Permit VI
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CI OP TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00161
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/25/2007
PARCEL: 2 S 109 D D -0 7 500
SITE ADDRESS: 12813 SW REMBRANDT LN ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 005 JURISDICTION: TIG
PROJECT: MUSSETTO
Project Description: Area drain.
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: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JASON MUSSETTO
12813 SW REMBRANDT Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/25/2007 $72.50
[TAX] 8% State Surcha 4/25/2007 $5.80
Phone : 971 -563 -7642 Total $78.30
Contractor:
ALL METRO LANDSCAPE
PO BOX 1812
BEAVERTON, OR 97075 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 642 -1350
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Reg #: LIC 7908
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 -0 00. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
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Issued By: AP, Permittee Signature:
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 Appl c ti l � c g ,_ FOR OFFICE ESE ONLY
City of Tigard Received dl � j f� Permit • 1 i/ •.t92J &/
11 a 13125 SW Hall Blvd, Tigard, OR 9jp 5 2007 Nan e
Phone: 503.639.4171 Fax: 503.5 I Date/By Other Permit No.:
Inspection Line: 503.639.4 .1r1w Y
N
f I G i� I: U Internet: www.tigard -or.go 9 j Or numb Notified/Method Ready/By. ,� ethod Supplemental Information
TYIS141YST1lTT @jar FEE* SCHEDULE
0 - New construction ❑ Demolition For dal in information use checklist.
Description Qty. Ea. Total
❑ Addition /alteration/replacement ❑ 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
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION • Site utilities
Job site address: / ms a 5,„, tat K. b ...n ka 4- Catch basin or area drain 0 16.60 '
City /State/ZIP: TN 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:
7� pp �" Manholes 16.60
v'-a-r to.1 th I4 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: RG I V tyi-s% I Lot no.: s` Water service (no. linear tl : ) Page 2
Tax map/parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK • Backflow preventer Page 2
* /) voi i k jJwet- Backwater valve 16.60
Clothes washer 16.60
• Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors sump 16.60
Name: `GIK 5 • Wo (C ✓4S •
Expansion tank 16.60
ic Address: s,\ �, _ f t. $ ..J Q �✓4� 1f- Fixture/sewer cap 16.60 _
City/State/ZIP: 10141' d .se Floor drain/floor sink/hub 16.60
Phone: („ ) 97 f _5' 3 7(, y L Fax: ( ) Garbage disposal \ 16.60
• ❑ APPLICANT ( ❑ CONTACT PERSON Hose bib 16.60
Business name: ,,,,II,y, Ice maker 16.60
(i.�0 Interceptor /grease trap 16.60
r Contact name: , N 1
'x` \ 1/� Ot/yq 5 Medical gas (value: $ ) Page 2
Address: Q 0 Qp X (ea Primer 16.60
�t
City/State/ZIP: �. a tr O v 9' tolc" Roof drain (commer 16.60
Phone: ( ) . tte . '1. 11517 Fax: : ( ) 5 33 - 1 • -:
E-mail: mZ Sink /basin/ lavatory _ 16.60
Tub/shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: i R..1 _ 1 _ Water heater 16.60
Address: 9 0 jl . ( t� Other:
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City/State/ZIP: G"C L 0i( Q'Zo? Subtotal
Minimum permit fee: $72.50
Phone: ( 'nn�� V A l N 1170 Fax: (tj'0) ' atk, L Residential backflow minimum permit fee: $36.25
CCB Lic.:
Plumbing Lic. no.: Plan review (25% of permit fee)
I , C ( ,
1 V D State surcharge (8% of permit fee)
Authorized signature: -y
/ TOTAL PERMIT FEE 3)
t'v
Print name: - ✓� ; Vi 4 I D ���7m2.. 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: & tilding\Pamits\Ptld- PmnitApp.doc 0626106 440- 4616T(I002/COM/W®)
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Plumbing Permit Application - City of Tigard .. _ "
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr- 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
Sewer - 1st 100' 55.00 3,601 to 7,200 • $220.00
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' ss.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 Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
including $1 0,000.00.
Commercial Badc 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 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
Qaaudty 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"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
-Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- Service plumbing permit can be issued •
Swimming Pool Filter
Washer - Clothes
Water Extractor s'
Water Closet - Toilet
Urinal
Other Fixtures:
iMl uildmgTermits\PLM- PamitApp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00161
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4125/2007
Phone: (503) 639 -4171 ' 1
Inspection Requests (24 Hrs.): (503) 639 -4175 I ..
INSPECTION WORKSHEET FOR DATE: 512212007 TIME: 7:01AM PAGE: 6
SITE ADDRESS: 12813 SW REMBRANDT IN CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 005 TYPE OF USE:
PROJECT NAME: MUSSETTO
DESCRIPTION: Area drain.
OWNER: MUSSETTO, JASON PHONE #: 971 -563 -7642
CONTRACTOR: ALL METRO LANDSCAPE PHONE #: 503-642 -1350
Inspection Request Scheduled For: Date: 5/222/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 048830.01 503-642 -1350 Y
Corrections /Comments /Instructions:
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.6' �//_ � r .mil
❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector/AI Date: • Phone #: (503) 718-