Permit 9' CITY OF TIGARD
PLUMBING PERMIT
4
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00128
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/25/2008
PARCEL: 2S 104AC -13900
SITE ADDRESS: 12892 SW 133RD AVE ZONING: R -4.5
SUBDIVISION: HILLSIDE ESTATES LOT: 004 JURISDICTION: TIG
PROJECT: NGUYEN
Project Description: Installing backflow preventer.
CLASS OF WORK: ADD 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
PHONG NGUYEN
12892 SW 133 AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/25/2008 $36.25
[TAX] 12% State Surch 3/25/2008 $4.35
Phone : 503- 807 -3459 Total $40.60
Contractor:
TERRA -SOL LANDSCAPING
21685 SW HEDGES DR
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -691 -6105
Reg #: LIC 5019
This permit is issued subject to the regulations contained in the Tigard Municipal Code, St. e • SR. Spe ialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permi 4 - 6 - if wor: is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon : re••' es yo to ollow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 thro •h OAR 952 -0001 4100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2:44.
Issued By __ ..4
Permittee Signature: ,/ A A
Call 503.639.4175 by 7:00 a.m. for an inspection that business .:y.
This permit card shall be kept in a conspicuous place on the job site until • pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
q ` `` FOR OFFICE USE ONLY
City of Ti and 97213 Received C
g c Ct Date/By: ." O� 'ennit No.: Aril �///�0 1rY)
a 13125 SW Hall Blvd., Tigard, OR - J �O v vv
is 2 Phone: 503.639.4171 Fax: 503.598.19600. Plan Review
�g Datey' Other Permit No.:
• Tl G A R D Inspection Line: 503.639.4175 '(`G P c`® ate B R e ady By: luris: ® See Page 2 for
Internet: www.[igard -OCgov �,1 ®� ` l , ] ot i fed /Method: Supplemental Information
TYPE OF'WORI ��
Gi i NG' FEE"' SCHEDULE. °
' New construction ❑ @molit � Olit ion For special information use checklist.
Description Qty. I 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
24 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
JOE SITE INFORMATION' :AND LOCATION Site utilities
( Job site address: ",_ VA Z '3 W ) � j 3 ' / Catch basin or area drain 16.60
City /State /ZIP: '7---f viz c a-a"� Drywell, leach line, or trench drain 16.60
�q�1 /�� Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: I Project name:
1 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: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Abso rption valve 16.60
DESCRIPTION OF WORK Back flow preventer ✓ 1 ( Page 2
c
�, a kwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• ❑ PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
( � y' � IV Ejectors /sump 16.60
Name: iir1 1 t I tj ( Expansion tank 16.60
Address: � Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: , � (( 6
-"� ) &^7_ 2 r� 5 ( ) Garbage disposal 16.60
7 Fax:
❑ APPLICANT Hose bib 16.60
0 PERSON
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Pagc 2
Address: Primer 16.60
City/State /ZIP:
Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: ( ) Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business naVA04k ^� I Water heater 16.60
Address: / �l 5- . _ 0 Other:
iec � �
Subtotal
City/State/ZIP: /State /ZIP: C I 7() Co 2/ Minimum permit fee: $72.50
Phone:Rh LA I ( 1 0, Fax: ( ) Residential backflow minimum permit fee: $36.25 56 ,
CCB Lic.:Jr"':r0 tOi Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) p '5'-'
Authorized s i t ` � ature: ^ TOTAL PERMIT FEE (1
^/`I ! 1,
me: , �
Print na 0 't �1\a_ � �,1 Date:3 2 0V 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.
L�Building�Permits�PLM- PermitApp.doc 12 440- 4616T(l0/02/COM /WEB)
Plumbing Permit Application - City of Tigard ` .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total _Square Footage: 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: Permit 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
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
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:
Are you capping, adding or replacing fixtures? If "yes ", Plan, Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type:' Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
- Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
' Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
3„ that meet the qualifications above.
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 *Note: If the fixture work under this permit results in an
- Bradley
- 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:.
is \Building\Permits\PLM- PermitApp doc 12/27/06
CITY OF TAG _ WI - _,.,
pug► 2007_6o
UD LIING DIVISION PERMIT #: 3`!", ,. ,.t_r' i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: eli' ei?/
Phone: (503) 639 -4171 �i i 1jm ii , �:
Inspection Requests (24 Hrs.): (503) 639 -4175 =` ._
INSPECTION WORKSHEET FOR DATE: 4190008 • TIME: 7'00AN1 PAGE: 9
SITE ADDRESS: 12B92 W 133RD AVE CLASS OF WORK:
SUBDIVISION: 'r III.i_L IDE ESTATE", I „:SS LOT #: 004 TYPE OF USE:
.PROJECT NAME: t DMA(' )1::: L I's. - i E
DESCRIPTION: S1'
OWNER: t l:Y Pt - £ON(. PHONE #: 503
CONTRACTOR: t) y , !E.R. PHONE #:
Inspection Request Scheduled For: Date: 4 / ;2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
359 Pitimi)i ng final 06010t3.01 5fl 8C£7- 3 Y
Corrections /Comments /Instructions: _
H E el c/ e to Li �v-, 0 u A--,N, ► -v "\--- - OF 1 LW► 20 a r e 0 ( 2� I' / k ( ` 1 t
. ,- ‘ .. ' ,. (} e 7 ,A 0 . ,_ e _ -e 7 r 0- , ;if
Cik cl ,....u..dip
X PASS ( I PARTIAL APPROVAL n CANCEL 1 I NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ''"17t/v -✓t its — Date: I c l t ?) Phone #: (503) 718-