Permit •
CITY O TI CARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00028
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/6/04
SITE ADDRESS: 11483 SW 90TH AVE PARCEL: 1S135DB-00400
SUBDIVISION: TIGARDVILLE PARK ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: NEW 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: 150 ft
WATER CLOSETS: WATER LINE: 150 ft
DISHWASHERS: RAIN DRAIN: 150 ft
Remarks: Private utilities, 150' each of water, sanitary sewer and storm sewer.
FEES
Owner:
Description Date Amount
HOFFMAN, MICHAEL J
1223 NW 24TH #5 [PLUMB] Permit Fee 2/6/04 $304.20
PORTLAND, OR 97210 [PLMPLN] Plan Review 2/6/04 $76.05
[TAX] 8% State Surcharl 2/6/04 $24.34
Phone : Total $404.59
Contractor:
F & F PLUMBING & HEATING INC
6810 SE 85TH AVE
PORTLAND, OR 97206 -7787 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503 774 5140
Water Service Insp
Reg #: LIC 101473 Storm Drain Insp
PLM 26 - 526PB Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires youto follow rules adopted by the Oregon
•
Issued By: ! j L� G Permittee Signature; i 7, f
Ca (50 •39 -4175 by 7:00 P.M. for an inspection needed the nex business day
Building Fixtures 1p
Plumbing Permit A on ^ 00 � FOR OFFICE USE ONLY
City of Tigard a i\N � ' PRA Date/By: / le VV Permit No. , G }//) ....4,90,943, 13125 SW Hall Blvd., Tigard, OR 97223 d� Plan Review rIPGtJ
Phone: 503.639.4171 • Fax: 503.598.1960 .`10 ` V ' i /r ( y Other Permit No.� t QO& ?
Dat /B
24- Hour Inspection Line: 503.639.4175 Ci � •' L � kris:
v r W , D ate R ea d y /B y: m See Page 2 for
Internet: www.ci.tigard.or.us v`� Notified/Method: ? Supplemental Information
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�te {1 'r.:f�,�r.,:'�u °�$),'�Erc�f �.�t'��(`�•,� rA���`. �: rl. x(�.�'��. ;�;;s } . p�- ?ac5.m-o,•�a;..���i •':`!1 t ^';�" "�GC!F ".e�,`� Swa�rai�',k �h�e,�!�a,. -;,. i. -, 9�.rs,,. �._,.. . _ 's��.. 2 . a r . 'u,. i�.,h, -::. -..... < .
24 New construction Ill Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1 2 family dwellings (includes 100 ft. for each utility connection)
R'�, «F`s" ,',ea °;�,;�.� ,;z,s. +sha;� aa'x•..e „c�, �rb..h,�a.. ,:sue- s�:'r�ar €�etz ^. �..�r�au:�s - -v�+ #': .arp*;,•e te�i "'Uy. Ri'S'I:�' _ -
r i " ` C�'Att'E OF CONS I iIZ ON z � SFR (I) bath 249.20
,l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi-family. SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
u =,ru•,A � , a r- - g , , . - 0, : d,r Fire sprinkler ( sq. ft.) Page 2
n ° � y tl xC -„ JOB SIT IN FO RMA TION `AAND- L OCATIONL , „ a ^ 1 z.� ..
�� � � �,.�A..S.�:�� _ -ar � :wr��.:'A;• A_�7 o f N ra . , t a.a,.i * "i S ut
Job site address: 0;L::,... r s j / q Catch basin or area drain 1 6.60
City /State /ZIP: - 17��pd OR 9 7 Q 2? 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: ihr. f Azona„) Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
6 l �
Cross street/directions to job site: 46CA/B Manholes 16.60
v \ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 6 CI ) Page 2 /4,. e./0
•
Storm sewer (no. linear ft.: /5")) Page 2 Mt . V/)
Subdivision: Lot no.: Water service (no. linear ft.: / ) Page 2 / Ol , yo
Fixture or item
Tax map/parcel no.. 13 c , r ti r z: R _ ' ..' *.` : ' hn mss' v Absorption valve 16.60
�. . "G ; "`DESCRIPTION O F£:pR QRK t -
" �` � '� :� � � � "� ��,.,_�.N..; .��;, - . � , _. .:rm � •.�'.�- � " s. - � . , � .,: � Backflow preventer Page 2
Q -rL U1/471. k L� 4 b LR J t C f Backwater valve • 16.60
!� �Pft Lc �. Clothes washer 16.60
� Dishwasher 16.60
= F i� , ; H ,�,.,, ,, t:,�' ,., r v a r, �.- : €,,t. ; .�, ,. . ,„ V ; G.. ,�, sra:, . ; r' 4s,ja ,. Drinking fountain 16.60
® PROPERT,Y OWNER : ® e TEN ANT,��
.,.� ;.� ��'� ��u>.. :. s.&,� a�� -a��ax .. . .?.,4� ., - ., :. '.4 � „.,... _ _. �x.�. :�ww: _ a r Electors /sump 16.60
Name: /Lt, c h e / //O Fyrf,¢,t/ Expansion tank 16.60
Address: /..1.0,_ 7 A/c., ?- f 44' S Fixture /sewer cap 16.60
City/State/ZIP: A - -A/L) 0,, 9 7 / I) Floor drain /floor sink/hub 16.60
Phone: (50,3) g' /O s 3 ota Fax: ( ) t s- ,v7 9s-01 Garbage disposal 16.60
O I� � ';�: ,��°.� ��.��,,:,; - = ,+s�; a; =� °� "i`��t� -'��s� is:�:F..�� � Hose bib 16.60
:i l `,,Z t , i APPLIC T - g, t t /qt,t _ iIt`'. �o;..C� ,,,Sz:� T ONl" J Ice maker - 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: 3 4 N1.E. /� Medical gas (value: $ ) - Page 2
Address: / Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E - mail: Urinal 16.60
„ r:r'S ' ;:tt, k . r # ,p =. itity' `+':'N ,i,ti.;a.y� 'z ca hWii , •f °ib {. 7,11,',' ». y I^ v .*:' ' +':35ti�' .8
4 t a� a t ONTRACTOR , ,,;,° - 4t// Water closet 16.60
Business name: 1r- / f (6 . t. A /lV� �C Water heater 16.60
Address: {( 66 2/3 i% I CJ Other: •
City/State /ZIP: �C, O 4�L, f-�� 7 6 _ 7g7 Subtotal
r Minimum permit fee: $72.50 .V°a®
Phone: (y 7I / 3 / i t 0 Fax: (', ,y) Residential ba minimum permit fee: $36.25
CCB Lie.: GU ( 4/ 73 t I 3 l 0 Y Plumbing Lic. no.: A, ...,5 P6 . Platt -r iew (25p/o ®f�errwtit -fee) _ 74, d(
'" State surcharge (8% of permit fee) at/
Authorized signature: . 7f 9/41
TOTAL PERMIT FEE ,</i)��
Print name: Date: j 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:\ Building \Permits\PLMF - PermitApp.doc 12/03 440- 4616T(10/02 /COM/WEB)
Plumbing Permit Application - City of Tigard `
-
Page 2 - Supplemental Information "�, ; ., ry
• Fee Schedule: Resitent Systems:
Skit z.,: aa`M.b:x':�'.r.'�x�a; :.`s : :-ri =. �� � , �i. �°#"- �'m�.7�:ry ^.':�e't... �.,� §; . .�, ..;k�.a_ ': r" ' .;:,�d �'� � �e�s +.
,S h: ' T , "+s ,.55� ; a:��. fi a kQt Fee (ea) :Total" *- `°
Site LT,talities ;',s; � . Y. ; 'z ... ; ; S :qp ar e F o ot age .a . Permi Fee: •
Footing drain - 1s 100' 55.00 0 to 2,000 - , ' t $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 " 1 'UP $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' /56 55.00 7,201 and greater $309.00
Sewer - each additional 100' ' 46.40
Water Service - 1st 100' f07) 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 f i `g 1 a r
Valuation : . P ermit Fee R , f ,.
Storm & Rain Drain - 1st 100' /5 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
Faxture�or It ' r , ( $ r �.1 qty ,... 0 ) r ee 4 ( k T oPA 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 * .
g antl r:.^ � + �Quanttty by,(Fixture) WorkPerfo�med
i r�' t ' kl�Q �` r5� i Replace v
Fixture Type , , ,� : � _ � � � � � ,
_w ,ra t � r `1VIuvea� Eztaig capped Comments regarding fixture work:
� gi.� 0, ? > I E
.» NW +. .. s ift ,> ... ?- :.%t° 5 ....
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 Mach. /Refrig. Drains
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 /Lavato Quantity Total
-Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
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:
i:\ Building \Permits\PLM- PermitApp.doc 3/03
C
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
e
Received,;. v Date Requested — Z AM PM BUP
Location 11 'lt.� ! d Y-ei. Suite MEC
Contact Person �� Ph ( ) PLM L i - - x \ e° a g
Contractor £ i i .-- 5 • Ph ( ) S 7, 15o (p SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access--
Ftg Drain
Crawl Drain L' ^t1 O ELR
Slab Inspection Notes: / SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear <"
Framing cl (/ -� " ( - "
Insulation
Drywall Nailing
Firewall ' CerC ti-
Fire Sprinkler — - _ -- :,_=,--.,
Fire Alarm - --
Susp'd Ceiling
Roof
Other: &.q
Final
PASS P RT t_o ! fi�� N L U BI
Post & Beam ((�;‘
Under Slab �-J' U U - _ -. —_. '°- AfC - i-, GO 4
Rough -In : �+-
Water Service J 05 i iy
Sanitary Sewer CO r ' 7 /^" . 9
.Rain Drains Z r..) C
_ Catch Basin / Manhole
rm Dr - ^ --
r an
Other: 7 '07 1 4
Fi..>
_ _ PART FAIL
1 A NICAL
Post -& Beam
4 14h
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage.
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA_ e2 /° b/ 1
Approach /Sidewalk Date , Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL