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Permit
� � CITY�OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00067 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/25/2008 PARCEL: 2S103BD -01200 SITE ADDRESS: 12630 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: NIX PARTITION LOT: 001 JURISDICTION: TIG PROJECT: NIX PARTITION Project Description: Connect existing house to newly installed storm drain, 100' or less. 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: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 100 ft Owner: FEES NIX, LOY CARL MARSHA A 12630 SW 121ST Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 2/25/2008 $72.50 [TAX] 12% State Surch 2/25/2008 $8.70 Phone : Total $81.20 Contractor: PACIFIC GROUND WORKS PO BOX 6613 ALOHA, OR 97007 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 649 -8002 Reg #: LIC 152746 PLM 34-451PB 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. / 0 Iss ed By: /o.' , 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. Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY • 111111 City of Tigard Received Date/By: a as og A .J % Permit No.: �L � PI $ /'r# 1 _ q 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.. Date/By: Inspection Line: 503.639.4175 Date Read /B r j s� ® See Page 2 for Internet: www.ti TIGA and -or. ov Ready /By: �� g g g Notified/Metho I G Supplemental Information TYPE OF" WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I 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 AM) LOCATION Site utilities Job site address: .2 t . • I v1 Catch basin or area drain 16.60 City /State /ZIP: / / U ra • / (V q • Drywell, leach line, or trench drain 16.60 / Suite/bldg. /apt. no.: Project name: IJl /� �/ / r A c J • Footing drain (no. linear ft.: ) Page 2 ovi 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 3j 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 . /41,6e355... Up loot In 6?)/1 .-fjx yj Backwater valve 16.60 41 61 n � L©!.in /12,,,, Clothes washer 16.60 4 Tr Dishwasher 16.60 1:1 PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: Ln C__ Expansion tank 16.60 Address: /Z.0.30 /Z / Fixture /sewer cap 16.60 City /State /ZIP: JO fa 61 ! 71 Z3 Floor drain/floor sink/hub 16.60 s / � ' i / 2Id Phone: (5 ) 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 Phone: ( ) Fax:: ( ) Sinl /basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR. Water closet 16.60 Business name: fiGr,6j e ( p, J„ G✓av'(' Water heater 16.60 Address: Other: City /State /ZIP: Subtotal 3y 9 S-iCa Minimum permit fee: $72.50 q Phone: -� Z Fax: ( ) Residential backflow minimum permit fee: $36.25 / � • � � �) CCB Lic.: / 1,2 '' q3 / Plan review (25% of permit fee) - - Authorized signature: / 7 r bin Lic. no.: / G State surcharge (12% of permit fee) g .7o TOTAL PERMIT FEE 5 . ,9.0 Print name: / 7 )/ / C., Ali i Date: 2 -2 ": 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. I \Building'Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard r' Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: SIte =Utilities Qty. Fee (ea) • Total • Square Footage:' Pei'Ynit: 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 - • 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 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 liy "(Future) Walt 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: i \ Building\Permits\PLM- PermitApp.doc 12/27/06 CITY OF TIGARD BUILDING DIVISIO PERMIT #: Pi.,M2008- 0W7 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/2512008 Phone: (503) 639 -4171 / �x�Nl�lpiq�� i?` Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 212a'2008 TIME: 7:00AM PAGE: 16 SITE ADDRESS: 12530 SW 1I 121ST AVE: :: CLASS OF WORK: SUBDIVISION: NIX PARTITION LOT #: 001 TYPE OF USE: PROJECT NAME: NIX PARTITION DESCRIPTION: Connect existing house to newly installed storm chain, 100' or less. OWNER: NIX, LtY CARL MARSHA A, PHONE #: CONTRACTOR: PACIFIC GROUND WORKS PHONE #: 503 - 649 -8002 Inspection Request Scheduled For: Date: 2/26/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storr i drain 065663 -01 503-690-3028 N 'dJ Corrections /Comments/ Instructions: PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS n FAIL CALL FOR INSPECTION Li ADDITIONAL FEES ASSESSED Inspector: Qt `'V�� Date: 2 C\ O Phone #: (503) 718-