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Permit .y "..1 c %.. CITY TIGARD PLUMBING PERMIT , l DEVELOPMENT SERVICES PERMIT #: PLM2004-00008 c''ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/13/04 SITE ADDRESS: 14695 SW 92ND AVE PARCEL: 2S111AC -02100 SUBDIVISION: PINEBROOK TERRACE ZONING: R - 4.5 BLOCK: LOT: 062 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: 1 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: Replace electric water heater with gas water heater. FEES Owner: Description Date Amount WALKER, DAVID R AND JUDY K 14695 SW 92ND [PLUMB] Permit Fee 1/13/04 $72.50 TIGARD, OR 97224 [TAX] 8% State Surchari 1/13/04 $5.80 Total $78.30 Phone : Contractor: OWNER REQUIRED INSPECTIONS Phone : Rough -in lnsp Final Inspection Reg #: 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 Issue 1 . , � � � �� P ermittee Signature: A _- __ i /, . L' Call (503) • 9 -4175 by 7:00 P.M. for an inspection needed the next business y Building Fixtures Plu Permit Application G 'FOR OFFICE USE ONLY City of Tigard f i Receved 049 P em» t No.: . / Date/By: �i3 D� � LM�ODY - IJOGMg 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 i " Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ' e'mamma .i Date Ready /By: Juris m See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information _.•-e_, ,ray.•En ^a: -'.; �,.�,. :\r'.:i `r3, - - •�,, .�,m.ar,� .1 }., e.�„ � ?2 s; �,G. ., ..x. -.. u•x, t`;'f''i:.i�,i r''A. •.N.: ;:7. !,i `t .'.i v� -,.<.. � ,• - x,.; :; r ,. _ r. - : l . ' z ., �w. t ,� : a,.? ".�!c k ^ {, .tr' :, - 4 ',`^�, 'u"•::a! -�.. a;�;�. '<ta., •i r t ;t+ '�`", . ` : E. , t: ,:. d " ,�' , .,,. , �,., '! . :5 .:,. ,. � , g � �,� it ; �, .,:. . FE SCHE : i s�! >I,• m ,? �F, ti t::0;, 4iA TZ'PE OFvR!ORI{c=4 00 , , , : `fi : A ti tii .4 4:- -- , , 'A'. ^�, n` • �` °..; x., .. .'„ ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. Ea. Total 4CiAddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ° +^ 'r 4._ .r,,, � / "_ >.^` ` >.�sa,�,: ism >�- sxesi.'.,:�y+�t:;�.;. -aas t,.wyt:.a5?�,sa,��e„� ts �:r' ;tl��yt;'^�''�>}���t;' %as`�r`s' 249.20 � y . j ATEG OF CONSTREICTION •I �' p , E = SFR (1) bath �,A+xA..,9t s14t a;n♦•e v'••' Ao�sdr. xIWa,z�A+N°,t43Fw"'si+."°.3,�,� nS m.ti.J�;' ❑ 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 SFR (3) bath 399.00 ❑ Accessory building 12 Multi-family Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Page 2 " Fire sprinkler ( sq. ft.) y `b- P s Np+ ; Y ? c. @ tdiinnKa z i,. Mi ,v€ma e 7?S 's'-d. �a :3 3b Swan" ,: FC�€ t ^� .. ,as � , EaWfE INFORMAT Iaft ND LOCATION, x $ x VAP Site utilities Job site address: i H (e 'S w 'j 2, A � t je ' Catch basin or area drain 16.60 City/State/ZIP: Ci 1 7 Z Z `-1 Drywell, leach line, or trench drain 16.60 ty Ti �v �l �(Z G Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 S Gtd ' r - Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 2 ,.:�g ?.pis . ru - - <:., .,; ..�' ��. t�r;.K.� �. ;.tr�:'�4a'�r "'; " ; <'r -=� =s� -` `:s "t °,"�;;; 61. � MP DESCRIPTIONS OE WORK + �' Page 2 t . �. , tt 1.W, ,,, .� T =4:, , , .� r , , 1 s ,<r .� < - , :, , ��,.., 4 :,11 Backflow preventer .71 it 1 - 4 6 C f.t4 )w t '' K Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ;�,. r . _a „'- `1 � '.¢',:,.Fr. g "1 r;,' „? Drinking fountain 16.60 - 1? r A � w,, lk T ENAN m �_ . 4- 1. 4 OWNER , , ; r., ;: 7,;m n, -, .:° .«,.. rot a -: .:,- f., . ;1. � , *. # ,. ., . . . h 1 Ejectors /sump 16.60 Name: D a V; ci t u a I K Expansion tank 16.60 Address: 1 Li [ p G S S , n1 4ve_ Fixture /sewer cap 16.60 City/State/ZIP: 'T' a r ©/t 9 7 3_2 y Floor drain /floor sink/hub 16.60 // / ( .5 9 7 2 7 Garbage disposal 16.60 Phone: (5b3) 1U.3 r3Q'7 Fax (p3 _l ! - ��'.•� �� � � ° 'K� � ,� �� tz € � l .° o Hose bib 16.60 � 3 e APPLICANT r' = CO I s:_9:nr - Ice maker 16.60 Business name: 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 -;�� , t 3=' -' � �% F.! c`- �': . <�,: €"�� ".z�sa:.;�r!:,;i�"p�;: ��,,�, +.a.±, a� �Y:r` ° -�. a . 2rr� �v �" is ": v,� r `i n .,,': .. :„ ,, M�, m � „:�'�; 1 6,\ , 'i CONTRACTOR s � ' ' �l .. k A-, ,�,?t# Water c loset 16.60 �"„ � a�i �a� �' a "� - .'��� '} .� - �� �e �b.: *��.; �: } ,,�q.+ �e . � ;lt;'� - a ,- ,�".,*�' .. §,k,.�5#.,..,a, ^r;3 Business name: /, // � A ) �` w _Water heater 16.60 111 t/L�/ ` Other: Address: Subtotal City/State /ZIP: Minimum permit fee: $72.50 -7; 60 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 / CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) j� State surcharge (8% of permit - fee) 6.e Authorized signature: l 1 . '/ Q j � �� TOTAL PERMIT FEE 7$ �a Print name: D a fI /V y Wei , a I k�" Date: la - 2m .. 03 This permit application expires if a permit is not obtained within " w � 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- 46t6T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: :, .. : , ,.;' .x :: ° � t o it &ee (ea), � , Total :S uaret Foota a Permit, Fee , a.. S ><te ;, itigNI l :Q r si: akom It * - A :�nA 9��. ..._ g... � ..,, Footing drain - 151 100' 55.00 0 to 2,000 $115.00 46.40 2,001 to 3,600 $160.00 Footing drain - each additional 100' 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 va luation,,,, 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 n u' ^ +' s+,' ` x'" 11 ` V' t�;'' r t_,efeti ^ additional $100.00 or fraction thereof, to and r , :i6i,is±t�^ � , �, i �Q. y� �_: �ay�, �^*.���. )�: � '[',p "tg�'..,j ;41,J tu,�re .!A tom;`. ] f :< rg g'1t .:,:g..1.1.a ,.1,:° .:. E, 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 * . k Quanttty:by (Ftxture)WorktPerformecl' t'..Ftxtare A 4 WNW' Replace €? y p e � lv f vd0 x �;JSt<og cappe� Comments regarding fixture work: �� €�.� . t S��P,.r':� N _ ,�,� ,. r .NC,w�.� A .'C�. 3.t.� ��:. `5�" _yex .aca,�.�; �.. 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 fees assessed for the sewer increase must be paid before the Oil Separator (Gas Station) 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 \Perndts\PLM- PemutApp.doc 3/03