Permit C ITY OF T PLUMBING PERMIT
44 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00150
' - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/20/2004
SITE ADDRESS: 10735 SW 69th AVE managment PARCEL: 1S136AD -04102
SUBDIVISION: VILLA RIDGE ZONING: R -12
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: 600 ft
Remarks: Installation of new storm sewer system for existing apartment complex.
FEES
Owner:
Description Date Amount
MCKIBBEN - GETTYSBURG VENTURE [PLUMB] Permit Fee 8/20/2004 $303.60
c/o KRICHMAR, JERRY + CAMILLE
790 HERMOSA WAY [TAX] 8% State Surchar! 8/20/2004 $24.29
LAGUNA BEACH, CA 92651 Total $327.89
Phone:
Contractor:
NORTHWEST RAINGARDEN & DRAINAGE MAS
PO BOX 533
RIDGEFIELD, WA 98642 REQUIRED INSPECTIONS
Phone : 360 Storm Drain Insp
Storm Drain Insp
Reg #: LIC 126506 Storm Drain Insp
Storm Drain Insp
Final Inspection
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 -000 -! : e. You may o• ain copies of these rules or direct questions to OUNC by calling (503)
246-6:•9.
Issu • d By: j , ,.�,, , 1 . 11 1��! Permittee Signature: ,�j , i ce ,
Call (503) 6 = -4175 by 7:00 P.M. for an inspection need • • the n • xt business day
nilding Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY •
Recved
City of Tigard Receve 1V Permit No.: L � /St
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Arny t f � � D Pl an ate Review JJ 4 y: M 14r�+ O er Permit No.:
24- Hour Inspection Line: 503.639.4175 •f I� Date Read /B tb o El Se e Page 2 for
`' ��.. y
Internet: www.ci.tigard.or.us Notified/Method: 09 Supplemental lnformation
TYPE OF WORK FEE SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
VA Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling . ommerciaLIindustrial 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: d 7 3 , _ . ' Catch basin or area drain ' 16.60 IL,
City/ State/ZIP: 'i - -gQ ("') • 97-2-2 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: ;am s F r _ Adm.,
Manufactured home utilities 110.00
Cross street/directions to job site: C7 � ,7a) / ; 5 O ( ., c - v
I Manholes 16.60
/ / i A C' J► Rain drain connector OW 16.60 lider
Sanitary sewer (no. linear ft.: ) Page 2 x.
Storm sewer (no. linear ft.:(icC') 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 Backflow preventer Page 2
l'A ) Yflq 12.14: S Backwater valve 16.60
t yOsT I g-c (..3 -4) l.. * I /�u, LQ Jr_ il ? t r C _ 0 Clothes washer 16.60
P � 0 1 ,3 , r ' Dishwasher 16.60
Drinking fountain 16.60
i, 1 fcrei�
❑ PROPERTY OWNER, / , ❑ TENANT -
1 Ejectors /sump 16.60
k'
Name: .y 4Jii, p mu Expansion tank 16.60
Address: i 5 ' (, J ( 6 0 tl Fixture/sewer cap 16.60
City/ State/ZIP: R i f e --g 6 ez 9 72 -2 3 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
WAPPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:M -I- (gg11JC DC A'W Dgich mAG6 Interceptor /grease trap 16.60
Contact name:: - U t K a.p Rte{ Y 1 4 4 4 , 15711 2 - - S Medical gas (value: $ ) Page 2
Address: Po K ' j'3 Primer 16.60
City/State/ZIP: t.R I (J 6.6 ' Zf6 9- /4, v Roof drain (commercial) 16.60
Phone: (360) a-7- / t 4 4 Fax: : 060 a'i -V 2 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR • Water closet 16.60
Business name: ,5ftrn-F 65 ov Water heater 16.60
Address: Other:
Subtotal
City/ State/ZIP:
Minimum permit fee: $72.50 22 (pe
Phone: ( ) iA/e/ pb Fax: ( ) Rf sidential backflow minimum permit fee: $36.25 6 J'
CCB Lic.: 5 0 Plumbing Lic. no/ • 9" --""Plan review (25% of permit fee) 4540 •
l State surcharge (8% of permit fee) ', y .i19
Authorized signature: ` J y�� TOTAL PERMIT FEE ' '
Print name: SITE PHE ' 77,/ D a :4 D This per mit application expires if a permit is not obta.
Y 180 days after it has been accepted as complet . a?i
• *Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pemtits\PLMF- PennitApp.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 - 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' 055.00 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 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
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
- Bradley Quantity Total
- 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 \Pernuts\PLM- PemtitApp.doc 3/03
A
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested F' 2 4/ AM PM ✓ BUP
Location 1 0"735 6 a `' 4-v c. Suite MEC
Contact Person PC 4 Ph (360 ) n7--//Y9 PLM 2ooLI- 0aISo
Contractor S Ph (3 ) 5/? /6 /F SWR
BUILDING Tenant/Owner 9, 1-f b a v Air tc. 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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In �
Water Service
- • ewer •
'ain Dra'•
C- • n / Manhole
torm Drai
Shower Pan
O a =r:
1 •
M � 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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA a te 712h l Inspector CRf IM JfI' 1 �"�� Ext
Approach/Sidewalk D � p
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
FIRE MARSHAL TO BUILDING DEPARTMENT
VIOLATION INFORMATION
Nature of Problem: p,p,g, xw•ow,
Address of Violation: 10735 Sw &gm Apr 3
2 &)D
Date and Time of Violation: '1 1 r
day of YaJZcH , V at t 9 ; 1£5 ‘a-FlIgA -n
Business Name: U Q_ 5 u . I( TS
Responsible Party - Name: a,, wei \nal Lo
Address: ko735 Sw ( -►►. pp 0 I
Person to Contact:
Phone: 21+ - C90 I
This Company / Person is Responsible as the (Circle all Applicable):
Property Owner Contractor Subcontractor Other (explain)
Description of Violation (Who, What, When, Where): Code Section: So
• v.a; Qr c C,, V. k • • c 'T' ► . v Locaxibv
9zAliIci p.DiR i cc( cart fit
Action Desired (check one)
O Letter
►� Notice of Civil Infraction (formal notice of violation with deadline to correct)
O Citation
Other: S o e Arlo v t.
Information, Such as Prior Violations, That Warrant Aggressive Enforcement Action:
Action Requested b)(_ � Q Date: -S _ Q
Fire Marshal / Supervisor Approval: ��.
Plug 19 04 02:55p Steve Kenworth� 694 -5847 p.4
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