Permit C ITY OF TIGARD- PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00113
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/22/2007
PARCEL: 1 S 134DD - 01200
SITE ADDRESS: 11675 SW TIEDEMAN AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: VILLASENOR
Project Description: Replace all waste, vent and water pipes.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
JOSE VILLASENOR
11675 SW TIEDEMAN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/22/2007 $149.40
[TAX] 8% State Surcha 3/22/2007 $11.95
Phone : Total $161.35
Contractor:
PORTLAND'S CHOICE PLUMBING, INC.
PO BOX 33201
PORTLAND, OR 97292 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 998 -9464
FAX na
Reg #: LIC 158565
PLM 26 -730PB
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 . - - = -ct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is - ed By: ( � Permittee Si nature:
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.
1.
Plumbing Permit Application FOR Oil ici USI ON'I., '
City of l
T SIY� �y 0 f' 07 Permit No.: i / -j �//
.; � U 0 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Plan e/gy eW Other Permit No.:
Inspection Line: 503.639.4175
Date T I G A R. D e ReadyBy.
lu g! See Page 2 for
Internet: www.tigard-or.gov Notified/Method ..//�'j, i.,
S opplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special Information use checklist
Description I Qty. I Ea. I Total
(.ddition/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
❑� Fire sprinkler ( , sq. ft.) Page 2 -
JOB SITE INFORMATION AND LOCATION Site utilities ' '
Job site address: \ \ f SI,rJ In u r A84 sr Catch basin or area drain 16.60
City /State/ZIP: T \C�AQ..S7 1 c)12- ,=r1-A-1_72_"1 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
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK
Back flow prevents Page 2
i?-- ,._JC 44-1.... W4/ \) 1." Backwater valve 16.60
` Clothes washer 16.60 I
"Es-) l D\ k--.1
Dishwasher 16.60 I(
JELPROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: J OS E VI L_L A.S 1 •- • 2 Expansion tank 16.60
Address: 11 C -- i-S 7 1Th E Sj G fl A‘Q S' Fixture/sewer cap 16.60
City/State/ZIP: . 71.C... 1 -4 1 02_ `7R--Z2'3 Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
• ILAPPLICANT . lasCONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Ftzte:cl_ �t■.I. C:5 S c_4.-k tce PLC.) rvaaIJ' Interceptor /grease trap 16.60
Contact name: L1/4Ptrc> a g i Medical gas (value: $ ) Page 2
Address: pp gp4c. 3320 ■ Primer 16.60
City/State/ZIP: rc�e...1L o 1 oQ- `In,'R-2°N'2- Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60 3
Phone: (Sp-s) `319 8, -- el (46 ( Fax:: ( ) Z
Tub /shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60 I.
Business name: P0R 1,-10 S CA -Eck.0 j Water heater 16.60 1
. Address: rip ezC,17--. -i. Other:
Y �f�'��L.klt - k. c'� ��'2�Z Subtotal
City/State/ZIP:
1,1,5`-'49.k-k(:. Minimum permit fee: $72.50 �
Phone: (565) Fax: ( ) Residential backflow minimum permit fee: $36.25 1 q (`
CCB Lic.: \S$S( i , ' ' Plumbin: Lic. no.: L, - r - k- o VS Plan review (25% of permit fee) 1.
Authorized signature:
I / 0 g State surcharge (8% of permit fee) / 1.
TOTAL PERMIT FEE / ,5
Print name: , U Sk..1C Date: 3 2'L_ c-. 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:\ &dlding\PamiMPLIN- PermitApp.doo 06/26/06 440- 4616T(10/02/COM/WEB)
�I
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 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 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
QuaodtY by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Future 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 Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
-Industrial
Ice MachiRefrig. 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
- Sommercial plumbing - Service P g Pe rmit can be issued.
Swimming Pool Filter .
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i: \BwIdingTamlawuN- PamitApp.doc 09/22/06
CITY OF TIGARD ��
BUILDING DIVISION PERMIT . PD1 .007 — �� /3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: , / 7 Phone: (503) 639 -4171 2 .1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 1 p 7 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: V vre/ L� 2 � PHONE #:
l /
CONTRACTOR: p / 640/ PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 99' % 4g -�
Corrections /Comments /Instructions:
G ireen7aim
o filW1 2.g a
y7
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL % A • 'lm► ! • 111 ADDITIO AL FEES SSESSED
Inspector: i i tl �- Date: Z9 °7 "Phone #: (503) 7149
CITY OF TIGARD -
BUILDING DIVISION PERMIT #7 -D V --Da / 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: -. 1 • 0-- V--
Phone: (503) 639 -4171 i�l�
Inspection Requests (24 Hrs.): (503) 639 -4175 s' , ^
INSPECTION WORKSHEET FOR DATE: 3/260 TIME: PAGE:
SITE ADDRESS: 11 6,. ‘ S -....- c h/ I I& T�6 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: c-JD „-- PHONE #:
CONTRACTOR: A lyzmi 1--0ie.72 4 -1VS atc9itE, PHONE #:
Inspection Request Scheduled or: Date: Pour Time:
Code # Inspection Descriptio Confirm # Contact # M ssage
a 2 O % 7 kvARVile- 0061/ --, Ai o 45 6,1a_ d
33 -vm.f y '/ c L 0,4 , Z
Corrections/ omments /Instruc � ns:
n / /1 ovc-4/-- AX-Y
/ ,z
ahI, &, 4-L •
1
1
PASS ❑ P. 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL PE !•R 1 ;1 10 ❑ ADDITIONAL F ES ASSESSED
/263
Inspector: Date: Phone #: (503) 71