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Permit CITY TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00269 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/22/2007 PARCEL: 2S 103BC -02700 SITE ADDRESS: 12120 SW ALBERTA AVE ZONING: R -4.5 SUBDIVISION: CANOGA PARK LOT: 001 JURISDICTION: TIG PROJECT: BUCHHOLZ Project Description: 28' of sewer line. 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: 28 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KYLE BUCHHOLZ 12120 SW ALBERTA Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 6/22/2007 $72.50 [TAX] 8% State Surcha 6/22/2007 $5.80 Phone : Total $78.30 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: / Permittee Signature ?� I� 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 • 5()312. es - es 4g . . Building' Fixtures . FOR OFFICE ,USE ONLY City of Tigard Received DDate/By: ( /2Z /6 S L ' Permit No.: FI M ZOOS - no 24, q P • 13125 SW Hall Blvd., Tigard, OR 97223 Review Phone: 503.639.4171 Fax: 503.598.1960 an By: DB ate/By: Other Permit No.: TI G AR D Inspection Line: 503.639.4175 Date Ready /By: Internet: www.ti s• g and - or. ov S See Pa et l g g Notified/Method: �'� Supplementalln formation TYPE OF WORK FEE* SCHEDULE • ❑ New construction ❑ Demolition For special information use checklist Description I 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 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 INFORMARQN AND LOCATION 1 Site utilities Job site address: Z (2_1!) S Catch basin or area drain 16.60 City /State /Z1P: s : \ Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: `�� Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: 2 / S-i Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: 2$ ') ' Page 2 55 . 00 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 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 -A - -\ 1 V P 2 > \, -Q Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑' PROPERTY OWNER I • ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: `/' /�� Z t/C_V�1C��-- Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ) 2- i -.- 9 p ; Fax: ( ) Garbage disposal 16.60 . ' El APPLICANT . CI 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: Sink/basin/lavatory 16.60 ( ) Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR, • Water closet 16.60 Business name: © j Water heater 16.60 Address: Other: City /State /ZIP: Subtotal S. 00 Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 � CCB Lic.: ' lumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: ? State surcharge (8% of permit fee) 5. 8a _ TOTAL PERMIT FEE n. 3D Print name: S w � 0 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(l0 /02 /COM/WHB) 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 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 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: • - 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) Work 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 , i BUILDING DIVISION PERMIT #: PLM2007- 00'2(9 I I 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/22/2007 • Phone: (503) 639 -4171 b Inspection Requests (24 Hrs.): (503) 639 -4175 � 1. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 10l31l 7:00AM 82 SITE ADDRESS: 12120 SW ALBERTA AVE CLASS OF WORK: SUBDIVISION: CANOGA PARK LOT #: 001 TYPE OF USE: PROJECT NAME: BUCHHOLZ DESCRIPTION: 28' of sewer line. OWNER: BUCHHOLZ, KYLE PHONE #: 503,521-8061 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/31/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 058705 -01 503-521-9061 N Corrections /Comments /Instructions: � t . e- '{-44 c t. e k . „ � 1 , Q . , e e c e yo -r c a. rf _ 1- q L., l c-t pt....i • 'I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 1 ' I 1 rY Date: 10 (3 i f 0 7 Phone #: (503) 718- Diana Dalke 360 -887 -2913 p.1 • • • J6 RD CJSTOMER'S 0 ER NO. PHG`JE DATE 1 kfffi SC 3 5)-i -fel � ' -z 'JANIE ADDRESS /G�j�{ 6aC�� ... - (J f a� ' fa XJ 5t /f r • SOLO J 2cl c/ By CASH C.O D. � ARGE ON ACCT. f SE. RETD. PAID OUT • GTY DESCRIPTION PRICE AMOUNT • D a inli rt 11476 • TAX RECEIVEC 3Y TOTAL / All claims and returned goods MUST Ce accompanied by this bill - L CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007- 00269 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/22/2007 Phone: (503) 639 -4171 �I Inspection Requests (24 Hrs.): (503) 639 -4175 �.. INSPECTION WORKSHEET FOR DATE: 7/6/2007 TIME: 7:06AM PAGE: 8 SITE ADDRESS: 12120 SW ALBERTA AVE CLASS OF WORK: SUBDIVISION: CANOGA PARK LOT #: 001 TYPE OF USE: PROJECT NAME: BUCHHOLZ DESCRIPTION: 28' of sewer line. OWNER: BUCHHOLZ, KYLE PHONE #: 503 - 521 -9061 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/6/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 051558 -01 503-590-3327 Y Corrections /Comments/ Instructions: 1 c� � e f , fia ,. k 4- / I I P,-e v$ (, P A44- g•c e ‘1 (? - 41(9 .- 7 I I PASS Zr PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I I FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 1►nlI_,. - Date: 7) 6 ) p') Phone #: (503) 718 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007 -00269 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/22/2007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/5/2007 TIME: 7:03AM PAGE: 42 SITE ADDRESS: 12120 SW ALBERTA AVE CLASS OF WORK: SUBDIVISION: CANOGA PARK LOT #: 001 TYPE OF USE: PROJECT NAME: BUCHHOLZ DESCRIPTION: 28' of sewer line. OWNER: BUCHHOLZ, KYLE PHONE #: 503 -521 -9061 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 7/512007 Pour Time: Code # Inspection Description Confirm # Contact # Message 505 Sanitary sewer 051467 -01 603 -590 -3327 Y Corrections /Comments/ Instructions: R,._ f' 1 ) ei/b•l Co vlo 1.4,1` „. Q iI c y' ` A-Scc :72- t 1 / 1 5 e-. T ✓z, c t\fr. 9 vie,e,L v cc is ❑ PASS n PARTIAL APPROVAL n CANCEL ❑. NO ACCESS FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: e1 3Y Date: 1 /& D� Phone #: (503) 718- INSPECTOR'S SIGNATURES ARE NOT Inspections Required for. >p -0029 REQUIRED ON GREEN INSPECTION CARD. ✓ Code Inspection Description PASS Date By ■ Code Inspection Description PASS Date By BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground /slab cover 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service 205 Footing 120 Electrical rough -in 805 MFG - Structure grading /footing 125 Wall cover 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab 140 Sign installation 310 Crawl drain 145 A/C or heating unit circuit 225 Post /beam structural 150 Hot tub /spa/pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors 199 Electrical final 240 Exterior sheathing 245 Firewall 250 Roof nailing ELR - Restricted Energy Permit 255 Wtr proofing basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing 810 MFG- Structure set -up MEC - Mechanical Permit 280 Insulation 605 Post/beam mechanical 285 Drywall nailing 610 Gas line 287 Suspended ceiling 615 Mechanical rough -in 295 Misc. inspection: 620 Hydronic piping 899 MFG- Structure final 625 Duct work 498 Grading final 630 Fire damper 299 Final inspection 635 Smoke detector shutdown 640 Exhaust hood 695 Misc. inspection: 699 Mechanical final BUP - Fire Protection System Permit 905 Sprinkler underfloor /slab PLM - Plumbing Permit 910 Sprinkler. rough -in 305 Plumbing underslab 915 Fire alarm rough -in 310 Crawl drain 920 Suppression trip test 315 Post/beam plumbing 995 Misc. inspection: 320 Plumbing rough -in 998 Alarm final 322 Shower pan 999 Sprinkler final kl 330 Water service 335 Rain drain 340 Storm drain SIT - Site Work Permit X 505 Sanitary sewer 405 Excavation / 345 Culvert /catch basin 410 Fill 350 Septic tank 415 Grading 395 Misc. inspection: 205 Footing \A 399 Plumbing final %I O? 1 1,-1 210 Foundation walls 215 Footing drain 420 Sprinkler supply lines SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final 595 Misc. inspection: 499 Final inspection 599 Final inspection I:\ Building \Forms \InspCard- AOP- Blankdoc 02/02/07 PLUMBING PERMIT CITY OF TIGARD ', I COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00269 TI9ARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/22/2007 PARCEL: 2 S 103 B C -027 00 SITE ADDRESS: 12120 SW ALBERTA AVE ZONING: R -4.5 SUBDIVISION: CANOGA PARK LOT: 001 JURISDICTION: TIG PROJECT: BUCHHOLZ Project Description: 28' of sewer line. 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: 28 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KYLE BUCHHOLZ 12120 SW ALBERTA Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 6/22/2007 $72.50 [TAX] 8% State Surcha 6/22/2007 $5.80 Phone : Total $78.30 Contractor: OWNER REQUIRED ITEMS AND REPORTS 0 Contact # : 0 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 ' ,/ r; ?''j�: ;; j� %' - Permittee Signature: _'.�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. 11/13/2007 Case Activity Listing 3:18:46PM 1C EL Case #: PLM2007 -00269 r� � %�. ^ -A eil. 0Done:.�. 3 >U dated= f, 9,r � o-, .,,.�,.. � .w r r � art;;•: ;; a e ......� ,'� ��,,, p Date ,r ate 2 t 3 ld• •• 5 vrt Desert tton y �.. D Ho � °.' ��Dls " Acts z D To` es. __... ., r... .i..,, ,, ,,,M,.., r, . w>.. „ ¢i�s4 „ w... ., i rt'•'�n'`f... ,..aa, .rtrrh #, r ,...__ a oz „a =i.. i ;T # ,• „« ,,. rt .:,., .... ...... ,..; �.. .. �� __ w .s:u4.&l ,... ,.r .. PLM1010 Application received 6/22/2007 None RECD SLN 6/22/2007 SLN PLM1020 Permit created 6/22/2007 None DONE SLN 6/22/2007 SLN PLM1030 Check for parcel tags 6/22/2007 None DONE SLN 6/22/2007 SLN PLM1280 Issue permit 6/22/2007 None DONE SLN 6/22/2007 SLN PLM2505 Sanitary sewer 7/4/2007 7/5/2007 7/5/2007 None FAIL JW 7/5/2007 051467 - 01 — 503 - 590 - 3327 -- VM - STI Y — 180 PLM2505 Sanitary sewer 7/5/2007 7/6/2007 7/6/2007 None PART JW 7/6/2007 051558 - 01 — 503 - 590 - 3327 VM - STI Y — 180 PLM2399 Plumbing final 10/30/2007 10/31/2007 10/31/2007 None PASS JW 10/31/2007 058705 - 01 — 503 - 521 - 9061 — VM - STl N PLM1740 Case finaled 10/31/2007 None DONE JW 10/31/2007 JW Page 1 of 1 CaseActivity..rpt