Permit (3) CITY OF TIGARD
PLUMBING PERMIT
iftgo I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00063
Ail ISSUED: 2/11/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13055 SW ST. JAMES LN PARCEL: 2S109A6 -07500
SUBDIVISION: RAVEN RIDGE ZONING: R -7
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
Remarks: installation of residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
JAMES ARNETT
15445 SW MIDDLETON CT. [PLUMB] Permit Fee 2/11/04 $36.25
BEAVERTON, OR 97007 [TAX] 8% State Surcharl 2/11/04 $2.90
Total $39.15
Phone : 503 - 574 - 4418
Contractor:
CONCEPT LANDSCAPES INC
PO BOX 1583
BEAVERTON, OR 97075 REQUIRED INSPECTIONS
RP /Backflow Preventer
Phone : 646 -5781 Final Inspection
Reg #: LIC 7040
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: , • s'!%r /it , � � �i Permittee Signatur �I!�� _
------ Call (503) 6 -4175 by 7:00 P.M. for an inspection neede • ` i ay
Building Fixtures
Numbing Permit Application FOR OFFICE USE ONLY
City of Tigard DDace�ed /'t/0 Permit No.: „/ _ ere ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ki.,0 , 1,,, Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 c, Date Ready/By: Juris: 61 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
•
• TYPE OF WORK FEE* SCHEDULE •
liNew construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes I00 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
ID Accessory building El Multi-family
Each additional bath/kitchen 45.00
❑ Master builder Other: Lt_ o1A) Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I a 0 5 5 k S 1: J)A s_s Liu • Catch basin or area drain 16.60
City/State/ZIP: .---- 1 <° t i,t2, DR 9 7 2Z x't Drywell, leach line, or trench drain 16.60 1 / Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: ?%$,Riv s "sig,
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
Lot no.: Water service (no. linear ft.: ) Page 2
Subdivision:
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer ' Page 2 A755
7. ,� -
T L t �� 00 1: q ST>s ,1,t �A(xV. (,� Backwater valve 16.60
1 `(.. - $L � - 1 J u_� Clothes washer 16.60
� Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER l 0 TENANT - 16.60
Ejectors /sump
Name: )1 L O M. Expansion tank 16.60
Address: tW 55 S W s- ,SA LO . Fixture/sewer cap 16.60
City/State/ZIP: - IkJ oz q Wi. Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Fax: Phone: ( ) ( ) 16.60
Hose bib
' ❑ APPLICANT . ❑ CONTACT PERSON
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address:
Primer 16.60
Roof drain (commercial) 16.60
City/State/ZIP:
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR Water closet 16.60
Business name: c_olicurc L 6apiS INtr . Water heater 16.60
t
Other:
Address: ? Q -elsG, P � ( 5
Subtotal
City/State/ZIP: . 6 f f1a f £ '7015 � / c p Minimum permit fee: $72.50 �
Phone: ( 646 - 5'76 i Fax: 6D3 o3 ) IOw d -9284 Residential backflow minimum permit fee: $36.25 �( ,‘
CCB Lic.: oCCB lit 40 Plumbing Lic. no.: )11 43 - Plan review (25% of permit fee)
v II State surcharge (8% of permit fee) a
Authorized signature: - TOTAL PERMIT FEE 43;1
Print name: L.�•lnne� ` a , Date:021I` ( 4. I This permit application expires if a permit is not obtained within
w� • 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pemtits\PLMF- PermitApp.doe 12/03 440- 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 - 100' 55.00 0 to 2,000 $115.00
2,001 to 3,600 $160.00
Footing drain - each additional 100' 46.40 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
Qty Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $1 0,000.00 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
_ 3 ,,
_
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach/Refrig. Drains fees assessed for the sewer increase must be paid before the
Oil Separator (Gas Station)
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang -
-Stall
Sink -Bar/Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service
_ Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
t Water Closet - Toilet Plan review is required if fixture quantity total is >9.
1 Urinal
Other Fixtures:
\Building\Pmmu\PLM- PcmitAPP.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received t l fl lu Date Requested c 1 7 AM PM BUP
Location r' b 55 - S ��C1 t9�s L '-1 Suite MEC
Contact Person Ph ( ) PLM G� hd 6 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors (�
Ext Sheath/Shear
0
Int Sheath/Shear I
Framing d
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _ /� ,
Roof P "
Other:
Final • /
PASS PART FAIL /W -
eaMIERG
Post & Beam
Under Slab
Rough -In
Water Service (1.-/(751.
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P
Other:
PART FAIL
iLl ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
ilalltlatsahno...— — 1
CITY OF TIGARD 24 -Hour
BUILDING 400 Inspection Line: (503) 1750 MST 3 � /og
IIQSPECTION DIVISION Business Line: (50 -417
BUP
Received Date Requested = — 13 AM PM BUP
Location 13 °5,C 4f el,mao ryi. Suite MEC
Contact Person 9yYL 2/ P--O Ph ( ) 1`'36 -S`J E.5" 450 9' d 00 63
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
g Acces _ Z ELR
Crawl Drain L 0
C --
Slab Inspetes 4 , ' SIT
Post & Beam
Shear Anchors , i /
Ext Sheath/Shear '
Int Sheath/Shear
Framing ��
/ -- ��l/�
Insulation , G � J �+� ���
Drywall Nailing ,/�/�
Firewall
Fire Sprinkler Al L il Lit L - ��L -
,i7,� S� i 1 _ i
Fire Alarm �
Susp'd C 'li ����g o
Roof !L� •
Other:
y PART FAIL
W-Le Le'—‘—.)2.-- 6-4-NT' 1/4..A...)/ C.....(-42-6..."- — c-.."..3
Post & Beam
Under Slab dot ,______.,
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P n �J -
0th:. G.� /`A^r
si r - •
� T FAIL
' AN!
L
Pos earn
Rough -In
Gas Line
Smoke D y rs
4 � PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ` 6 1(/ \'..‘. ADA Approach/Sidewalk Date `' ' / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the jobs .
PASS PART FAIL