Permit 40, CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00135
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/13/2006
PARCEL: 2 S 104 D B -03800
SITE ADDRESS: 13212 SW WELLINGTON PL ZONING: R -4.5
SUBDIVISION: AMESBURY HEIGHTS LOT: 038 JURISDICTION: TIG
Project Description: Footing drain tie into rain drains.
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:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 15 ft
Owner: FEES
TODD HOLZEMER
13212 SW WELLINGTON PL Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/13/2006 $72.50
[TAX] 8% State Surcha 4/13/2006 $5.80
Phone : 503- 401 -4684 Total $78.30
Contractor:
L.S. PANAS AND ASSOC
17261 SW KELOK RD.
LAKE OSWEGO, OR 97034 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 697 -7094
PRI 503- 209 -9600
Reg #: PLM 149456
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.
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Issued By: 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.
Buildan Fixtures G B ,
. _ . . .
Plumbing Permit Application FOIL OFl ICi IJSI ONLY- ,, ."
City of Tigard APR 13 2006 Received
Date/By '� 0 / • P Permit No /�� a� Q
b '0
q 13125 SW Hall Blvd, Tigard, OR 97223 , 'Ian Review • I N
® Phone: 503.639.4171 Fax: 503.59 8 9 V J I ,y , Date/BY
Permit Other Pet No :
Inspection Line: 503.639.4175 t,,1 a r � - i u k Ty •
f I G A R D I 1 SI A ReadyBy El See Page 2 for
Internet' www.tigard- or.gov D Cx Nott fi e d/Method
T Supplemental Information
TYPE OF - WORK - FEE* S EDULE
D New construction 0 Demolition N ctCA.iiJ For special information use checklist
Descri . tion I . Ea. Total
❑ Addition /alteration/replacement Other: _.^ - _- • -- ew 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
[XJ- 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
Job site address: (37.40... 611`) itie C.0.- 31v tOfv s- Catch basin or area drain 16.60
City /State /ZIP. t\v . Ve-CZ2 :;.\1 Drywell, leach line, or trench drain • 16.60
Suite/bldg. /apt. no.: Project name: [40 u o a yE Footing drain (no. linear ft.: S ) Page 2
yz? r.0 Manufactured home utilities 110.00
Cross street /directions to job site: k
Manholes 16.60
h ��� � I� �- �I �
L";•-4 1 � ��"""�"'• 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 preventer Page 2
I J4 e . 4 Z. PLYriJ "F C ( A:" Backwater valve 16.60
W ba A) 4 N-i J f OW - L--1-1/45,-4.- Clothes washer 16.60
(AP Y �� r -116--10 Dishwasher 16.60
�V�Y'CS � �f`' 'CO �Ct�rl� P��•s � �e.Qrl of
Drinking fountain 16.60
' PROPERTY OWNER I ❑ TENANT
Ejectors/sump 16.60
Name: i T� \•2 61,N.) LvL(- .l.Ikep - L)°J FL. ,q--(...C.:-., Expansion tank 16.60
Address - 1 -" Z c�tA�.) (��l }, } Fixture /sewer cap . 16.60
City/State - t - o v> .z' M Floor drain/floor sink/hub 16.60
Phone: ( Zj) "[ 'ci i 4( Fax: ( ) Garbage disposal 16.60
• ❑ APPLICANT CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: G . ► ( v ii,. A /I OC• . Interceptor /grease trap 16.60
Contact name: Lf k f 7>At\j 7 Medical gas (value: $ ) Page 2
Address: 11 2-'69 l : C.O 540.0ca Primer 16.60
City /State /ZIP: LA-1,c;_, MS et (i ?v34- Roof drain (commercial) 16.60
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Phone: (5$1) ZO9 - z j(JU 17 I Fax:: ( ) (ac 7 _ - el4 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail. 6 t - u if I LLAr c,E 1&Y Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: !( s pIf ta, Water heater 16.60
Address
Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 _70..,56t
CCB Lic.: (4-q ‘6 07 Plumbing Lic. no.: A Plan review (25% of permit fee)
Authorized signature: •/ !!! State surcharge (8% of permit fee) 5-$0
TOTAL PERMIT FEE ` 30
Print name: T v` Date4/ K(06, 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 \ Budding \Pcmits\PLMF- PermitApp,doc 04/06/06 4104616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard w
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: $50,001.00 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 Complex Structures -
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by(Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ' ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA I 3 multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain - Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
I \Building\Penmas\PLM -Perms W pp doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM20O(e- 01135
13125 SW Hall Blvd., Tigard, OR \ 97223 DATE ISSUED: 4113/200;
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 IL
INSPECTION WORKSHEET FOR DATE: 4/14/2006 TIME: • 7:07AM PAGE: 15
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SITE ADDRESS: 1 3212 SW WELLINGTON PL. CLASS OF WORK:
SUBDIVISION: AMESBURY HEIGHTS LOT #: 038 TYPE OF USE:
PROJECT NAME: HOLZEMER
' DESCRIPTION: Footing drain tie into rain drains,
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OWNER: HOLZEMER, TODD PHONE #: 1 .303- 401 -451 4
CONTRACTOR: L.S. PANAS AND ASSOC PHONE #: 503 - 205 - 0600
Inspection Request Scheduled For: Date: 4114/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
309 Plumbing final 0280M-02 5503.209.9600 N
Corrections /Comments /Instructions:
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M 'AS : • •ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONA FEES .SESSED
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Inspector ItAfiAdat ' - Date: A./ hone #: (503) 7
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CITY OF TIGARD '--1 g r
' BUILDING DIVISION PERMIT #: PLM2006-00135
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2006
Phone: (503) 639 -4171 ,,,,)41-71111 ' �, ,r
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/14/2006 TIME: 7:07AIM1 PAGE: 16
SITE ADDRESS: 13212 SW WELLINGTON PI_ CLASS OF WORK:
SUBDIVISION: AMESBURY HEIGHTS LOT #: 033 TYPE OF USE:
PROJECT NAME: HOLZEIMER
DESCRIPTION: Footing drain tie into rain drains.
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OWNER: 1 IOI.ZEMF_'R, TODD PHONE #: 503 - 401.46.81
CONTRACTOR: L.S. PANAS AND ACSOC PHONE #: 503 - 20:3 -9600
Inspection Request Scheduled For: Date: 4/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
335 Rain Chain 02t3034 -01 503- 203 -9600 • N
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Corrections/Comments/Instructions:
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PASS II •ARTIAL APPROVAL - ❑ CANCEL ❑ NO ACCESS
❑ FAIL i A CALL FO -� ION ❑ ADDITION' FEES ' .SESSED
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• Inspector: ■ 00. . Date: , thone #: (503) 711 4 t_� jr