Permit n CITY OF TIGARD PLUMBING PERMIT
A ' PERMIT #: PLM2007 -00024
•• COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/25/2007
PARCEL: 2 S 103 B D - 09700
SITE ADDRESS: 12957 SW 116TH PL ZONING: R - 4.5
SUBDIVISION: HUNTER'S WOODLAND LOT: 009 JURISDICTION: TIG
Project Description: Remodel. Other fixtures: (1) sump, (1) hose bib.
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: 2 OTHER FIXTURES: 2
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TED & KIM THOREN
12957 SW 116TH PL Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/25/2007 $99.60
[TAX] 8% State Surcha 1/25/2007 $7.97
Phone : 503 -579 -0768 Total $107.57
Contractor:
MP (MILWAUKIE) PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 655 -9161
FAX 503- 650 -7050
Reg #: LIC 5002
PLM 3 -17PB
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: ��„ Permittee Signature: _.SP P c ,,
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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.
From: 01 /2512007 09:02 #544 P.002/003
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Plumbing Permit Ar , , • I t►ir 01 11SI: ( i A,
CI of Ti and \C ' Received _ � J
131 SW Hall Blvd., Tigard, OR 97223 n T. 2 Date/By; /r..� o / - . Pennit N6.F )M �. 7 aQ 0,/
A�j` '! c) .. Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 \ J\' 1.4 /L l , )n l Date/By: Other Permit No..
24- Hour Inspection Line: 503.639.4175 _¢4'tic�- _. L I Date Read /B i�rig:
Internet: www.ci.tigardor.us
y y: See Page 2 for
--N c 1. a ci:' Notified/Method: Supplemental Information
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�Sl+:; , l y , ;� ��; � G . {� tt t .� rf t'� � i..f +,i a 1•.x.'!+ �1�::,i � 5 � $ �,.�• 9 3,, .iid'i'�. • r A z:.! 1� 0 ,r;� �fg.:t�.l;G*`ilt'ii: y,ll'r 1 �j.. , 5 , i
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❑ New construction 8, \ '"❑ Demolition For special information use checklist
Description 1 Qty. k Ea. 1 Total
a Add /alte ❑ Other. 4 {{ p �@ New 1- 2- family dwellings (includes 100 ft. for each utility connection)
r 111 it 11 ���� -p t} I i iz I� f litho �
�F'S' n k 1 ! t ERB iv al(Z E i n 1 $"' n�DU ' F li
} a at 1 +, Y u 3 A,�,U Cti p 8 �' + it l rz ! It t SFR(1)bath 249.20
x. .I :i,„ . i,e 1;K ..r• lair 11 ra pt. tog ,.a rittaillu. i t ter t ! r
P. % 1- and 2 -family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fires rinkler
i t r ,� + s a 's 1•reua i zt, ti �tr a . t a H,u .a P ( sq. ft.) Page 2
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I tit bILL3` �i' 4 ;w /r I, rtu I,ttsd i t o §ant rifttiz ttirrs lI . �, l,_ , .s . * t ?a,. S ut
Job site address: /i i a - 7 4 1 9 0 /�6' Catch basin or area drain 16.60
City/State/ZIP: / ell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: / Project name: ird /fi 4,,, Footing drain (no. linear S.: ) Page 2
Cross street/directions to job site:
j Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear f: ) • Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no
Fixture or item
! ) n G 1 ( p�� 1r ti I �l . `� Abso lion valve
sxs >r t � p s � t i ,`� x -t, --��tu > t � °- � ,. � , r 16.60
1 (( 1 , i t . •„ N ,,h# s a si al §c � a , r + ,� ��� t{ -
t :�+ 11.t., 13,1 .l LI it h,t1,, liEli Fd a.6r .tol.t suii, " i� nlrtha�n_ ;i 1(.� lv: „Il , €. fl t:S! #1 1 ii ilk& Baekflow preventer Page t
d ,, / / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
pp}'i i l if�ri;� i i 3 i IC [t e a'
t n r , rl' If T i" j� �h i , s i 1 i j 1' i t ti ` + . uf g � ' 1' pi l Drinking fountain 16.60
ititillili t liii,4 :s r lt. e{' tAninra.:BIGIlltlR;nl.i : l _ ilu.. llluIllI iii:: Ejectorei„mp r' 16.60 ! ce
Name: ,
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax g Garbage disposal 16.60 �
E I � [ I r 111, �1 tt ri r G i t t 1{ t t to„ ? f A i t € ~ f, � i-i a� l� ( t + F, : , : i 1 1� Hose bib J 16.60 J f
# ni ttra . o rA. w , II t� i tti { ' A lib i Ice maker J 16.60 / (P , /
Business name: MP PLUMBING CO. Interceptor /greast trap 16.60
Contact name: TAMI Medical gas (value: $ ) Page 2
Address: PO BOX 393 Primer 16.60
City /State/ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16.60
Phone: (503) 655 -9161 Fax:: (503) 650 -7050 Sink/basin/lavatory z, 16.60 -/
Tub /shower /shower pan / 16.60 , k_e„..--
Email
' ` t ii i i !" a �t x 'tk a o n I ill a i' 1r" t r 1 s t tl �sky ar 1i�� °I , R {"t( F i ' �p ,. r 3 a Urinal 16.60 / f
„ 1 7� # i i ,: „ a, ..., ie i 1t... ( l II, . 1tt' a a ; i � ii: i , , s,a,}m .,;! 6 t , ti 3 zl a . ,t 1 i1{ t , §i *`' , • i I f, t ., , , , v t j a r c ose • Wtelt /Its, TO%
16.60
Business name: MP PLUMBING CO. Water heater 16.60
Address: PO BOX 393 Other: L p}
City /State /ZIP: CLACKAMAS OR 97015 Subtotal
Minimum permit fee: $72.50
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25
CCB Lie.: 5002 Plumbing Lic. no.: 3 -17PB Plan review (25% of permit fee)
� State surcharge (8% of permit fee) 9. r�
Authorized signature: i' /!�,e / - TOTAL PERMIT FEE I 4)7-
I Print name: TAMI GEORGE Date: /.•J� ,/7 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.
is muilding \Pennits\PLM- PeratitApp.doc 06/05 440- 4616T(IW02/C0M/WEB)
From: 01/25/2007 09:02 11544 P.003/003
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • • ression S stems:
1 1 7 "s',, t.- ga . � t ' - ,11.,: a1 x1 , } ii Y wl ;: ki rig . , i «.;. r.,M i. 141 S L11 ;:liiC(jaY�l .1 ftRi .gill Mai ", a ma } . p,. i • :?Z ug . {
� �4 ! a i : t t ill �u Fl l l l � , ti ' ��,1, /Loge , fitut illii0 l 1�tW ll, ; l ? I `
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 S stems:
Water Service - each additional 100' 46.40 PF }l Milt i F1 { r fir }jl} }d li(I { fqi n i m,
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
t }�.it k � li '>' ' ti ii11 ill ! t _ {II M milii'4 S; t H ier 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 . ermit 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
s.eciall re•uested ins.ections - • er hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and for
each additional $100.00 or fraction thereof.
•
Fixture Work: ,ii k 1 }�1 l it '_..' l < a ` i „ipi i k: 1 . it Is 4 rr, ;
_ 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.
II III re. ort fixtures could result in increased sewer fees *. Please check all that apply.
Y ' s i , i a fl ! 7 - 1 t [ �^ Y� y1" 5i i'`„£�r?Ct;3,'i 0{ Nk�t,Md .R:. ,�t # i t> S D r lg . ❑ Any new commercial building.
�1ii� ,�, �i y�� 1 #i i i F t r + + ip + ❑ Any new exterior plumbing site utilities.
ti riIi [ALI :::1111 ii gel gala la ? {M t: } 1,1312. . ' " i ` '! ,151 ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower j_ ❑ 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
Eye Wash El Any NFPA 13-D multipurpose fire sprinkler system.
Floor Drain/sink - 2"
Submit 2 sets of plans with any of the above.
-3"
- 4" ti (# rg �11�Fri {'; (i '�p lli ra '"11,7 'II} "G.��aPtri m = i i ll ¢ a g il li 4 l t el
Car Wash Drain i�; I,lsfa=t ' ') 111,11 Y a 1 i J',1 t (t.161;r gli, t. 1, ° . c r: i ` I
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) Co ments regarding fixture work:
Rec. Vehicle Dump Station /i ilti lb j , 1 /J) / , jd .,
Shower -Gang
-stall � /.��i i�'J1,
Sink - Bar/Lavatory y`
- 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 i 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: 1. plumbing permit can be issued.
iaauildingPermita \PLM- PamitApp.doc 07,06/05
CITY ��h����B�������� -
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BUILDING DIVISION PERMIT #: PLk43007'00024
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1[2612007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/2/2008 TIME: 7:00AIVI PAGE: 24
SITE ADDRESS: 1266ySVV11QTMPL. CLASS OF WORK:
SUBDIVISION: HUNTER'S WOODLAND LOT #: 009 TYPE OF USE:
PROJECT NAME: TM0REN
DESCRIPTION: Remodel. Other fixtures: (1) sump, (1) hose bib.
OWNER: TH{]REN. TED [&KIM PHONE #: 503-579
CONTRACTOR: &4P(W|LV*Ai)K|E) PLUMBING C[> PHONE #: 603'555'9161
Inspection Request Scheduled For: Date: 4/272008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 087730-01 603-579-0768 N
Corrections/Comments/Instructions:
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���� � PARTIAL El | |NDA�ESS
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Fi FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ~+-- Date: ' ^
\�'� «��� Phone #: (503) 718-
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BUILDING DIVISION ^ PERMIT #: PLM2007-00024
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| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/25/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 "4�W 1J.:.
INSPECTION WORKSHEET FOR DATE: 3/15/2007 TIME: 7:01AM PAGE: 46
SITE ADDRESS: 12957SVV116THPL CLASS OF WORK:
SUBDIVISION: HUNTER'S WOODLAND LOT #: 009 TYPE OF USE:
PROJECT NAME: THOREN
DESCRIPTION: Remodel. Other fixtures (1) sump, (1) hose bib.
OWNER: THOREN, TED & KIM PHONE #: 503-679-0788
CONTRACTOR: hMp8N|LWAUK|E\FLUK4BINSC0 PHONE #: 503
Inspection Request Scheduled For: Date: 3/15V2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
520 Plumbing rough-in 044867-01 503-665-9161 Y
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11 PASS L1 PARTIAL APPROVAL 0CANCEL 0 N ACCESS
i FAIL fl CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
) t |nopectoInspector: [ Y \ Dete: I Phone#: (SU3) 718' "~-~/^^~ / ' ]0 �
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BUILDING DIVISION PERMIT #: PLM2007'00024
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/25/3007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 630-4175 �
INSPECTION WORKSHEET FOR DATE: 2120/2007 TIME: 7:09AM PAGE: 38
SITE ADDRESS: 12957 SW 116TH PL CLASS OF WORK:
SUBDIVISION: HUNTER'S WOODLAND LOT #: 009 TYPE OF USE:
PROJECT NAME: THOREN
DESCRIPTION: Remodel. Other fixtures: (1) sump, (1) hose bib.
OWNER: 7H0REN TED &KIM PHONE #: 503'579-0768
CONTRACTOR: kXP(iW1LVVAUK]E) PLUMBING CO PHONE #: 503-655-9161
Inspection Request Scheduled For: Date: 2120/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 P1urnbioQundmv01ab 043591^01 503 N
Corrections/Comments/Instructions:
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t Ass ri PARTIAL APPROVAL �� CANCEL �� NO ACCESS
| L ri CALL FOR INSPECTION | | ADDITIONAL FEES ASSESSED
in �� � ���
Inspector: Jv / � �, ~^—^~ Date: Phone #: (503) 718'~~ �~'
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CITY OF TIGARD , „ _ c_., , .1
1 BUILDING DIVISION , #: PLM2007-00024
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1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2512007
Phone: (503) 639-4171 4 144104111 .
Inspecti 1
on Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 202007 TIME: 7:03Alvi PAGE: 20
SITE ADDRESS: 12957 SW '116TH Pi_ CLASS OF WORK:
SUBDIVISION: HUNTER'S WOODLAND LOT #: 009 TYPE OF USE:
PROJECT NAME: THOREN
DESCRIPTION: Remodel. Other fixtures: (1) sump, (1) hose bib.
OWNER: THOREN, TED & KIM PHONE #: 503-579-0760
CONTRACTOR: MP (MILWAUKIE) PLUMBING CO PHONE #: 503-655-9161
Inspection Request Scheduled For: Date: 2/&2007 Pour Tim- . _ A , 1
/ 0 : (7 V
Code # Inspection Description / ( • Confirm # Contact # -ss:ge
' *
395 Misc. inspection i , 043123-01 503-655-9161 Y
Corrz;-.ons/Comm-nts/Instructions:
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Inspector: Date: Phone #: (503) 718-