Permit CITY OF TIGARD PLUMBING PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: PLM2015-00109
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/09/2015
Parcel: 2S112AD00500
Jurisdiction: Tigard
Site address: 14650 SW 72ND AVE
Project: Rogers Machinery Subdivision: BONITA GARDENS Lot: 4
Project Description: Installation of 40'of water service,(1)backflow device and(1)PRV
Contractor: RAYBORN'S PLUMBING INC Owner: UNION CENTRAL LIFE
PO BOX 69 TREASURY SERVICES
19990 SW CIPOLE RD ATTN: DIANE THOMAS
TUALATIN,OR 97062 PO BOX 888
CINCINNATI, OH 45240
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
40 If Water Service 04/09/2015 $62.54
Specifics: 1 ea Backflow Preventer 04/09/2015 $31.27
25 Misc Other Fee 04/09/2015 $25.02
Type of Use: COM 1 12%State Surcharge- 04/09/2015 $14.26
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Ut i o i ica -.Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
r direct questions to OUNC b (ling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspects. .:te.
This permit card shall be kept in a conspicuous place on the job site until comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application FOR ohF,cl. use: ONLY
Building Fixtures tt
� p�Vill Received �3 �„� Permit No.: `��xl�)����g
City of Tigard �) *
Date/By:
_ e Plan Review Other Permit No.:
+ 13125 S5 Hall Blvd.,Tigard, Date/By:
Phone: 503.639.4171 Fax: 503.598.1960 Date Ready/By: Jurs: Ed See Page 2 for
Supplemental Information
Internet:n Line: 503.639.4175 r.g0v 9 �01 Notified/Method:
T l G A RD Internet: www.tigard-or.gov 1 FEE* SCHEDULE
�"
•
TYPE OF WO �`_� Far special in armation use checklist.
+r V Ea. Total
$ Ne. onstruction �ii i�t , Descri•tion
VII New l-2-family dwellings(includes 100 ft.for each utility connection)
A� Addition/alteration/replacement SFR(1)bath 312.70
CA I EGORY OF CONSTRUCTION SFR(2)bath 437.78
❑
ommerciaVindustrial SFR(3)bath Nil 500.32
1 and 2-family dwelling
❑Multi-family Each additional bath/kitchen
25.02 111111
❑ Accessory building Page 2 -
❑Other: Fire sprinkler( sq.ft.)
❑ Master builder
JOB SITE INFORMATION AND LOCATION 18.76 -
Catch basin or area drain _
V 18.76 -
Job site address (j 0 S .= Drywell,leach line,or trench drain _
* • Footing drain(no.linear ft.:_) Page 2 -
AJ � 50.03
♦�f�S !�• Manufactured home utilities _
Suite/bldg./apt.no.: Project name: � . 18.76 -
Manholes
Cross street directions to job site: 18.76 Mil
Rain drain connector 11111_
- Sanitary sewer(no.linear ft.:_) _
Page 2
Storm sewer(no.linear ft.:_) Page 2 Mill Water service(no.linear ft.: ) 0
Page 2 WM
Lot no.: Fixture or item: 31.27
Subdivision: Backflow preventer MEW
Tax map/parcel no.: 22.51
DESCRIPTION OF WOE 12.51 Clothes washer
25.02
A f ` r c, 0 t,./ Dishwasher
•y� 1�
Drinking fountain 25.02
V Ejectors/sump 25.02 -
❑ TENANT Expansion tank 12.51
_
❑ PROPERTY OWNER 25.02 1111111111 Fixture/sewer cap _
Floor drain/floor sink/hub
25.02 -
■ Garbage disposal
25.02 111111111 Address:
Hose bib 25.02
• Phone:( )
12.51
25.02
Interceptor/grease trap _
APPLICANT ❑ CONTACT PERSON Page 2
Medical gas(value:$ )
12.51
Primer
r •- 12.51
C> e- -V� `_ Roof drain(commercial)
Contact name: � � 25.02
_ • .. • 1 Sink/basin/lavatory
Address: • a,' 0 (potable water) 62.54
•
• 0 G a Solar units(p
City/State/ZIP: 12.51
Tub/shower/shower pan _
<3 25.02
t Phone: ; l
25.02
�` Water closet
•,i� 37.52 Ezrz
' CONTRACTOR
56.29
' - Water piping/��+'V v 25.02 • ' r'
•- Other , -
Address: f (mew G' i Subtotal
) q Minimum permit fee: $72.50 r
Fax: D ) �0 Plan review (25%of permit fee)
PPlumbing Lic.no._ , State surcharge(12%of permit fee) r TOTAL PERMIT FEE �s
Authorized signature: � r/. / This permit application expires if a permit is not obtained wit in 180 days
Date: --' `•/5 after it has been accepted as complete.
, rvice Boa
•, �� `Fee methodology set by been accepted
Building Industry t7�
440-4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14650 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
FAIL
PLM2015-00109
George Heimos
1. Previous corrections regarding Backflow MINIMUM depth below grade and below
device and providing boxes not completed.
2. This is third inspection. Re-inspection fee due. 103.4.4/103.5.6/455.058
3. Recall inspection when corrections have been completed. Re-inspection required.
103.5.6.1
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14650 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2015-00109
Inspection Type: Inspector:
399 Plumbing final George Heimos
Result:
FA I L
Comments:
1 . Provide method to prevent infill below new boxes for a minimum of 12" below device.
As noted on first inspection.
2. Recall inspection when completed.
Ok to backfill trench and around boxes
1 " watts model 007 serial number 023957
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14650 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00109
George Heimos
Violation Summary:
Inspector Contractor