Permit {
C ITY OF TIGARD PLUMBING PERMIT
!'<< DEVELOPMENT SERVICES PERMIT #: PLM2003 -00098
�� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/24/03
SITE ADDRESS: 11185 SW 79TH AVE PARCEL: 1S136CA -03000
SUBDIVISION: FRIENDLY ACRES ZONING: R -4.5
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 40' of water service.
FEES
Owner:
Description Date Amount
DENNY, DOUGLAS D
11185 SW 79TH AVE [PLUMB] Permit Fee 3/24/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 3/24/03 $5.80
Total $78.30
Phone :
Contractor:
GLOBAL PLUMBING
NEDJO MARKANOVICH
11077 SW 81ST AVE REQUIRED INSPECTIONS
TIGARD, OR 97223 -8454
Phone : 503 620 8971 Water Line Insp
Final Inspection
Reg #: LIC 38881
PLM 34 -128PB
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
.,,,e
Issued By:, if i , Permittee Signature: 'V ' i "1/1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
N� Received �u/ tubin M n q
Date/By: 1/ Permit No. / °1 (ZaD Planning proval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other '
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
D//e� �dl� ' d
Internet: www.ci.tigard.or.us e.' I Date /By: Case No.:
J� Contact 1u ® See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 W - Name /Method:
Supplemental Information.
? �, �,„ a M F SCHEDULE (for special information use checklisst „`";
.¢ F��.' � =�. , �. s, � � . �.:�,.. ?, TYP,E...QF�WORK � =n ... ,�~� -� . � � .�. _ ) � w,�
Description Qty. Fee(ea)
❑ New construction El Demolition p � 1 1 Total
En Addition/alteration/replacement ID Other: g4 New�,1 -8r. 2 family dwellings ' t f ,a r , ,
_ 6 1f1c 'des;100 ft•.;foreach utih y conne ,i_;3a` ° '.s 4o
to m ii fit.. _�„ y,:. ... _ ._
_ CA�TEGORY,,OF'COIVSTRUCTION_., h§ ... SFR (1) bath 249.20
® 1 & 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
' tt„ JO BISITEINFORIVIATIONlandLOCATION MWM Fire sprinkler sq. ft Page 2
Job site address: 41 s3 5 -S ( 7 9 -,1,7 Aye Co ' 1 .: , . . , 6 , Stte.:Utuittes .. . "t .. 1 .. n
Suite #: 7IG A 10) Bldg. /Apt. #: Catch basin /area drain 16.60
Drywell /leach line /trench drain 16.60
Project Name: 'DEAN y D O l./ G Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: ''r'FA *FF b L. AYe 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 # I
,
_ .._ � �. � � � ixtureor�I � �.. � �.� :�.�_;��.,. ��'
itmov., `, ,DESC ttiMi N OF, W®RIC' ,,' s _ ..,;„ '
Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
:PR®RERT$YOWIVER ,, 1., #" TENANT ,; E , Ejectors /sump 16.60
Name: 3 FNN 3 c. (--c C Expansion tank 16.60
Address: 7 j 5 &V Er y AV' Fixture /sewer cap 16.60
City /State /Zip: F f c 4 /€ D C92, n2 2 7 Floor drain floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
'0441I081qT; c l t. ' 1.' 0j.NTACili0tRS®N „' =',. „-$ 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
Phone: Fax: Sink/basin/lavatory 16.60
E - mail: - Tub /shower /shower. pan 16.60
a t t ' CONTRACTORIt -:. s =3 T; Urinal 16.60
Business Name: G G o Z ,p-i_ -- P L 6t pl E 1 NG' a Water closet 16.60
Water heater 16.60
Address: 11 01 S U/ g .1 Sil Ave Other:
City /State /Zip: r IG p `/ZD C9 9 '' 2_2.. 3 '� Other
Phone: 6 2 D - 29 7 1 Fax: ..3 y /2//'.6 8 8 �_
79 Subtotal $
CCB Lic. #: '� Plumb. Lic.#:2 7 �i�1 � Minimum Permit Fee $72.50 $
Authorized '/ °� /, �� Residential Backflow Minimum Fee $36.25 "�' s�
Signature: � // m z -- 0.6r :.3 - z. tJ Z � 3
gn /7 / G�a�b`- Plan Review (25% of Permit Fee) $
M A ? / A N o i/ 1 C 41 / 1 7D State Surcharge (8% of Permit Fee) $ -.5". re)
(Please print name)
L TOTAL PERMIT FEE $ 7 ?, 36
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 �.
274 Qty: Fee (ea) t Square`Footage : r• PermitFee;
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
p Medical Gas Systems:
Water Service - each additional 100' 46.40+
Val s ; Pe rmi t 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
_ m, .. ,; E , additional $100.00 or fraction thereof, to and
re orI
agFtute Qt 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 *.
Comments regarding fixture work:
� � � Quant�t�by�(FrxYu Work,Perfor � g g
, Replace: ��
g . s }' .New . ,. Movetl f i tlExistitivn EtC•afilkiVA,
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
P
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 - 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 / - °
INSPECTION DIVISION Business Line: (503) 639 -4171
� BUP
Received Date Requested 3_ �6 AM PM BUP
Location • • Suite MEC
Contact Person Ph ( ) PLM 3
Contractor Ph ( ) a. CD g/ 1 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain '
Slab Inspect • n otes: Q� 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
anitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
(P 1 3 , PART FAIL
MECHANICAL
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: 0 Unable to inspect — no access
Fire Supply Line � ''J /Ij�� / �.
ADA
Approach /Sidewalk • Date t0 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL