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Permit CI TY OF TIGARD PLUMBING PERMIT al DEVELOPMENT SERVICES PERMIT #: PLM2004 -00434 - - -II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/17/2004 SITE ADDRESS: 15070 SW 81ST AVE PARCEL: 2S112CB -12700 SUBDIVISION: PP1991 -017 ZONING: R -4.5 BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: OTR 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: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of sewer ejector pump for addition. FEES Owner: Description Date Amount CORBIN, GARY S AND TERRIE [PLUMB] Permit Fee 9/17/2004 $72.50 13950 SW BONNIE BRAE COURT BEAVERTON, OR 97005 [TAX] 8% State Surchan 9/17/2004 $5.80 Total $78.30 Phone : Contractor: METRO HOMES INC 31175 SW COUNTRY VIEW LP WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone : 503 772 - 1217 Final Inspection Reg #: PLM 78182 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 9524.: -: $ I. You may obtain copies of these rules or direct questions to OUNC by calling (503) 6 -6699. Issued By: � I ' . f / 1 , lu� � . ' Permittee Signature Call (503 .39-4175 by 7:00 P.M. for an inspection needed the next busin -ss day Buildi-ngTixtures Plumbing Permit Application FOR OFFICE USE ONLY • , y of Ti g Received �� I' "6D Cit and DateB Permit No. , 13125 SW Hall Blvd., Tigard, OR 97223 y .44 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 644114\ Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 I Date Ready/By: Juris: IZI See Page 2 for Internet: www.ci.tigard.or.us NotifiedlMethod: Supplemental Information d- `F'tl £ b .'+t' _ x-'.' , t f °n ( 5 Z -- :' £'d c W ' ' . •k y `Z f1 i z, u. 3 W y y }vr lc A ,I , ,t1, , T..i„ uQ��x �. = ? Iiid.,.. : .: " B EE $ CHEDIJLE , . . er� '.�ti ' v E�.nxX�„ 2� j # H 4 �:� - f � e �.« 33 t1.N ,�,, .& .......�Y . ,9.y.Yl kX_ ❑ New construction El Demolition For special information use checklist Description I Qty. Ea. Total R I Addition/alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) s `l 6' * tC. C , � RY x A - , C� TIOI F� - 1N ' SFR (1) bath 249.20 Z 1- and 2- family dwelling El Cornmerciallindustrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: t s � Fire sprinkler ( sq. ft) Page 2 s' Va (OB S A IlrF6 ATION AN IW TION .1 r r _ . :, , ...e 43-n , it, .. .J,-. .... .., . 4.E..�. .. a ..5 Site utilities Job site address: / i LCD . -.-/ 6 J Z /t -��e / , ' Catch basin or area drain 16.60 City / State/ZIP: �� G Ge, L ) / C Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 4 Project name: Footing drain (no. linear ft.: ) Page 2 / S J - ,263 Manufactured home utilities 110.00 Cross street/directions to job site: ! G� Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 x `' l `` //� � F , affil rt ` 1 ;V B ac kfl ow preventer Page 2 P C-0 ( //'2S �l . .SC J i t -C &/A C) EW ` . Backwater valve 16.60 O / Clothes washer 16.60 cL /0 v Dishwasher 16.60 f, a 4,rt s ue, � Jul es Drinking fountain 16.60 if, ` , s iff 5 fi r:, 'v( is i l '' _ -574 y ,Wif,V0,,i // Ge, // Ejectors /sump 16.60 Name: (9-- ,'t ( /' 6.4/0 / Expansion tank 16.60 Address: / ` /J,0 t c ., CA F'/ (If }Q - - Fixture /sewer cap 16.60 City/State/ZIP: 7--/ y,_,, r-i , -./e_ 92 �. z Floor drain/floor sink/hub 16.60 - Phone: Sad) ,2 O/ � J L 7 Fax: ( ) Garbage disposal 16.60 � u .a r `'_ - 5 eH s 3� n Hose bib 16.60 3 �" "fir S / APPLICANT : $,...t, �CONTAC.T PERSON �� .�. �� �w�.x � -nne =c, . � aQ. ...:40axs,. ii Ice maker 16.60 Business name: cj P�.;C:::- '- Interceptor /grease trap 16.60 Contact name: / J4e., / Medical gas (value: $ ) Page 2 Address: //- Y ( -___,D G f.[ �G y f( eLeyj Liea Primer 16.60 City/ State/ZIP: 40,7 /Sc-2 v�� 1 '�-' ,9- Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: (S)3) 7e7 ,1 - /2- l 9 Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 e.. r' *x 1x. C ,r r a > -4or4e 4 Water closet 16.60 Business name: --. -7 - n /' �/7 � / S / �T _ \ Water heater 16.60 Address: c2 / /�> c > ` , [�(`. -L�7/ ,' ��l �`-� Other:af,,aG QTi� /4, .40 P 6 / / Q /f d • J S ubtotal City/ State/ZIP: �G /S ©� � Minimum permit fee: $72.50 Phone: (M) 2 7) (2 /9 Fax: ( ) Residential backflow minimum permit fee: $36.25 / CCB Lic.: 9 �G 5 Z /I /2 4, Plumbing Lic. no.: Plan review (25% of permit fee) ( State surcharge (8% of permit fee) , TO Authorized signature: -- ": ' - - .4,1._ TOTAL PERMIT FEE X78. 3 0 �j�O /� : -- _ /� Print name:•w /� /� �� ._ - 'Date: °Lj - 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. iABuilding'Permits\PLMF- 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: i i ' o t 3 tEee (ea)r Totat e c ", s �S><teUtilrtie „ . - , g � , ��. .. 4 , a Sg3uare Foota a PermitF"ee s, • Footing drain - 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,1)01 to 3,600 $160.00 3,501 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'Iedlcal Gas Systems: Water Service - each additional 100' 46.40 aluatton w k , < r "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 $:i to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each �� ee �ea Tol additional $100.00 or fraction thereof, to and Fixitur or;Ite m w _„ Q ; ja > 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: $ 50,001.00 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 * . , !"Ni r��" 7 1 ,, �� tQuanhtyz6y (F�ature)VorkPerformed�! tFFixure TYpe efT Spa ' � ��, -A � `exr. t 1 x�sitng capp a 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" • -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 and 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 Quantity Total - Bradley 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 \Permits'PLM- PermitApp. doc 3/03