Permit PLUMBING PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00242
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/30/2008
PARCEL: 2S 102 BC -01702
SITE ADDRESS: 12680 SW WATKINS AVE ZONING: R -4.5
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT: 027 JURISDICTION: TIG
PROJECT: FIELD -EATON
Project Description: Bathroom remodel - (1) lay, (1) shower pan & (1) water closet.
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: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
FRED FIELD -EATON
12680 SW WATKINS Description Date Amount
TIGARD, OR 97223 [TAX] 12% State Surch 5/30/2008 $8.70
[PLUMB] Permit Fee 5/30/2008 $72.50
Phone : 503 620 - 5630 Total $81.20
Contractor:
HALF MOON PLUMBING INC
11720 SW SUMMERCREST DR
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -521 -0401
FAX 503- 236 -6189
Reg #: LIC 128288
PLM 34 -330PB
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 - questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued :y: / ✓ PermitteeSignature -� 75 !64—U
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.
ding Permit Application
,Iding Fixtures FOR OFFICE USE ONLY ived 5 , City of Tigard Dat D ' ' Permit No / 9e 0 ,
• e III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone 503 639 4171 Fax 503 598 1960 Date/By. Other Permit No
TI G A R D Inspection Line 503 639 4175 Date Ready /By Jur ' < is w ® See Page 2 for
Internet www.tigard - gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list
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
co I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
12 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: 11 6 (2), a S L) L.S q - k k i s tA S t"c Catch basin or area drain 16 60
City /State /ZIP: �� ,, O � Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: ` "t 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: Lot no.: Water service (no linear ft.. _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16 60
DESCRIPTION OF WORK Backftow preventer Page 2
\ p'q,- /\ pr'v V" �. v 6 . ., Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 1214ROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
_� 1 `
Ejectors/sump 16 60
Name: 7— VZ c- , -e \ 2 - ( . WA
^ Expansion tank 16 60
Address: \ ).- 6 8 0 S w W c---\-C\ l/ M S. Fixture /sewer cap 16.60
City/State /ZIP: r ,\ Floor drain/floor sink/hub 16 60
Phone: ( I,'a, ` Z v I 5 — V O Fax: ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Ice maker 16.60
Business name: P � y CA. I n terceptor /grease trap 16 60
Contact name: G t' U7 c • . r ! Medical gas (value $ ) Page 2
Address: 2 -2 Lk cl ) l S ? ; s Primer 1660
City /State /ZIP: S ke t4) exA, V a G1 ( kc o Roof drain (commercial) 16 60
Sink/basin/lavatory 16.60 i
Phone: (t ?3) 6 Z 5 -7 7 c Fax: : ( ) r
Tub /showe shower pan 16 60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60 i
Business name: -k� MAN Biduti �1vw‘ ,.. 1NL Water heater 16 60
Address: 1 pr2z 5(.j S , ,,,d. ..i. Other
/State /ZIP:�� Subtotal
Cit
Y i �� ' Q �'�-223 Minimum permit fee. $72.50 50
Phone: ( ) 4 _ -22:44 Fax: ( ) • Residential backflow minimum permit fee: $36 25 ;: '
CCB Lic.: 12 -, 4 , ' � • ' lumbin Lic. no.: -34 33Q Plan review (25% of permit fee) -6
' State surcharge (12% of permit fee) a , 20
Authorized signature: ,
i1��� / TOTAL PERMIT FEE a `g/- 2)
[rint name: r� .`` e_s/' i "ic./1 Date:5 _21 - GZCI This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Trt -County Building Industry Service Board
I \Buildmg\Permits\PLMF- PermiiApp doe 12/27/06 440- 4616T(I0 /02/COM/WEB)
NI
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 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.
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 Isometric or Riser Diagram
Drinking Fountain g
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
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach /Refng 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 \ Bui lding\Permits\PLM- PermttApp.doc 12/27/06
.CITY OF TIGARD
, Ai
BUILDING DIVISION PERMIT #: PLM200S -00242
13125 SW Hall Blvd., Tigard, OR 97223 4 0,. , DATE ISSUED: 5/30/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . ':. '
INSPECTION WORKSHEET FOR DATE: 9/6!2008 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 12680 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 027 TYPE OF USE:
PROJECT NAME. FIELD - EATON
DESCRIPTION: Bathroom remodel - (1) lav, (1) shower pan & (1) water closet.
OWNER: FIELD-EATON, FRED PHONE #: 503-620 -5630
CONTRACTOR: HALF MOON PLUMBING INC PHONE #: 50352.1 -0401
Inspection Request Scheduled For: Date: 9/5/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 075154 -02 503.880 -8846 N
Corrections /Comments/ Instructions:
Ca r-c- F 1.1.4„.. (._ei p
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION (11 ADDITIONAL FEES ASSESSED
Inspector: V u V )\ VV. , t.----a-- Date: ci 1 .S) 07 Phone #: (503) 718-
CITY OF TIGARD,
BUILDING DIVISION PERMIT #: PLM2008-00242
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/30 /2008
Phone: (503) 639 -4171 r�
Inspection Requests (24 Hrs.): (503) 639 -4175 'L _
INSPECTION WORKSHEET FOR DATE: 6/2/2008 TIME: 7:02AM PAGE: 4
SITE ADDRESS: 12680 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 027 TYPE OF USE:
PROJECT NAME: FIELD - EATON
DESCRIPTION: Bathroom remodel - (1) lay, (1) shower pan & (1) water closet.
OWNER: FIELD - EATON, FRED • PHONE #: 503-620-5630
CONTRACTOR: HALF MOON PLUMBING INC PHONE #: 503- 521 - 0440
Inspection Request Scheduled For: Date: 6/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 • Shower pan 070654 -05 503-880 -8846 N
Corrections /Comments /Instructions:
•
•
•
•
[PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cl vm...1 Date:, Ce 2 \0q . Phone #: (503) 718 -
•
CITY OF TIGARD ' ,t
BUILDING DIVISION PERMIT #: PLM2008 -00242
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/30/2008
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/2/2008 TIME: 7:02AM • PAGE: 5
SITE ADDRESS: 12680 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 027 TYPE OF USE:
PROJECT NAME: FIELD - EATON
DESCRIPTION: .Bathroom remodel - (1) lav, (1) shower pan & (1) water closet.
OWNER: FIELD-EATON, FRED PHONE #: 503- 620 -5630
CONTRACTOR: HALF MOON PLUMBING INC PHONE #: 503- 521 -0401
•
Inspection Request Scheduled For: Date: 6/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # , Message
320 Plumbing rough -in 0706EA -04 503 -880 -8846 N (
•
Corrections /Comments /Instructions:
•
•
•
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Td \ Date: C. 2 OTJ Phone #: (503) 718-