Loading...
Permit {_CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2004 -00486 o f �l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/26/2004 SITE ADDRESS: 14600 SW 91ST AVE PARCEL: 2S111AC 00400 SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5 BLOCK: LOT: 045 JURISDICTION: TIG CLASS OF WORK: ALT 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: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Repair 50 ft of sewer line FEES Owner: Description Date Amount SCHMIDT, ROBERT W 14600 SW 91ST [PLUMB] Permit Fee 10/26/2004 $72.50 TIGARD, OR 97223 [TAX] 8% State Surchan 10/26/2004 $5.80 Total $78.30 • Phone : Contractor: RAYMOND CUSHMAN 12428 NE HASSALO PORTLAND, OR 97230 REQUIRED INSPECTIONS Phone : 503 254 - 9134 Final Inspection Reg #: LIC 118079 PLM 26 -653PB 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. Issued By: I / Permittee Signature: i / Call 03) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing Permit Application - F O USE O NLY City of Tigatd R eceived /� Permit N o.: Ain 13125 SW Hall Blvd., Tigard, OR 97223 Date /By: /O / . L o�t/•'T ��/ Plan Review Phone: 503.639.4171 Fax: 503.598.1960 //hntuN� + +I:, Date/By: Other Permit No.: Date Ready/By: . l 24- Hour Inspection Line: 503.639.4175 ■ E! L� hit's Page 2 for ..�. See Pa g Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ,. �. i.ak't1: =irt :',a<";: «e_R'3- i :9 ": - " -„: i,, -;•r.'t 'i,o 1 + f . N r� x? Ail „. ",' : ''` 4 - iIF `. 'T , r'va R',i.e : t . ":6'`1;'twlP:.f ii , :;r , :��;4i '� %'ix� ,1) �F i, +f ", .,.F .. Y':. r Y.s 'ry 'dr' "" .;',?+ ., x Rt�:� .l " f a. _ .. .• „r. �. ,,} .� . t,. � �OF.WO n , ^ „�:v, .�_; _ .. � ��f � :,., ' EE,.t..SC ". .�f:�;� -5 ��'tu+a:a- v �.'�'����d�r,'�a "�•�a •a ^r7��i .ani s •, . ��� a� @e.. .4 . -a. ^ �� " r -.��'. , i_, .. +r -r . -c ,, aP •: ■ construction ■ Demolition For special information use checklist. Description 1 Qty. Ea, Total E Addition/alteration/replacement ■ • New 1- 2- family dwellings (includes 100 ft. for each utility connection) o ' 0 0 o SFR (1) bath 249.20 Gg and dwelling ■ Commercial/industrial SFR (2) bath 350.00 ■ ■ SFR (3) bath 399.00 Accessory building Each additional bath/kitchen 45.00 Fire sprinkler ( sq. ft.) Page 2 0 0 ' 0 1 © ® Site ut .. / Catch basin or area drain 16.60 City/State /ZIP: T 4 ,, OR Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 l Manufactured home utilities 110.00 Cross street/directions to job site: p/ he- 86904 /I i/O,+, 0' - Manholes 16.60 l74,brpok 0 /p ro . 2 0( ' 0h CiLiTvl p 07 Rain drain connector 16.60 r -I-t a v-e . Sanitary sewer (no. linear ft.: SO ) Page 2 SS, v0 Storm sewer (no. linear ft.: _ ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: L,ot no.: Fixture or item Tax map/parcel no.: b,, A sorption valve 16.60 1 1' 0 0 0' 1100 I Q . - F t 9 ttv2 C [J s4 • Clothes ■ 6.1 Dishwasher =rc: -;:as;, s�.,,. �.. 's.,"+.,`,•y33r".:+Si:.�b;. t ,., : �, ,Krt �...�,,.. . - �.e. - K'a=> ar, 0 I I •' 661 vir , dr.,, � RO TY OWNEI t t i :,1 ".i x . "w TErj 'ANT - l . Name: pA o e t J( P ,/4. t / c9%OQ n) e,-, 7 Expansion tank 1 6.60 Address: (D -, '`. E , .S - / -el r 0 ■ .61 - City/State /ZIP: ?a r .1.-: f) R Floor •' • ', Phone: 463 ) , 3ij' 7.2 ^/ Fax: ( ) Garbage '1'� E. i s!: - ,`�•;t,?L.e. :':,Ri" ": ,- t Nv?t'�r a+. :.,u:ti,aS�?i?^ ^:;�".f • .1 t . bib P `�' �i ngtICANTJ � " '" `� s ,CON ACTa PERS(1Ni : . z a,� € . a .: , ,^sAo -r .- 4,41,:;u.::X ,,t , i,-, 451; •,, / >� a: .r e., ,� i t Iii 16.60 ice Business name: ��)/rno-t4 ( �/'►4 /pf ci,u %I-ta n Interceptor/grease •. 6.1 Contact name: Re / y y � ‘9„./ C'4s4;,?? 6 ,..„ : - Address: 12 y.2 g NE Ha Primer 16.60 City/State /ZIP: f `-I OR 9'?,2 3 0 • •' • 16.60 Phone: Cd 3 ) .25-4/ - c/ / 3 y Fax: I ( ) 16.60 Tub/shower/shower pan 16.60 Ce (/ St.) S'7_).-- LI1 ,Ac7 661 e ,.. .. -2'.€+." P r ., v,� x.<;;a�,t. ... e��f +ajr./ {j�'s, r =a" a t.... ;i y'$"a.'ix:s,'s:�. s R s �r RIMI '' is } CON'TRe� iF' ��- ti O „� . ';<., • � � tX e��'�,.. #��'�� x�'.,:..,'.fe• : Lk=; t�d; �� :ray:sr,:tt�.`,.�stc5,��.:ta:a �:;},itr., >Srrv a.., a- �.�..,..- a.x „�.�1;`af.�:..�: , 61 . Business name: /e m 0,1 ft �A 1 ,, d 1/ Vf er d r 16.60 Address: 1.2 .:4F OV E &/4J S,4 L.0 Other: Subtotal City/State/ZIP: por-4- e /z ,, 2 0 Minimum permit fee: $72.50 •!07 Phone: (,c-03 a p3 ) . /-- e 'P 1/ (S ) ,s��'^ z/ /,Z q Residential backflow minimum permit fee: $36.25 Plan review (25% of permit fee) CCB Lic.: Q Plumbi jg Lic. no.: ,26.._ 683 1 00 State surcharge (8% of permit fee) $* S D Authorized signature: i TOTAL PERMIT FEE i i Print name: of yk.4 ,, C',1/f y M At✓ Date: /0 .--) i• 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(10l02 /COM/WES) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ,s, �, " ° rw`S , �g 4, tl" „:a•� :.u'.S , . ;.a- . iU ' ', 8:zi',SUT'dE,Tp. > kzi@ Y'^: rx <'h.,' + . r i Ree ea TotaL uae,Foo>ta e s�a kr tasv.. .. k . ti v, x .Scl% :...,..n........g+.,.. tr `w . -' :Permlt;'Fee...t :.. , . 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 S 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 ValUatxOn:,, ,,.,. PerrrutFee 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]tXtll'T e O)r T>E t k h 3 Q�3 ., - fee (ea n 0, - additional $100.00 or fraction thereof, to and y _.� ,�,�,�.�, ...� � x, ���.,,.� �. ��`a- =. ., 1430,15B 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 * . s xe v;c " 'ft�s Quantit xt �� 3 a '�F►xture � � � ?� � �'' s��e -� _ 'Replace fi , °v � �w i o � e a E t � yp �c�ea Comments regarding fixture work: _�i �.z, . . 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 „ 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 /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: is\ Building \Permits\PLM- PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST o� BUP Received Date Requested /� _ / AM PM BUP Location (L(� q Suite MEC /p� Contact Person az �" tr)\y�-�i p �d.6 �" Ph ( ) 5— 2 - z - � � PLM 0 � 7Q� Contractor - ! Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ` �� ELR Crawl Drain Slab Inspectio t es: SIT Post & Beam Shear Anchors .Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler /- Al Fire Alarm / 'f�W ���/ Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING . • Post & Beam Under Slab Rough -In Water Service nitary Sew Rain rains Catch Basin / Manhole Storm Drain Shower Pan Other: Fin � PART FAIL HANICAL 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 ❑ Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date ! Inspector 1 21 / 21 9' Est Other: 6 G Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL