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Permit
CITY OF TIGARD PLUMBING PERMIT • • DEVELOPMENT SERVICES PERMIT #: PLM2006 -10051 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/27/2006 PARCEL: 2S 1038 D -03200 SITE ADDRESS: 12840 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Reverse plumbing under house 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 RAMIREZ, EDUARDO + LUCIA 12840 SW 121ST AVE Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 4/6/2006 $72.50 [TAX] 8% State Surcha 4/6/2006 $5.80 Phone : Total $78.30 Contractor: MCROOTER DRAIN SEWER & PLBG SVC PO BOX 301415 PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 632 -821 1 FAX 503- 939 -3246 Reg #: LIC 103682 PLM 26 -724PB 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. 4 R) Issued By: j a Permittee Signature: di / `/ 0 0 ∎ 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. lit try EI V a/ Plu ing Permit Applic t�tt� . 'EUIt' 9Ipl 1( 1`' US OIN ,� MAR © sue "A, ,�.. �.. City Of Tigard 9 °iAR (3 �� I. i D az y J i2 -7 ...c, , " Penult No. - /OQ5/ aA 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 iFrr r,'I� ; %'� Date/B Y Other Permit Noo / 2 dd /).J, ,lxt . ., 24- Hour Inspection Line: 503.639.4175 CITY OF TIG . • I Ij! Date Ready/By: June: ® See Pa e 2 for Internet: www.tigard- or.gov g BUILDING DI 1 • Notified/Method Supplemental Information '_TYPE.:OF WORK " = }' ;, .. „ : , r =" rt "':.FEE* . °"' '_ ' ❑ New construction El Demolition For special information use checklist. Description I Qty. I Ea. I Total dition /alteration/replacement El Other: New 1 dwellings (includes 100 ft. for each utility connection) • + `2 4 'E, ' ! ;CATEGORY OF CONSTRUCTION . .• „,. SFR(1) - 249.20 . 7 L1. and 2- famtiy dwelling El Commercial/industrial SFR (2) bath 350.00 El Accessory building El Multi-family SFR (3) bath 399.00 El Master builder " Each additional bath/kitchen 45.00 ❑ Ot her: . Fire sprinkler ( sq. ft.) Page 2 d(B SITE• INFORMATION..AND °LOCATION:; - � Site utilities Job site address: /„../95/6 Ca / / Catch basin or area drain 16.60 City / State/ZIP: / ! "7 Drywell, leach line, or trench drain 16.60 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 - ��// .D D E OF WORK IPTION Back flow preventer Page 2 � /i'7s' fr Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 -- - l',,.- ❑ PROPERTY-;OWNER': ' , ❑ TEN ` . Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax ( ) Garbage disposal 16.60 • ' ❑ APPLICANT - • . •- - • . ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: /yf � a 72 / 3�x � . C "� m ,,,,, r /j j Interceptor/grease trap 16.60 Contact name: ,L . Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) . - . 16.60 Phone: Sink/basin/lavatory 16.60 ( ) Fax::( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR -.; ; Water closet / � 16.60 Business name: r 2 /P7 -7� Q/L/a-iei . SEswc v ,,., Water heater 16.60 Address: // �-(1G- 5i/ 4/ (S / Othe e City /State/ZIP: /-(-7/77.__,0.--,T.... I /f Subtotal Minimum permit fee: $72.50 / Phone: (--.-03) 0y 2 - o _ f Fax: ( c-) 9' ?y 4'2 ` fy Residential backflow minimum permit fee: $36.25 . ,., 9 7.,,_ 5 .. CCB Lic.: /o 5e� Plumbing Lic. no. era- =7z. Y ��r Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: � � TOTAL PERMIT FEE -7g, ao Print name: A ' Ay / 12 :7 ____.-- Date:3 - 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\PLM- PemitApp doc 12J30/05 440- 1616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • �l, •> • Fee Schedule: Residential Fire Suppression Systems: 4' -:,'. - :9'.yxc�y'j?',:n,� '.:; ',i„v5>:�:w'.,�...,.•.. . -.ry 1.. t k . , p . .a U ..t :'r. s; :t'.';ya.,g.• _ Site'�t a I ¢ Qt .{ " cFee(ea) . :Total t � • . - �'�. -�,�� .�,, 1� . � ....� . 'SQ1IIare�FOOta�,e ''�.'.. �,PQ"I1111t _, -- 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 Water Service - each additional 100' 46.40 S yStemS: -•.i'- d' .r k a. Valuation:r Peiit F.ee.= 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 ; i'ee.(ea) " y; 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 $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: 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 CI Any new commercial building. . . -.,, L , R ,< ❑ Any new exterior plumbing site utilities. j�.' eP Previous Capaed 'name istio ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower El 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 -D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain = ":ISOffiCtr1C Or:R1SCC:D1agCalY1_= �'',` =:: ''r =` 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. i:\Building \Permits \PLM- PermitApp.doc 07/06/05 . CITY OF TIGARD f BUILDING DIVISION PERMIT #:7_0,04,-10051 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 u Npngii� ilia Inspection Requests (24 Hrs.): (503) 639 -4175 ...' 11. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / 2_. to) / e' / -(lam CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 3 --c)-- ? — fo Pour Time: / O Code # Inspection Description Confirm # Contact # Message 7 (c(- 0 33 d Corrections /Comments /Instructions: I "‘"°----j- ..-) tt - ASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I 1 1 Inspector: I °�./ Date: / / Phone #: (503) 718-