Permit C ITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00230
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/21/2008
PARCEL: 2S 102CA - 00943
SITE ADDRESS: 13580 SW VILLAGE GLENN DR ZONING: R -4.5
SUBDIVISION: VILLAGE GLENN LOT: 043 JURISDICTION: TIG
PROJECT: ROBBINS
Project Description: Replace less than 100' of water service.
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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
KEITH ROBBINS Description Date Amount
13580 SW VILLAGE GLENN DR
TIGARD, OR 97223 [PLUMB] Permit Fee 5/21/2008 $72.50
[TAX] 12% State Surch 5/21/2008 $8.70
Phone : 503- 670 -7589 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : piu
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 B 7, Permittee Signature: i ��rrypG J112 ,
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
Building Fixtures FOR OFFICE USE ONLY
R eceived +
City of Tigard Permit No
II • 131 SW Hall Blvd , Tigard, OR 97223 Date/By � (S �� C•I /d��''� �-L J Pl
C Phone: 503 639 4171 Fax. 503 598 1960 an Review
Dan Other Permit No
T I G A R D Inspection Line. 503 639 4175 Date Ready/By 0 Se Page 2 for
Internet' www tigard -or gov Notified/Method 7 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description I Qty I Ea I 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 INFORMATION AND LOCATION Site utilities
Ly
Job site address: /3 5 (, J Jo,„ ,_ a Gi 0 r Catch basin or area drain 16 60
City /State /ZIPT/ b Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: soip;/e ,49 g lut .../0 — oonng drain (no linear ft.: ) Page 2
// I 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: Lot no.: Water service (no linear ft PV) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventer Page 2
�1/ C A, � .1 fir! / 1144,r -7 % i,, Backwater valve 16 60
.,Z COG C/3 //7e. � ) Clothes washer 16 60
7 /7 / , //7 /// Dishwasher 16 60
❑ PROPERTY OWNER / / ❑ TENANT Drinking fountain 16 60
�� � ��// Ejectors /sump 16.60
Name: ° y // '�CG1 ,0 ei/ i/l Expansion tank 16 60
Address: /35 , j / � /4 .674A------ ` 01 - Fixture /sewer cap 16.60
City /State /ZIP: o c7E C,9 -3 Floor drain/floor sink/hub 16 60
Phone: (cSp -j) /
650 — s p ( )
Fax: Garbage disposal 16.60
❑ APPLICANT ❑ 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: ( ) I Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16 60
E -mail: Urinal 16 60
CONTRACTOR Water closet 16.60
Business name: ,O C� � �, ) F Water heater 16.60
Address: ` ! Other:
City /State /ZIP: Subtotal
Minimum permit fee $72 50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee $36 25 7�'
CCB Lic.: / Plumbing Lic. no.: Plan review (25% of permit fee) Q
Authorized si a ► e �6��� State surcharge (12% of permit fee) ff. 7D
'i TOTAL PERMIT FEE 87 , a&
Print name: - / ,a1„ Date: / y - This permit application expires if a permit is not obtained within
i 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I \Building\Permits\PLMF- PermnApp doc 12 /27/06 440- 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: I Permit Fee:
Footing drain - 100' 55 00 0 to 2,000 $1 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
Inspection of existing plumbing or each additional $100 00 or fraction thereof, to
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
Commercial 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.
-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
Unnal
Other Fixtures
i \Budding\Permns\PLM- PermnApp doc 12/27/06
CITY - OF TIGAR®
BUILDING DIVISION PERMIT #: PLM2008 -00230
13125 SW Hall Blvd., Tigard, OR 97223 C` DATE ISSUED: 5/2.112008
Phone: (503) 639 -4171 AIN M
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7 :00AM PAGE: 56
SITE ADDRESS: 13580 SW VILLAGE GLENN DR CLASS OF WORK:
SUBDIVISION: VILLAGE GLENN LOT #: 043 TYPE OF USE:
PROJECT NAME: ROBBINS
DESCRIPTION: Replace less than 100' of water service.
OWNER: ROBBINS, KEITH PHONE #: 603- 670 -7508
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
398 Plumbing final 070387 503 -670 -7588 N
Corrections /Comments /Instructions:
( ta rt o..id.L 1
•
•
•
•
•
A PASS ❑ PARTIAL APPROVAL ❑' CANCEL r ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ .ADDITIONAL FEES ASSESSED
•
Inspector: >> `^-2.— Date: � 2.fl o Phone #: (503) 718-
.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -00230
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/21 /2008
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 6/23/2008 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 13580 SW VILLAGE GLENN DR CLASS OF WORK:
SUBDIVISION: VILLAGE GLENN LOT #: 043 TYPE OF USE:
PROJECT NAME: ROl3BINS
DESCRIPTION: Replace less than 100' of water service.
' OWNER: ROBF INS, KEITH PHONE #: 50:3
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/23/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final - 070328 -01 603.670 -7589 N
Corrections /Comments / Instructions:
� n
a " r o p 1 �, - Z( �,,� -F/U ►e 1--- C N1 e) � ► � t.ia ( S 2-) 1 V)
•
•
•
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C ku Lt l • Date: 5' 2,3 Ion Phone #: (503) 718-