Permit C ITY OF TIGARD PLUMBING PERMIT
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: DEVELOPMENT SERVICES PERMIT #: PLM2003 -00419
� DATE ISSUED: 8/14/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
/ASV/ PARCEL: 2S 101 AA -08700
SITE ADDRESS: 1.26e5 68TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 029 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Add 2 bar sinks.
FEES
Owner:
Description Date Amount
HEINTZBERGER
12505 SW 68TH AVE. [PLUMB] Permit Fee 8/14/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 8/14/03 $5.80
Total $78.30
Phone :
Contractor:
ED MULLEN PLUMBING
24470 SW RAINBOW LANE
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone : 503- 628 1632 Rough -in Insp
Final Inspection
Reg #: LIC 92689
PLM 34 -260PB
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: e,t.6�� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next j is day
Building Fixtures
PlumbinzPermit Application FOR OFFICE USE ONLY
Received Plumbingr 'M , O ` L
RECE Date/By: 0 �a � �� PemitNo /-4 '7 9
City of Tigard IVED Planning Approval
Date/By: Se Date/By: YeTmmi No.: ,9490 - CC Wo
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 AUG 12 2003 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
//a wa1 � ' i Date/By: Case No.:
Internet: www.ci.tigard.or.usCITY OF TIGARD ■ t j. ��i Contact Juris.: ® See Page 2 for
24 -hour Inspection RequestM OI SIO r^ J Name/Method: 71 CY Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. 1 Fee(ea.) 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CON,SRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
El & 2- Family dwelling Commercial/Industrial SFR (2) bath 350.00
❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: 7 54/4.g Site Utilities
Suite #: /a,s'// 1 Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line/trench drain 16.60
7 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 1 Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map /parcel #: Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
la / / 1 .dC/ fil/Af Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER 1 ❑ TENANT Ejectors/sump 16.60
Name: . S'7' fln4A e'0 Expansion tank • 16.60
Address: / / ()O $ i,/ 72.4 Fixture/sewer cap 16.60
City /State /Zip: ! / q , L. 0. Floor drain /floor sink/hub 16.60
/ �y Garbage disposal 16.60
Phone: GJq•oX ti Fax: 6 ''d.2 -399 Hose bib 16.60
❑ APPLICANT 0 CONTACT PERSON Ice maker 16.60
Name: ,4'4, //e (2 z97 /j 7 Interceptor /grease trap 16.60
Address: �yy90 )-j„ / j.9 c t/ 1...,rf , Medical
1 l gas - value: $ Page 16.60
City/State/Zip: f ro
Roof drain (commercial) 16.60
Phone: 6:2z -/63� I Fax: x -w33 Sink/basin/lavatory 16.60 32
E -mail: Tub /shower /shower. pan 16.60
CONTRACTOR Urinal 16.60
Y ..7 l� �v� Water closet 16.60
Business Name: �,.,, Water heater 16.60
Address: Other:
City /State /Zip: )1 Other:
Phone:�,i 26' Fax: Plumbing Permit Fees*
Subtotal $
CCB Lic. #: <2 Plumb. Lic. #: 3V2,0 Pj3 Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25 `702 SV
Signature: Date: Plan Review (25% of Permit Fee) $
, ' ems . State Surcharge (8% of Permit Fee) $ 6..80
(Please print name) TOTAL PERMIT FEE $ W 30
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
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
Total additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) 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
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 Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
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 *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink (- Bavatory .
- tsradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03