne Temple at 503- 718 -2433 for further information regarding reinstatement
and methods of application, payment of fees or how to schedule an inspection.
Sincerely,
7
Darrel "Hap" Watkins
Inspection Supervisor
C: Permit file
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard or.gov • TTY Relay: 503.684.2772