Permit :: .___. _.
:.
CITY OF TIGARD PLUMBING PERMIT
44 4 i 6 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00332
s i l- DATE ISSUED: 7/15/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12703 SW 67TH AVE PARCEL: 2S101AD -01000
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 033 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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: Irrigation backflow.
FEES
Owner:
Description Date Amount
BEACON HOMES NORTHWEST [PLUMB] Permit Fee 7/15/2004 $72.50
25115 SW PARKWAY AVE STE C
WILSONVILLE, OR 97070 [TAX] 8% State Surcharl 7/15/2004 $5.80
Total $78.30
Phone : 503 - 570 - 8828
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone : 682 1302 RP /Backflow Preventer
Final Inspection
Reg #: LIC 5698
PLM 10972 ALL PHASE;
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.
Issued By Adia Permittee Signature: c-e^- c 1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application ECE 1 VED FOR OFFICE USE ONLY
CI of Ti and l I FF permit No. � 0� 13125 SW HaIII Blvd., Tigard, OR 97223 JUL 1 " 2U oT Md 33
Phone: 503.639.4171 Fax: 503.598.1960 / /x Date/By: ther Permit No.:
24- Hour Inspection Line: 503.639.4175 CITY OFa�� Date Re a d y /B y : Juris:
_�. yBy: ®See Page 2 for
Internet: www.ci.tigard.or.us B U I LD I N G �i I • Notified/Method:
1 G Supplemental Information
' TYPE OF WORK r. a a1 4 a �, 2 �, _ E *. ° S ,
_. _ . -.. ,,,� .. FE CHEDULE
f New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 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
F� «�" .. , .. k b. . Y,, . 'x ..l•..e .,... h _ J ).,.n r .. ..,,.^ '... - __ `_.a '�.x. ,,..r .. ...r ,_ _ . \ _ ,
❑ 1- 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
N _ ;�* ; 7OB SITE 'INFORMATION AND LOGATION c _ Site utilities
Job site address: f a, 7 7 f Catch basin or area drain 16.60
City/State/ZIP: �� (4 i4_77._) Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: -�� Footing drain (no. linear ft.: ) Page 2
• Qp 1�� Manufactured home utilities 1 10.00
Cross street/directions to job site: tom-" O
Manholes 16.60
S l) I1 � tit) G '( , t-J 6 ) - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no
.. X . L . � t � tt Absorption valve 16.60
_ ^ zr « ._ ' DESCRIPTION j OF WORK; Backflow preventer Page 2
S L u i (� IL ' Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
x s r - Drinking fountain 16.60
r . r �YROPERTY:OWNER & I g - ❑. TENANT y c . y
rr .. __.
_ _ Ejectors /sump 16.60
Name: kUt2 ► i y}L-Rey Expansion tank 16.60
Address: j3 R (o7 Fixture /sewer cap 16.60
City/State/ZIP: o .� 1 1(� t o 2e_ G'j ? p (b g Floor drain /floor sink/hub 16.60
Phone: ( 'p() j 7o - � ' -B Fax: ( ) Garbage disposal 16.60
+ „rAP�LICANT r w ; O' CONTACT PERSON + 1
Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) l Fax:: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
- ir .« 4 CON { AC v T � OR s K ... Watercloset 16.60
Business name: C Q �b U R vQ ` S�i1 lWQ Water heater 16.60
Address: I - / �' 5 W �Jp�� J Other:
Ci /StatelZIP: _ Subtotal
ty S' - e1 0 Ot � ` 1 Y Minimum permit fee: $72.50
Phone: - j 3 o - Fax: (,3) - ( (7 Z Residential backflow minimum permit fee: $36.25
CCB Lic.: �b 8 Plumbing Lic. no.: Plan review (25% of permit fee)
i State surcharge (8% of permit fee) k
Authorized signature: c'�.,e.j►rn. (:c1 i.-) TOTAL PERMIT FEE -' 3o
Print name: f /3 L r'\ Lo lJ1JD W Date: 7 + (J n 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:\ Building4.Permits \PLMF- PermitApp.doc 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 - 1s 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 / 446.40 $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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50 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, 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"
-4"
Car Wash Drain
Garbage - Domestic
Disposal Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
is\ Building \Pemtits\PLM•PermitApp.doc 3/03
1 CITY OF TIGARD _ 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received . . 4 - Date Requested —)/Z AM PM BUP
Location / - 7 a 3 (e 7 ]] Suite MEC C� `
Contact Person 61C Ph ( ) 0 7 6 V c ; -- ad 7 DO 2 -- 4 ip
Contractor / Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing K1
Firewall
Fire Sprinkler
Fire Alarm 0
Susp'd Ceiling
Roof
Other: .
Final
P ac PART FAIL
LUMG
- - ost & Beam
_ . -" Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower PAn
S -
11
7 PART FAIL
' 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 0 Please call for reinspection RE: Q Unable to inspect — no access
Fire Supply Line >
ADA Approach/Sidewalk
pat e �/ 1 1 7 Inspector Ext
Other: -
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL