Permit C ITY OF TIGARD PLUMBING PERMIT
�,It DEVELOPMENT SERVICES PERMIT #: PLM2003 -00022
' c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/22/03
SITE ADDRESS: 14315 SW 90TH AVE PARCEL: .2S111AA 06000
SUBDIVISION: GREENSWARD PARK NO. 2 ZONING: R -4.5
BLOCK: LOT: 046 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install irrigation backflow preventer.
FEES
Owner:
Description Date Amount
ORCHARD, SHAUN F + SHELLY
14315 SW 90TH AVE [PLUMB] Permit Fee 1/22/03 $36.25
TIGARD, OR 97224 [TAX] 8% State Tax 1/22/03 $2.90
Total $39.15
Phone : 503 684 - 6977
Contractor:
LYNN HATCH LANDSCAPING
23560 SW BOONES FERRY
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 503 691 1878
Final Inspection
Reg #: PLM 5284
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
• 9 A x j
Issued By: _ _e _ _ , Permittee Signature: Al&
/ •�j
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed4h¢ n- t business day
Plumbing Permit Application .FOR OFFICE U$E ONLY
Received t '.- 7-Z- -'0 3 Plumbing
Date /B : S Permit No. 1 l-. r2O'w 1- "
Planning Approval Sewer
City of Tigard Date /B : Permit No:
13125 SW Hall Blvd. Plan Review Other '
Tigard, Oregon 97223 Date /B : Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ` t' Post - Review Land Use
Nl�' I I ' Date /B : Case No.:
Internet: www.ci.tigard.or.us ■ e Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 "� W Name /Method: Su lemental Information.
HEDUI)E foi' "s` "ecial nfo "r'mati „`ctiecklst,)s,;
. !�t .. w-?1���tt• �- ��`' �. �._, �,fTYPEOF .�'� �k.� - ��. "FEE * �SC�.. _ - ��.� ._.gyp..,.
❑ New construction ❑ Demolition Description I Qty. 1 Fee(ea) I Total
� ��,a� � � N 1 � &�2�fam dw �' `�
❑ Addition/alteration/replacement ❑ Other. ( elua ft ii " n� ty�' nn i .; ° ._ .
t < ; -¶.. CATEGORYAOF£CONSTRUCTION . Y' 4 ` Y ,
a zI�� �n " es 100 r eac ' utih A co ec � n) _ �
���� ``��
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00
▪ Accessor Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
4• JOBsSITE INFQRMATION'Fand LOCATION ° , 'I Fire sprinkler - sq. ft.: Page 2
Job site address: / / - ( 5 5,0 %)14 �- x a ..
t. �� � � >�. �,�r � � ��.� .� � ' z5►teUfilit►s : °� {,. �.� -. - � -�� :_ w _
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line /trench drain 16.60
1 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 #:
ixture or Items
;; . ,,, .;, s DESCRIPTON OF WORK; . ,' : ASV,..`.. >W
Absorption valve 16.60
Backflow preventer 1 Page 2 _
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
`' ®P E�RTYA
ROPOWNER , +, 2 :. I/ TENANT ' l �- •;• Ejectors /sump 16.60
Name: k Gt, kv\ C) rciAp, i(. k Expansion tank 16.60
Address : 3 l 5 - 5 Li ot 0 Fixture /sewer cap 16.60
City /State / T v0l / 0 a 7 'a Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: ,3 (oj ' 1 -/ 49 77 Fax Hose bib 16.60 •
ig 'APPLICANT * ,.Z C01100-T "' Ice maker 16.60
Name: Interceptor /grease trap 16.60
Medical gas - value: $ Page 2
Address: 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
at: = Relt , ,I , ; Urinal 16.60
CONTR.AC'TOR g � �<
N 1 f _ , Water closet 16.60
Business Name: <y� F 1�4�t6l��j / �'�� Water heater 16.60
Address: '( . U. Sp,. Tyr✓ Its `J Other:
City /State /Zip:"T s o 9' 706 ... c)
, Other:
;40 ,ri, ', iPlumbmg e fiii Fees *` ' x '
Phone: 5 � =',/ Fax: 5�8y� lbal�' .E.
�- Subtotal $
CCB Lic. #: I b(7 d 4 ; P to b. Lic. #: • CC6 Minimum Permit Fee $72.50 $
Authorized / ' A Residential Backflow Minimum Fee $36.25
Signature: <, Al Wilkir Date: I/42 Plan Review (25% of Permit Fee) $
U State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $ 'EP1 1 5
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 - - ; _ �
Fee Schedule: Residential Fire Suppression Systems:
_ Total Square Foot ` Perm f Feeir
a r.:
Footing drain -1' 100' 55.00 0 to 2,000 $115.00
2,001 to 3,600 $160.00
Footing drain - each additional 100' 46.40 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 V al l latio r i : , ' . :,Per►nit
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
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 (Ftxtur e)�Woi k'Perforrried- Comments regarding fixture work:
F►xteR� e� _ ;
11 4. N_ 4_ s _;Nett' B ;? Moved t Ca
_Exishng ed '
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.
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 \PlrnPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour '
Inspection Line: 639-4175 '(
503
BUILDING p ( 4175 MST ,
INSPECTION DIVISION - Business Line: (503) 639 -4171 •
BUP
Received rr JJ Date Requested I t AM PM BUP
T
Location / 3 / S ?i° / ..\---ll -2-- Suite MEC
Contact Person ' U AA— Ph ( ) to 9/ — l ? PLM 2 9 3 ° 60O a-2__
Contractor Ph ( ) SWR _
BUILDING Tenant/Owner ELC
Footing _
Foundation Access:C ELC
Ftg Drain ELR `
Crawl Drain
Slab Inspect' otes:- 2 -AY1 (t 3 SIT
Post & Beam'
Shear Anchors .
nchors `
Ext Sheath/Shear . 4 �� --6-e--- �' *LI,
Int Sheatl /Shear
Framing
Insulation
Drywall Nailing .
Firewall
Fire Sprinkler ''
Fire Alarm
Susp'd Ceiling .. ,
Roof .�' f �/� / /
Other: f, • J fa pr, ,�/
Final �,; <-°/ PASS PART FAIL /. � ,�
PLUMBING . 7-bef
-- Post & Beam �,,,.''
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains •
Catch Basin / Manhole .
Storm Drain
Shower Pan a r •
Ot -r Y'r
PAS PART FAIL
ME • ANICAL
-, t -& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
1 /� 9
Approach /Sidewalk Date Inspector :,.. Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL