Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00387
TIGARD DATE ISSUED: 8/23/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S1036C - 00700
SITE ADDRESS: 12220 SW WALNUT ST ZONING: R
SUBDIVISION: MASON PARTITION LOT: JURISDICTION: TIG
PROJECT: MASON PARTITION
Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement
District #18 fee paid this date.
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: 14 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
JON & KARI MASON
12220 SW WALNUT ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/23/2007 $72.50
[TAX] 8% State Surchart 8/23/2007 $5.80
Phone : Total $78.30
Contractor:
JLM SERVICES INC
12220 SW WALNUT ST
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 590 -2451
Reg #: LIC 70082
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 _ . _ •699 or 1 800 332 2344
Issue By: / Permittee Signature: 40 10
Call 503.639.4175 by 7:00 a.m. for an inspection at b . siness day.
This permit card shall be kept in a conspicuous place on the job - it- ntil completion oft e project.
Approved plans are required on the job site at the ti of each inspection.
Plumbing Permit Application
2 I FOR OFFICE USE ONLY '
City of Tigard DateB Received i J V� Permit No . ' `ti / 3 g7
® 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review w
11 111
°' C Phone 503 639 4171 Fax 503 598 1960 Permit No �U7,...0b
Date/By W
T I G A R U Inspection Line 503.639 Date Ready /By luny la See Page 2 for
• Internet. www tigard -or gov Notified/Method 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 (I) bath 249 20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
El 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
Job site address: / . 2, Z-0 5 Lc' e.,,J / Catch basin or area drain 16.60
City /State /ZIP: ` L a N� : ®12 9 7 7i 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
/7iZ CC s A 4" ��01( Rain drain connector 16 60
Sanitary sewer (no. linear ft pi Page 2 4
Storm sewer,(no. linear ft . ) Page 2
Water service (no linear ft ) Page 2
Subdivision: Lot no.: __- —
Fixture or item .
Tax map /parcel no:: Absorption valve 16.60
. DESCRIPTION , OF WORK Backflow preventer Page 2
.___Q(•..(J err / /3 e..., C-0 It ,7L Backwater valve 16 60
V e-le-to 9 rzr.ifiG� Clothes washer 16 60 '
fJ Dishwasher 16.60
Drinking fountain 16.60
XPROPERTY OWNER ❑ TENANT
Ejectors /sump 16 60
Name: 0 1 /'1&' Expansion tank 16.60
Address: / 27,--"Z-61 G.t� . - L a m , Fixture /sewer cap 16 60
City /State /ZIP: n 6/A a /0AZ 972 sink/hub 22 Floor drain/floor sin , 16 60
Phone: (33 ) 5 — 8 2....!7 iz 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: , Cr-1 e., Medical gas (value: $ ) Page 2
Address: Primer 16 60
City /State /ZIP: Roof drain (commercial) 16 60
Sink/basin/lavatory 16 60
Phone:( ) Fax::( ) -
Tub /shower /shower.pan 16 60
E -mail: Unnal 16 60
" CONTRACTOR . Water closet 16.60
Business name: �L s.PXll, Ceet'5 T _ Water heater 16 60
Address: T' Other
• Subtotal
City /State /ZIP: Minimum permit fee $72.50 7a,60
Phone: ( ) l g'2 7 g Fax: ( ) Residential backflow minimum permit fee $36.25
CCB Lic.: 70-0 1 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature. A / State surcharge (8% of permit fee) `5 SU
/
At y 0_ 'T/ ` TOTAL PERMIT FEE 7
Print name: �� Jt/J Bh
i lip Date: /er 04 This permit application expires if a permit is not obtained within
G 180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
mmt
I \Building\Pers\PLM App 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: 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 Dram - 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 00 and up $742 00 for the first $50,000 00 and $1 20 for
each additional $100.00 or fraction thereof
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
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
Urinal
Other Fixtures
I \Budding\Permits\PLM- PermlApp doc 12/27/06
CITY OF TIGARD .. ;
- BUILDING DIVISION 4 ._ PERMIT #: PLM2007-00387
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/23/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 „... j..
INSPECTION WORKSHEET FOR DATE: 8/24 /2007 TIME: 7:00AM PAGE: 59
SITE ADDRESS: 12220 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: MASON PARTITION LOT #: TYPE OF USE:
PROJECT NAME: MASON PARTITION
DESCRIPTION: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement
District #18 fee paid this date.
OWNER: MASON. JON & KARI PHONE #:
CONTRACTOR: JLM SERVICES INC n PHONE #: 503-590-2451
o
N r'
Inspection Request Scheduled For: Date: 8/24/2007 � Pour Time: i • /0
Code # Inspection Description Confirm # Contact # Me age 9,
505 Sanitary sewer 054588 -01 503 -504 -8278 Y
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Corrections/Com
4 ments/Instructions:
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• FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ,
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Inspector: Dat e: Phone #: (503) 718-
CITY OF TIGARD • •
BUILDING DIVISION PERMIT #: PLM2007 -00387
. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/23/2007
. Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' i ...
INSPECTION WORKSHEET FOR DATE: 8/24/2007 TIME: 7:00AM PAGE: 68
SITE ADDRESS: 12220 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: MASON PARTITION LOT #: TYPE OF USE:
PROJECT NAME: MASON PARTITION
DESCRIPTION: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement
District #18 fee paid this date.
OWNER: MASON. JON & KARI PHONE #:
CONTRACTOR: JLM SERVICES INC PHONE #: 503 - 590 - 2451
Inspection Request Scheduled For: Date: 8/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 umbing final 054588 -02 603 -504 -8278 N
Corrections/ omments /Instructions: � L.i.f -- i___Tc),62)._ e‘A-A , p/A- i i1(7-- i —,=,,,
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n PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
(l FAIL (l CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED i*Vii-JM____ •
Inspector: Date: Phone #: (503) 718- -)112v7