Permit s , fi
C ITY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2006 -00327
J DATE ISSUED: 7/5/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104AA -03500
SITE ADDRESS: 12230 SW 126TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD LOT: 031 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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
MOXLEY, ROBERT E + SHANNON M
12230 SW 126TH ST Description Date Amount
TIGARD, OR 97223 [TAX] 8% State Surcha 7/5/2006 $2.90
[PLUMB] Permit Fee 7/5/2006 $36.25
Phone : 503 -524 -5171 Total $39.15
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 �`_ Z � _ � �� L Permittee Signature: j
Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day. 4
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.
Building Fixtures . _
Plumbing Permit Application,
FOR OFFICE USE ONLY'
City of Tigard °� E C E { ii E ® Received Permit No.
-q 13125 SW Hall Blvd., Tigard, OR 97221 II II 5 Daz � /d� Ns �!/�.+
C Phone: 503.639.4171 Fax: 503.598. t60L O 5 2006 Plan Revt /B Other Permit No.:
Datey.
Inspection Line: 503.639.4175 D ate Ready/By: " See Page 2 for
TIC A-RD' CITY OF TIGARD y y ' g
Internet: www.tigard - or.gov III , _. _ ' Notified/Method: k 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)
e ` CATEGORY OF CONSTRUCTION - SFR(I)bath 2 49.20
❑ 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,(7z / (d ,4 Catch basin or area drain 16.60
1 _ ,:City /State /ZIP: / i ,a ,, 7)2,, 9 � 0 2 3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no. :0 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
/ iltRi ' DESCRIPTION" OF WORK , ' Backflow preventer f Page 2
i's- d, Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. • ❑ PROPERTY OWNER I ❑ TENANT ' .
Drinking fountain 16.60
Ejectors /sump 16.60
Name: �� ,�1 Expansion tank 16.60
Address: /Z? J L.J 7a,-- Fixture /sewer cap 16.60
City /State /ZIP: 7; , J v e ,)t ? Z 3 Floor drain /floor sink/hub 16.60
Phone: ( 3)3 ) S - S7 i) ( Fax: ( ) Garbage disposal 16.60
❑ APPLICANT. 0 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: ( ) I p ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
. ' . CONTRACTOR Water closet 16.60
Business name: r)L.J Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 4 ,15
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) G d
Authorized signature: TOTAL PERMIT FEE
39. /5
Print name: 4 G' 7 P, /� r� Date: /S /UG 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.
1:\ Building \Permits\PLMF- PermilApp.doc 04/06/06 440 -4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard - -
Page 2 - Supplemental Information
• Fee Schedule: 4. . Residential Fire Suppression Systems:
•
, Site;Utilities " _ „,Qty fee (ea) Total Square Footage: .m 'Perm mit F e - m
Footing drain - I' 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 s
Storm & Rain Drain - 1st 100' 55.00 ValuatiOn:' Permi 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. ,Qt. 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 Back flow 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: `_ 'PlanReview for Coinplex ,. __
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 El Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous' . Capped . Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ 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 Isometric or Riser Diagram .. -
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 permit results in an
• Water Extractor
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- PerrnitApp.doc 07/06/05
I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006.00327
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/5/2006
Phone: (503) 639 -4171 4,00 ,4 �I
Inspection Requests (24 Hrs.): (503) 639 -4175 A 11.
INSPECTION WORKSHEET FOR DATE: 7/28/7006 TIME: 7:01AM PAGE: 56
SITE ADDRESS: 12230 SW 126TH AVE CLASS OF WORK:
SUBDIVISION: BC=LL.WOOD LOT #: 031 TYPE OF USE:
PROJECT NAME: A E. IYIt7XLE( DESCRIPTION: Backflow preventer for irrigation.
OWNER: MVMOXLEY, ROBERT E 4- SHANNON M, PHONE #: 503.524 -6171
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 033943-01 503.524 -5171 N
•
Corrections /Comments /Instructions:
i , k _
/,
fr/f!',! Jpr
ik PASS El PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ri, 7 '6 L, Date: Phone #: (503) 718- 2/
,.,_ .