Permit t" I
CITY OF TIGARD
PLUMBING PERMIT
° ' `` COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00544
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/10/2007
PARCEL: 2S 102AB - 00916
SITE ADDRESS: 12110 SW 92ND AVE ZONING: R -
SUBDIVISION: KIMBERLY ADDITION LOT: 016 JURISDICTION: TIG
PROJECT: ROSAS
Project De French drain between fence and house, draining to existing ditch at back.
CLASS OF WORK: OTR 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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
KELLIE SERGIO ROSAS
12110 SW 92ND Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/10/2007 $72.50
[TAX] 8% State Surcha 12/10/2007 $5.80
Phone : 503- 670 -1105 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 may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: OP / Aar Permittee Signature: �(�� ��- b 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.
' Plbmbing Permit Application
Building Fixtures - ' FOR OFFICE USE. O .
City of Tigard
Received /o'J
1 0 .Z0 rl i Date /By: `�-/ Permit No ' ���' �� s"�lt�(
a 13125 SW Hall Blvd., Tigard, OR 9L 3" UU Plan Review
Phone: 503.639.4171 Fax: 503.5�503.5A.460 Date/B Y Other Permit No.:
LA yy ((�� Al��� ry
T I GARD Inspection Line: 503.639.4175 ��Vi' , �� Date Ready /By: Jury la See Page 2 for
• Internet: www.tigard- or.gov BUILDING Notified/Method: // Supplemental Information
- TYPE OF WORK' . FEE* SCHEDULE
El New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
El Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
El 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ID 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: LO D 51-_ -) 6 1 --- AQ e.. Catch basin or area drain 16.60
City /State /ZIP: -1--f. A L T V 0 �� q - -T � ' Drywell, leach line, or trench drain 1 16.60 /440
Suite/bldg. /apt. no.: �' ` I Project name: &) Footing drain (no. linear ft.: ) Page 2
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
j
• lit , '1 - (J...�,\ / '-2_, Vhf \A A VC..A V.-- `(� SLTi-R -.) te. Backwater valve 16.60 .
e/ V'1._ u Q '*'C CA QJCL,t,t_ C k.Ci" t UL- Clothes washer 16.60
Dishwasher 16.60
❑ PROP> OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: .t< e a v L Q, . b N Q � C Expansion tank 16.60
Address: l D \ \ 5 (� v-ok- i k u iz___ Fixture /sewer cap 16.60
City /State /ZIP: •' I f d o C 1 a a '?_ Floor drain/floor sink/hub 16.60
Phone: (c5 2) C l 1. b rJ 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: ( ) Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR • Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP: ON w i Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7�'
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 7 .. !cO
Authorized signature: , \D`_ _im TOTAL PERMIT FEE 7g.
Print name:, i \ 01 L �S G___ Date: 01 ` b `( 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.
t:\Building\Permits\PLMF- 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 - li 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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
Subtotal: $50,001.00 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.
-3"
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: •
1:\Building \Permits \PLM- PermitApp.doc 12/27/06
CITY ������U��������
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BUILDING ��UN��� DIVISION ' PERMIT #: PLk8ZO��OO644
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12y10/2.O07
Phone: (503) 639-4171 � �
Inspection Requests (24 Hrs.): (503) 639-4-175 - AJL
INSPECTION WORKSHEET FOR DATE: 12/24/2{]7 TIME: 7:00Ah4 PAGE: 31
SITE ADDRESS: 12110 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: KIMBERLY ADDITION LOT #: 016 TYPE OF USE:
PROJECT NAME: ROSAS
DESCRIPTION: French drain between fence and house, dra toexiting dtch at back.
OWNER: 3ER �|O ROSAS, KELLIE PHONE #: 603-670-1105
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12124/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 [turn} drain 062086-01 603-670°1105 M
—_`^.
Corrections/Comments/Instructions:
c= AJ= t
ri PASS 0 PARTIAL APPROVAL . CANCEL n NO ACCESS
| | FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
\.
Inspector: 1 Date: yJJ�- �� ���� Phone /5O3)718'
-° . \�_ ^ . . ` '