Permit CITY TIGARD PLUMBING PERMIT
,, Ali DEVELOPMENT SERVICES PERMIT #: PLM2003 -00183
E:��. DATE ISSUED: 5/7/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14660 SW 76TH AVE 074 PARCEL: 2S112BD-00100
SUBDIVISION: TIFFANY COURT APT. ZONING: R -12
BLOCK: LOT: 065 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 2 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing fixtures install. 2 lays, 1 tub, 1 toilet.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 5/7/03 $72.50
#200 -L, MS63 [TAX] 8% State Tax 5/7/03 $5.80
HILLSBORO, OR 97124 - 3082 Total $78.30
Phone : 503 846 - 4794
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 -7619 Final Inspection
Reg #: MET 00001047
LIC 12889
PLM 34 -4PB
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: 6 4/L� Permittee Signature: X A _AI
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
PlumJin Permit A lication FOR OFFICE USE ONLY
N Received Plumbing
DateB : / --- _ 0 3 j r Permit NoY -• 400 -- i,
City of Tigard Planning Approval Sewer
Date /B Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DateB : Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 h „, , , A Post-Review Land Use
� I �' Date /B : Case No.:
Internet: www.ci.tigard.or.us �. I I W Cont Ju El See Page 2 for ■ 24 -hour Inspection Request: 503- 639 -4175 Name /Method: (1 su lemental Information.
.,''0 , . " •TYP,.E OF'W,ORIC ; ,_ : , . • L . :, : .. >' .{ FEE * (forspecial tnformation;;use clieckhst)
❑ New construction ❑ Demolition Description 1 Qty. 1 Fee(ea) I Total
1k2 Addition/alteration /replacement ❑ Other: • .A New 1 - & 2 - family dwellings
CATEGORY.OF CONSTRUCTION : `: ? ,tmcludes`100Yt ;for each utd n
�ty conection)
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00
❑Accessory Building N. Multi- Family SFR (3) bath 399.00
El Master Builder Other: Each additional bath/kitchen 45.00
J,OB'SiTE`INFORMATION and LOCATION _t ` (: Fire sprinkler sq. ft Page 2
,• ':' n :` ' Site Utiliti ' _ !23:
Job site address? t4 ( `-f O SO..), 4 .. - AVE----
Suite #: / el .6 4,,o Bldg. /Apt. #: - I LI Catch basin/area drain 16.60
�y� Drywell /leach line /trench drain 16.60
Project Name: 1/J('n4 U I x L/ /-ii" 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: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map /parcel #: ,;, > � ti, ,., "; w._ _ 7.F
- �: Ftxture Item��� ���
�.., 1 ' DESCRIPT "
ION.OF WORK " Absorption valve 16.60
//YS?At.-(_ f�J L) PLi39 4 Xi1Xl• 3 Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher -* 16.60
. '
Drinking fountain 16.60
®:PROPERTY OWNER ,�;> .r '1 ._ E . Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
' '® CONTACThPERSON 4x
® vAPPLICANT . ` ,u , .. Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
16.60
Phone: Fax: Sink/basin/lavatory ��
E -mail: Tub /shower /shower . pan f 16.60 1G , (3
ONTRACTOR ;``z ' 1 Urinal 16.60
�� _ C t 1 6.60 ( 60 •
_lAlh 'to pLQ ��L Water closet ( ,
Business Name: ` Water heater 16.60
Address: 13 SL.-J 7, V, Other
City /State /Zip: 1K ) 0 , I -WO\ Other: 40`
- Plumbing Permit Fees *, , .,t
Phone: (pi'�� Fax: Subtotal $ _ �:,
CCB Lic. #: p Plumb. Lic. # .)c{ k4 ep Minimum Permit Fee $72.50 $ `? Z. "I)
Authorized ( � ^/ 0/ 0 .) Residential Backflow Minimum Fee $36.25
1 Signature: q W Date: Plan Review (25% of Permit Fee) $ cv {7
y State Surcharge (8% of Permit Fee) $ ` ' a 3
a WvatcN
(Please print name) TOTAL PERMIT FEE $ - 7 6 P',
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.
•
is \Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information a �_
Fee Schedule: Residential Fire Suppression Systems:
;Site Utilities a Qt Fee (ea) Totar.. 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
Valu'atiori:.:. 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
additional $100.00 or fraction thereof, to and
Future or,Item Qty Fee (ea) Total,' 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 (F�xture) work Performed Comments regarding fixture work:
Fixt re Type . „.New . Moved. s tin e a
1 ,. 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.
Oi Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\P1mPermitAppPg2.doc 01/03
CITY OF TIGARD . 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INS • TION DIVISION Business Line: (503) 639 -4171 MST
p BUP
Received • /3 _ Date Requested " �P m' PM BUP
Location / / C. (® * A O Q Suite � MEC
Contact Person Ph ( 5Z3) 6 SY3 ° 7‘v / g PL - Q A F__3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: J ELR
Crawl Drain s h 1/ Q. !.'—
Slab Inspection Notes: SIT
Post & Beam
Ext /
Ext Sheath/Shear
Int Sheath /Shear •
Framing
Insulation
Drywall Nailing
Firewall a'
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PART FAIL
LUMBI
eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
ma C�
PART FAIL
HANICAL
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 reinspectio+ RE: ❑ Unable to inspect — no access
Fire Supply Line ` � /�
ADA Date • � Inspector
Est
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site
PASS PART FAIL