Permit Y 1 CITY OF TIGARD PLUMBING PERMIT
°' COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00453
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/29/2008
PARCEL: 2S 114BB -18900
SITE ADDRESS: 16145 SW 103RD AVE ZONING: R -
SUBDIVISION: RIVERVIEW ESTATES LOT: 035 JURISDICTION: TIG
PROJECT: REILLY
Project Description: Kitchen remodel.
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner:
FEES
MARK & AMY REILLY
16145 S. 103RD AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/29/200€ $72.50
[TAX] 12% State Surch 12/29/200€ $8.70
Phone : 503- 260 -6671 Total $81.20
Contractor:
MICHAEL T DUNN PLUMBING
3618 SE CONRAD CT
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 640 -2459
Reg #: LIC 181088
PLM PB519
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.
Iss d B y: , �' / ,(/ a �� Permittee Signatur `�`� icaci
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 ..
A City of Tigard Received
Date/By: /2- 9 A. 0,5"" Permit No.: A/. /.. /./..4,,,,,,k_404/675
O 13125 SW Hall Blvd., Tigard, OR 97223
I
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date /By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read /B s. ®See Page 2 for
Internet: www.ti
T I G A RD and -or gov y) g
g c Notified/Method: I ( Supplemental Information
. TYPE OF WORK • FEE* SCHEDULE
El New construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ 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
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: I (p' 4 5 Sul / 05v' d -,q Catch basin or area drain 16.60
City /State /ZIP: F 1 a rA d Q rZ q - Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J I Project name: RU n b/ .F � ✓ ( Footing drain (no. linear ft.: _) Page 2
Y 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
- - 1' DESCRIPTION OF WORK`- Backflow preventer Page 2
w10VC�1j SIv* I otiginualf hey I - d - Gi(XxL9cqc. ctiSpow) Backwater valve 16.60
�J 1 Clothes washer 16.60
Dishwasher ( 16.60
Drinking fountain 16.60
PROPERTY OWNER . ❑ TENANT ,
Ejectors/sump 16.60
Name: �..� 1 i\ Expansion ion tank tank 16.60
Address: l Le ) Li S ( p 3 �- c d ,�� Fixture /sewer cap 16.60
City /State /ZIP:` I I Wed D a 1 2.44) 224 Floor drain /floor sink/hub 16.60
�OZ t / t ' _ r 7 . I Garbage isposa
Phone: ( "' JJ'' lK y Fax: ( ) Gb disposal l _ 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: H t LH.A. EL T - 7 - D L �1,.) P(.tl gI A/ Water heater 16.60
Address: -5 Q o,e, e_,,,,,,) 1 ft C_T , Other:
City /State /ZIP: i_t_ f: jo OA . ? 7 / a Subtotal
A Minimum permit fee: $72.50 t-7, �
Phone: ( `5b � c/o_ � Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: /� P6 5 t Plan review (25% of permit fee) �/ t'
� � � � �j y t p Plumbing Lic. no.:
�i�(� 7/1 f i
Authorized signature � State surcharge (12% of permit fee) IS. 70
�c� I TOTAL PERMIT FEE
Print name: m � $l ( Date: ( 712 ` 0 Q' This permit application expires if a permit is not obtained within
`� + D 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:1Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(I0 /02 /COM/WEB)
Pluming Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Supp,ression Systems:
Site Utilities,'. Qty' F ee (ea) .. : Total . Sgpllare,FOOtage: " ': , „ ,P ermit Fee:
Footing drain - 1s 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- . :Pernik 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
a additional $100.00 or fraction thereof, to and
Fixture orltei Qty. Fee (e—)' Total
_ 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.
Commercial Fixture Work: i PlanLLReYiew; forPlumbing Installations f
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
engineer.
• .Previous ' 'Capped , ; 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 Diagra .
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 \Permits \PLM•PermitApp.doc 12/27/06
CITY OF TIGARD - f
BUILDING DIVISION 0 PERMIT #: PI M200B
13125 SW Hall Blvd., Tigard, OR 97223 `/' DATE ISSUED: •1.)/244/2000
Phone: (503) 639 -4171 Ava I i p
Inspection Requests (24 Hrs.): (503) 639 -4175 °`•' �. .
INSPECTION WORKSHEET FOR DATE: 12/30/2001 TIME: 7 :00AM PAGE: 20
SITE ADDRESS: 16146 SW 103RD AVE CLASS OF WORK:
SUBDIVISION: RIVERVIEW ESTATES LOT #: 035 TYPE OF USE:
PROJECT NAME: REILLY
DESCRIPTION: Kitchen remodel. t O�
OWNER: REILLY, MARK & AMY + PHONE #: 603- 260 -6G71
CONTRACTOR: MICHAEL T DUNN PLUMBING PHONE #: 503. 640 -24ti9
r' - h
Inspection Request Scheduled For: Date: •12/30/2008 Pour Time ° .
Code # Inspection Description Confirm # Contact # Mes. • � � O
399 ' Plumbing final 079242 -01 503.620.0674
Corrections /Comments /Instructions:
11/40
0
147" t.,e G ll e t/ 4 -, �,�r. ) I 9 4
ASS H PARTIAL APPROVAL _ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ,1 1 7 a` Phone #: (503) 718 - '41