Permit CITY 'TIGARD PLUMBING PERMIT
,,.-1 DEVELOPMENT SERVICES PERMIT #: PLM2006 -10021
1 DATE ISSUED: 3/7/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103BB 04500
SITE ADDRESS: 12475 SW KATHERINE ST ZONING: R - 4.5
SUBDIVISION: BROOKWAY LOT: 045 JURISDICTION: TIG
Project Description: 100' water service, repipe 1st floor, remodel (2) baths.
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: 2 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CAROLYN BALLARD
12475 SW KATHERINE ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/1/2006 $171.20
[TAX] 8% State Surcha 4/1/2006 $13.70
Phone : Total $184.90
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 624 -4880
FAX 503- 624 -2173
Reg #: LIC 81837
PLM 26 -445PB
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 i i! c
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.
CITY OF TIGARD
PLUMBING PERMIT F
.N, ,,, - BUILDING SERVICES DIVISION
f i , l 13125 SW Hall Blvd., Tigard, OR 97223
503 - 639 -4171 www.tigard- or.gov PERMIT i e ®,z
DATE ISSUED: 3= - 0 6
SITE ADDRESS: j .L/'J S s 1,J fie. r � �e ,- __— PARCEL #:
BLDG/STE #: ZONING:
SUBDIVISION: 3c:6\\ ( - LOT: JURISDICTION: -n (
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
PROJECT DESCRIPTION:(3 ; t 4 \4� t ° -5 - Y :.. ,ky,. _�
CLASS OF WORK: p , GARBAGE DISPOSALS: _ HOME SPACES:
- --- - - -...
TYPE OF USE: ____ WASHING MACHINES: BACKFLOW PREVENTERS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS: — W _
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: „2_, OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: _ 0_0_ ft
DISHWASHERS: RAIN DRAIN: ft
- - - - • OWNER _ - FEES . f
Name: "Zgl \p Permit Fee $ .J_� _• .b
Address: Plan Review Fee $
City /State /Zip: State Surcharge (8 %) $ 0
Phone: Other Fee: $
--- - - - - -_ --------------- _______�__ ------------------ - - - - -.
Other Fee: $
Total Fees: $ 1 . 9
CONTRACTOR
Name:
Address: :._.r�.. `R.6<39 C._... .._..._._.._._._......
City/State/Zip: y c q- a_�-- .- .---- __...._...
Phone: .iS1../ - 624' - /»O
Fax: -,? 3 ' _L..49!...m? 1.?3
CCB Lic #:
Plumb. Lic. #.
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 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies
of these rules or direct questions to OUNC by calling 503 - 246 -1987 or 1- 800 - 332 -2344.
Issued By: �)- ,CO ! Permittee Signature:
Call 503 - 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance.
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.
1:\ Building\ Forms\ ManualPermitForms \ManualPLMpermit.doc 3/62006
• Building Fixtures
ED .
Plumbing Perm ii o w FOR OFFICE USE ONLY ,
City of Tigard Received _ ,� ( 7
Y' �
1 20 Date /By: 5 f 7 6 6 Permit No \S\ X U 7 i d /
13125 SW Hall Blvd., Tigard, OR 9 1
Other Permit No.:
24- Hour Inspection Line: 503639
• Phone: 503.639.4171 Fax: 503.59. 0 1 �� ��� /�yirr Plan Review
,;r�W�.- i�i'{� Date/By: - our nspecon ne: ..4175 _a i, _ f Daze Ready/By: J ° °S 0 See Page 2 for •
Internet: www.ci.tigard.or.us Notified/Method: Su
r�T� Nifid/Mhd _......_Jurist:
pplemental Information
- - B4'f1'X1 RK ., ' ' FEE* SCHEDULE
❑ New construction ��jj @@ °° ❑ Demolition For special information use checklist.
Description I Qty. I Ea. 1 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
•- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
. • JOB SITE INFORMATION AND -LOCATION - - • Site utilities -
Job site address: 0 L f 7 ' W k'
�,/ it 1
, ' J 3- . Catch basin or area drain 16.60
City /State /ZIP: e i� „-,eQ ( a on � Drywell, leach line, or trench drain 16.60
° I P t ' L , L , -/]ten �� � Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: J Project name: Tt Y`/ )
Manufactured home utilities 1 10.00
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 ,1525 CD
Fixture or item
Tax map /parcel no.: ,
Absorption valve 16.60 •
DESCRIPTION OF WORK Backflow preventer Page 2
V v 2iVA W)1,,(f j&t, 1 ---P1 air 0 Backwater valve 16.60 •
bath ))J2AVv► -octet' i Clothes washer 16.60
Dishwasher 16.60
.❑ PROPERTY - OWNER . . - - Drinking fountain 16.60
�' ,[] TENANT
• 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
Hose bib 16.60
CI, APPLICANT ' ❑ CONTACT PERSON
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: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 3 Dc )
Tub /shower /shower pan 16.60 - D_iD
E -mail: Urinal 16.60
CONTRACTOR Water closet ..3 , ' . 16.60 q, 'FU
Business name: MAO
,j V2 A jam- T tL. 4 f ' ," f . 1. j4,C. Water heater 16.60
-
Address: 1' 0 _ & `a q?;:-_-1 Other: 1.„-- ct'oor• e, Lpe ,
1
City /State /ZIP I f an- S a 1 Subtotal
/ t Mi nimum perm fee: $72.50
Phone: ( 3 - 1 - 1 ( L g - O Fax: ( "7 3 G u _ o ).1 Residential backflow minimum permit fee: $36.25 ' 7/ L Q
CCB Lic: � t g 3 7 Plumbing Lic. no.: xo--1-1� :5 -
Plan review (25% of permit fee) .
State surcharge (8% of permit fee) j 3, 10
Authorized signature: �� --
• TOTAL PERMIT FEE /W
. q 0
Print name: \/ ctra( `3 , �f1_e -r-- Date: r 7 , c)( This permit application expires if a permit is not obtained within
(-a 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 06/05 440-4616T(10/02/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: F., ,
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 ,55= Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm & Rain Drain - 1st 100' 55.00 Valuation: , 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 Qtyr. 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
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 Re for Complex Structures:
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 ❑ 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
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3 „
-4"
Car Wash Drain
Isometric of Riser'Iiagl din - -
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
•
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~~~°.~~~~..~~° ~°"°"~,"~,"° , PERMIT #: P1jN200610021
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 3/7/2006
Phone: (503) 639-4171 lit
Inspection Requests 4Hmj �
�03)G3O~4175 *J�m��*�
INSPECTION WORKSHEET FOR DATE: 5/11/2006 TIME: 7:00AM PAGE: 61
SITE ADDRESS: 12476SWKATHERINE ST CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 045 TYPE OF USE:
PROJECT NAME: BALLARD
DESCRIPTION: 1OU' water service, /epip 1st floor, remodel (2) baths.
OWNER: BALLARD, CAROLYN PHONE #:
CONTRACTOR: BRUMERPLUk8B|M6 PHONE #: 6M
Inspection Request Scheduled For: Date: 5/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 02956401 503'6244880 Y
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Corrections/Comments/Instructions: . lq_ � )(� ::., .
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.121 ,PASS | | PARTIAL APPROVAL _ CANCEL | | NO ACCESS
| I FAIL I I CALL FOR INSPECTION p ADDITIONAL FEES ASSESSED
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Inspector: . /4 K Oate� ^� - Phone #� K�U3\ 718' ` -
. . '
CITY OF TIGARD t .�
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BUILDING DIVISION • • PERMIT #: PLM200 - 100021
13125 SW Hall Blvd., Tigard, OR 97223 ,51 DATE ISSUED: 7.0/20116 Phone: (503) 639 -4171 , �,d ,
Inspection Requests (24 Hrs.): (503) 639 -4175 �� �+mo�dgm41F'I I ..
INSPECTION WORKSHEET FOR DATE: 5/8/2006 TIME: 7:07AM PAGE: 95 .
SITE ADDRESS: 12475 SW KATHERINE ST CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 046 TYPE OF USE:
PROJECT NAME: BALLARD
DESCRIPTION: 100' water service, repipe '1st floor, remodel (2) baths.
OWNER: BALLARD, CAROLYN PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 - 624 - 4880
Inspection Request Scheduled For: Date: 6/8/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 029409-01 503-624-4880 N
Corrections /Comments /Instructions:
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7 PASS el I PARTIAL APPROVAL ❑ CANCEL —_ ❑_NO ACCESS__ ___
'FAT[ ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: ) / Phone #: (503) 718- Z YZ "Y
CITY OF TIGARD QL.N
BUILDING DIVISION PERMIT #: � /�0 2-1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 4, u ' n�lhu iii "
Inspection " Requests (24 Hrs.): (503) 639 -4175 J� ' �..
INSPECTION WORKSHEET FOR DATE: 3/ 2 ..2 /Q4 TIME: PAGE:
SITE ADDRESS: k 2_') s 1 -.\--(„p_r R CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE: -
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: 6 Z_ L-og -D
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions: Q
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FAIL I I CALL FOR INSPECTION (i ADDITIONAL FEES ASSESSED
Inspector: Date: / U/6 (P Phone #: (503) 718- -2,- 7 2
,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: P Lttl 2006- /002_1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 oimt�g �l
Inspection Requests (24 Hrs.):'(503) 639 -4175
INSPECTION WORKSHEET FOR DATE:3 i / 00 (7 TIME: PAGE:
SITE ADDRESS: i 2 � I7 7 SA- )14111 t ✓I' � CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: 5b3 C 2 " 4 — ( 4 8 °
CONTRACTOR: v - LA ,, t y � i �^'' -b �r j ; ., G PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments /Instructions:
PASS__ _ PARTIAL APPROVAL _ ..CANCEL _I -_NO- ACCESS- - - - - -
1 I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �►►�- �� Date: 3)) 6 Phone #: (503) 718-