Loading...
Permit , CITY OF TIGARD PLUMBING PERMIT Ai l DEVELOPMENT SERVICES PERMIT #: PLM2004 -00225 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/25/2004 SITE ADDRESS: 15762 SW 79TH AVE PARCEL: 2S112CD -07000 SUBDIVISION: PP1991 -063 ZONING: R -12 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: 300 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Site Utilities. Line work for sewer connection FEES Owner: Description Date Amount DANIEL SLIMICK 11345 SW 97TH CT [PLUMB] Permit Fee 5/20/2004 $147.80 TIGARD, OR 97223 [PLMPLN] Plan Review 5/20/2004 $36.95 [TAX] 8% State Surchari 5/20/2004 $11.82 Phone : Total $196.57 Contractor: SLIMICK, DANIEL 11345 SW 97TH CT. TIGARD, OR 97223 REQUIRED INSPECTIONS Phone : 5503 Sewer Inspection Final Inspection Reg #: PLM 107487 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. 1 / Issued By: ii L, ,,,,N1 /. Permittee Signature: cm a f . L 0 - Lyn- - \ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Site Utilities Y . Plumbic Permit App�lei ,� , FOR OFFICE U SE O , . , City g of Tigard �(1 4 Received �jQ /�y� `�I/ /tiG Date/By: d t;/ a Permit No 7.1 !I (2 7 ' 13125 SW Hall Blvd., Tigard, OR 97223 \ fl O 4 y] ° Plan Review I Phone: 503.639.4171 Fax: 503.598.1960 \I'� G P a:mll�I r (r� Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ?Y O i I. ``'' � er Date Ready/By: J ris: ® See Page 2 for Internet: www.ci.tigard.or.us C'' , D, V Notified/Method �/ Supplemental Information iii t r ? i:_;: t ^ '> _ ..� S... : 'A. "... < ri & "- P ro' , , ,r,UT* z „ r, rt .it11318R +�-�_.'�'I' W - ir��Igai m1.. � , I., '4, . ! = - :, i » t -i., 1 , , T YPElote;, -, ORK d - � ,,,, -, ` i + f 9 z "rs ? v v 4,. x,�i'; s/ . .t: ,,.: ra:,,.c /',I S ,I�� D ..a .'- n., ,, - r , : a sMe -_ f ti ,- . ,1, 04,, ,uArkwa 07,,t sa s rAlf 1: . a N a . KNew construction ❑ Demolition For special information use checklist. Description Qty. I Ea. Total F Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ' gi' CATEGORY QFCOI�STRUCTION`�a��k f t 4 , SFR (1) bath 249.20 d`a,; s Nt'au_ � <,�:.,9,.. ; �= �. �s�. �aa�. �, nn3�, �, ��i4s-, ..��.�.�c�.;rx._n�.�n.�''ut..., rd ro. =xii n'�, iE „»�:�i;' �1- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building I=1 Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: a Eye z �� f Fire sprinkler ( sq. ft.) Page 2 ' r 4n r * ‘; ` l 'JOB. S ITE IIYFORMAPION AND I: ' " at Si u tili ti es Job site address: /5' )(D a_ S _ c(+ ,A. V .,-x -- Catch basin or area drain 16.60 City/State /ZIP: 1 a v Q k \ • G ) Drywell, leach line, or trench dram 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: ■ T� T', Manholes 16.60 �t' _ 0 tr Rain drain connector 16.60 S c9-e1 , P ( St` 6( E' - .J S t G, I9 f ---- e Sanitary sewer (no. linear ft.: ) Page 2 R 0 g Storm sewer (no. linear ft.: ) Page 2 f Subdivision: 1\ Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no K ce a °t € r , } . . E Absorption valve 16.60 1: 1 � .°'3 aiiiSCRIPTI®N OF WORK it ,r�a ,61,0,,, an , i 41a aa , X,; , ,,, , :', ,,Ida . a.� .� .x,. .,.. s , €... H - r +, _ ,, Backflow preventer Page 2 S' 4 Li 4 t ! I. t1.� •, W© �.� w,p 1---- Backwater valve 16.60 I Clothes washer 16.60 Dishwasher 16.60 N ® & PROPEfiri OWNER ` ;I , Wi ❑` 4 4{- & Drinking fountain 16.60 w ri:14� ,rmAz .v , .: ... :,: v, � ,. t , - E.�,� . ... 2 ._ <aa &;A,= Ejectors /sump 16.60 Name: - D0.kk1 ' e. \ ' (t - Expansion tank 16.60 Address: (/ GI C .S G q 7 f C f Fixture /sewer cap 16.60 City/State /ZIP: 7`Cr� a ®q-- q> D- 02_ Floor drain /floor sink/hub 16.60 Phone: (g 3) ( ge - 6 tfa (D Fax: (5:;,V 6?(- y q c Garbage disposal 16.60 �" APPLICANTT u r'' ` a r ,� ® C P ER S ON xt r a Hose bib 16.60 , � 3s . s i . r - s_ r . .� , r � .,. , = . , ,,,,,g w ..w, � tes t al _ _, A .. A Ice maker 16.60 Business name: Qti , • ., \ S (I ‘ •c , - 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: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 a1���1r "`� ,M i am fi>ir`r a - _ t � CONTRACTOR m� -.� Water closet 16.60 a e ` . ,141 .3;. . `° .. f ,,.°uu= 9 , 114.<. aw9� sn xa,a,..,,�,�s,0 ,,. „ , 9 a� .,...1, . . .. Business name: 7.-a u ‘' , f S (t' CM t IC Water heater 16.60 Address: ' Other: Q- Subtotal City/State/ZIP: Minimum permit fee: $72.50 / L c A \ Phone: (b J 6 8c�"60 c(et , Fax: (2?) 6 gcf ^ 6 c( cif c, Residential backflow minimum permit fee: $36.25 / `7 i • CCB Lic.: / { 'g 7 ' 7 Plumbing Lic. no.: Plan review (25% of permit fee) 36 _96 j ] /o State surcharge (8 of permit fee) It 52- Authorized signaturet .--' TOTAL PERMIT FEE / 57 Print name: D k e ( S' (,N C L Date: _"`0,0(0 'y 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:\ BuildingWermits \PLMU- 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: ..x *: s ta ?l e a *' q Qty GS Fee (ea) 1' , TgtaI ra �� iV Foota 1 , 'Perthit FeC `. S><te •. �� sW .0 .�.q �..w�.,...,..�. ,.�.g _ e�.2, . __. _. ..�. A- ��x.. . 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 l 3,601 to 7,200 $220.00 Sewer- 1st 100' 55.00 L�j 7,201 and greater $309.00 Sewer - each additional 100' 46.40 9a • V) Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 ' Valuat1O,I1', ` ,, g Perml'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 r tf ..�a 4` s fps B * r Qty; r Fee (ea) $ ial additional $100.00 or fraction thereof, to and i orte : �'i :.... v..:. r w..5:, , '.. ,:: _..x 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 * . a �,Quinttty by�(Ftxture) Work�Perforrued° Fixture Typ � 3 ( � a Replace? mom a� � Muve � � =Exsti Capped Comments regarding fixture work: ,1 , _ z h _New .� c&,&&&04 L ,.M 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 increase of sewer EDUs, a sewer permit will be issued and Ice O il l Separator (Gas (G as Statioo n) Drains Oil 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 Isometric or riser diagram is required if fixture quantity - Commercial total is >9. - Service 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: i:\ Building \Pemilts\PLM- PermitApp.doc 3/03