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Permit C ITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00443 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/28/2007 PARCEL: 2 S 104 B D -00500 SITE ADDRESS: 12615 SW 136TH CT ZONING: R -7 SUBDIVISION: HUSKE PARTITION LOT: 003 JURISDICTION: TIG PROJECT: HUSKE Project Description: Replacing (1) tub and (1) seperate shower. 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: 2 SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES PATRICK HUSKE 23352 SW MURDOCK RD Description Date Amount • SHERWOOD, OR 97140 [PLUMB] Permit Fee 9/28/2007 $72.50 [TAX] 8% State Surcha 9/28/2007 $5.80 Phone : 503- 625 -5180 Total $78.30 Contractor: BLACKHAWK PLUMBING LLC N NE WBERG, OR 97132 BOX REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 705 -9685 • Reg #: LIC 171447 PLM PB185 • 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 wit n 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to foll.w rules adopte4l by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 ;; You may obt. copies of these rules or direct questions to OUN • calling 503.246.6699 or 1.800.332.2344. Issued : �/���41 J / Permittee Signature: A AS& ' I J r Call 503.639.4175 by 7:00 a.m. for an inspection that • \ siness day. This permit card shall be kept in a conspicuous place on the job site u • it completion of the project. Approved plans are required on the job site at the time of each inspection. -Plumbing Permit Applic Is CP--,90O7 04372 Building Fixtures RECEIVED • FOR OFFICE USE ONLY Received r- 1 of Tigard S E P 2 2007 y Pe No.. pLN./ !.. ,,I�� a 13125 25 SW hall Blvd., Tigard, OR 97223 Date/By. Plan Review Phone: 503.639.4171 Fax: 503.598.1 Y ® `y Date/By: Other Permit No.: Inspection Line: 503.639.4175 BUILDING 1 �Q Date Read ® See P a 2 T I G A R D Internet: www.ti and -or. ov Bu to NG O� y y g g g Notified / M eth /8 od: �'upplemeatal Info for TYPE OF WORK FEE* SCHEDULE ❑ New construction El Demolition For special information use checklist Description I Qty. Ea. Total Lys c dition/alteration/replacement El Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building El 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: / Z6/3' .c w / Catch basin or area drain 16.60 City /State /ZIP: 7 4 . a r - % ? 7 3 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 COCWIl` / /36 I uct f Vl.4 G ` ( Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 1 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 P-tpa s Qf I TIt5 i to,k- 114 !S ce5 , l Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 j Ejectors /sump 16.60 Name: P 4 � S' Expansion tank 16.60 Address: 1 Z S IA) G Fixture /sewer cap 16.60 City/State /ZIP: ( j ©,9„;1 (4 77/g Floor drain/floor sink/hub 16.60 Phone: ( ) 57 .0, Fax:.( Garbage disposal 16.60 aii iICANT CI PERSON Hose bib 16.60 llT Ice maker 16.60 Business name: © jr. . Interceptor /grease trap 16.60 Contact name: /, , � f l , Medical gas (value: $ ) Page 2 Address: 6-) 1, / 1 T'� Primer 16.60 CV t A. Roof drain (commercial) 16.60 City /State /ZIP: S CV - _ 6 2 ,, I r0 6 J7 Sink /basin/lavatory 16.60 Phone: ( �) S y Fax:: ( ) Z Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR. Water closet 16.60 . Business name: e)( , G1A! R Water heater 16.60 / ��I/ Address: Po cp( l 6 Other: City /State /ZIP: 9'/ 0 7ze Subtotal 77J' < 7 Minimum perniit fee: $72.50 Phone: ) 15 --%, / i , Fax: ( ) Residential backflow minimum permit fee: $36.25 7 CCB Lic.: 3- )1/ / 7 ,/' Plu , i nr Lic. no.: /e5 di] ( Plan review (25% of permit fee) State surcharge (8% of permit fee) 5 go Authorized signature: % 0 ..- � �� TOTAL PERMIT FEE • 5o � Print name: / ��, i ! Date: 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(I0/02/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: • Permit 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 Valuati0111: 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: . 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 by (Fixture) WorkPerformed 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 EDITS, 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 DIVISION PERMIT #: 1)1142007-00443 13125 SW Hall Blvd., Tigard, OR 97223 I40 DATE ISSUED: 908/2007 Phone: (503) 639-4171 kar vilth - 4 ' • ' 010I11)' Inspection Requests (24 Hrs.): (503) 639-4175 E4. 11... INSPECTION WORKSHEET FOR DATE: 4/1 '.108 TIME: 7:02AM PAGE: 23 , 14.44.--A)0" SITE ADDRESS: 12615 SW 136TH CT CLASS OF WORK: SUBDIVISION: HUSKE PARTITION LOT #: 003 TYPE OF USE: PROJECT NAME: HUSKE DESCRIPTION: Repining (1) tub and (1) seperate shower. OWNER: HUSKE, PATRICK PHONE #: 503-625-5180 CONTRACTOR: BLACKHAWK PLUMBING LLC PHONE #: 503-705-9685 Inspection Request Scheduled For: Date: 4/15/2008 Pour Time: Code # Inspection Description Confirm # Contact # Messa! - 399 Plumbing final 068390-01 603-939-5545 a 110 Corrections/Comments/Instructions: 4 I FA PA • PARTIAL APPROVAL El CANCEL 1 NO ACCESS FAIL TA CALL FOR INSPECTION ID ADDITIONAL FEES ASSESSED -...... Inspector: Date: ,/ / Phone #: (503) 718- 7 \k , , CITY OF TIGARD, BUILDING DIVISION PERMIT #: PLM2007.00,443 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: n,28/2007 • Phone: (503) 639 -4171 / �q�,� l f ll� Inspection Requests (24 Hrs.): (503) 639 -4175 .�' INSPECTION WORKSHEET FOR DATE: 10/2/2007 TIME: 7:04AM PAGE: 38 SITE ADDRESS: 12615 SW 136TH CT CLASS OF WORK: SUBDIVISION: HUSKE PARTITION LOT #: 003 TYPE OF USE: PROJECT NAME: HUSKE DESCRIPTION: Replacing (1) tub and (1) seperate shover. OWNER: HUSKE, PATRICK PHONE #: 503 -625 -5180 CONTRACTOR. BLACKHAWK PLUMBING LW PHONE #: 503405.8605 Inspection Request Scheduled For: Date: 10/212007 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 056776-01 503.939-5545 N Corrections /Comments /Instructions: I 4 11 Me.,,.J e I ,,,-.. Li 4 --E-u„ -ems; 4- s P I L. p i li, 4_14v e..... (..) ; t. N (Ai c, -c✓ Rb�a L.-:" ,UA -`v Pi��w.� 1 R e, �JJ c. k 1 1 f l 1 1. ss -+ ./.�� e a d-- Psr a At., t1 ci, is c . k. Bc Ie." Pos t I% PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: (1 )' -,-. _A 1A---..— Date: 1 6 f 2/ 07 Phone #: (503) 718- . f : r