Permit lc
CITY OF TIGARD
PLUMBING PERMIT
t.� PERMIT #: PLM2004 -00252
DEVELOPMENT SERVICES DATE ISSUED: 6/3/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15280 SW 94TH AVE PARCEL: 2S111 DB -11300
SUBDIVISION: SUMMERFIELD NO.12 ZONING: R -7
BLOCK: LOT: 640 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: Replacement of residential backflow prevention device.
FEES
Owner:
Description Date Amount
JUNE WILBUR
15280 SW 94TH AVE [PLUMB] Permit Fee 6/3/2004 $36.25
TIGARD, OR 97224 [TAX] 8% State Surcharl 6/3/2004 $2.90
Total $39.15
Phone : 503 968 - 0885
Contractor:
CRAIG COOPER LANDSCAPES
2960 SW 207TH AVE
ALOHA, OR 97006 REQUIRED INSPECTIONS
Phone : 503 RP /Backflow Preventer -
Final Inspection
Reg #: PLM 5720
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 question o OUNC b calling (503)
246 -66' '.
Issu: d By: , ;�� � di % / Permittee Signature: L jar
Call (503)_6 !-4175 by 7:00 P.M. for an inspection needed the next bu - ness day
i
i Building Fixtures
Plumbing Permit Application F OFFIC USE ;- ' ' e ,'
City of Tigard
Date/13y: d Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223
r Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Otti lik\ Date/By: Other Permit No:
24- Hour Inspection Line: 503.639.4175 ! I Date Ready /By: 1aris l J See Page 2 for
Internet: www.ci.tigard.or.us Notified/Ivlethod: Supplemental Information
.. a yt ,_ a? ry�. , ,,#"` ..�, a e = a ° ="Jr° r� _ " �` >�`: �� *+ � a.. �..'� -�F � Y w ...
- t " ,. M 4c ' ri-- Ai,,F- O( tW,. d ; -et �. K ;it, t* � . ) EE ^„ .
SCHEDi.LE.`
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. I Ea. I Total
A gi Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
i.n GATE Orin C,O STR[1CtiO1Y e " v 0 0 SFR (1) bath 249.20
❑ 1- 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:
Fire sprinkler ( sq. ft.) Page 2
. JO &,S1T ;IN l ORMA TION ,ANI reSid "
�1 ,, . Site utilities
Job site address: 6 t� -1 9, k ) JC_ L / Catch basin or area drain 16.60
City/State /ZIP: 11 l�?-L/ ( c n 7ZL 1/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: / Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: )4 j (j2-C--57
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
a t4 , �" 4Sige IPTION 3 0 WOR D . A 4
' � , ,,,,.a,_,,,,,, , � <. .. ,, i- . , .. 1 - "....,. Backflow preventer / Page 2 x
p g_ p - v d- 5A(� f < f a's Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
„ c,,,wo � s Drinking fountain 16.60
'°o" , �m�., ' Ejectors /sump 16.60
Name: C\ j u IL8 (/( Expansion tank 16.60
Address: i si ,3 u Fixture /sewer cap 16.60
City/State /ZIP: U Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
: , k; , „. ,. - gli rz�o , :,. :,a.:E. m ; t ri
;d °APEI ICi'NT r. v .' s .9 , ONI"A GTs 'P ERS , ,
Hose bib 16.60
..� x. "� _ r� , Ice maker 16.60
Business name: OM /4 Col) Pr
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
J
.
Phone: ( ') ' 3 q -9 I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
t G"OIVTiR O R
� w ,.,i � a q -� . ) ., .,�?`.<, t�,.�. t rx�,., a. -: - .:;t »I +,,•:.. �������.�, Water closet 16.60
Business name: ((i W J� l_ D SG Water heater 16.60
Address: Z 9 6 ,:5 S (• J / Other:
City/State /ZIP: al 64014 /'� ab Subtotal
l.7
,` l r I Minimum permit fee: $72.50 _Jo, Phone: 03) 6 CQ_ (/573 y p 4 `f`ax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: . 1152 . 2./ b ---""" 5720 Plumbing Lic. no.: S7,94) Plan review (25% of permit fee)
State surcharge (8% of permit fee) e „,
Authorized signature: TOTAL PERMIT FEE /6
Print name: Ch Date This permit application expires if a permit is not obtained within
i 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(I0 /02/C0M/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sup . ression Systems:
..s .. t. :,:Ar; .r��s, : = � F .- ,�,p.��r. -, �.,��'� �, .,� „ s �.�.' .»,. -. , `,'ETw"#:C, '�e:.,.y,''�'' =?` "t a '" ,`. .�a :
$t Vito epoi Qt < , F Total`s ;U Foota ,e ;'�Perm�<t Fee
Footing drain - 1s 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
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
Valuation} t Pe`rmrt 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 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
." ~ = 3 'r ? ^ =Fee"(ea" T' t it additional $100.00 or fraction thereof, to and
Fixture or itexm ,.... Q E � A a
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
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 * .
.Q'uantrt b tx ur Work P Evane7
R0 13Ce ,!�` "� e
3 �Vew C t tM d ,. s R P4 g appeal 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"
-3"
- 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:
\ Building \Pemuts\PLM- PerniiApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�, BUP
i R i3ed` / `r Date Requested I AM PM BUP
Location 1 5 (.& i ' Suite MEC
Contact Person c • Ph ( St3 ) C2cfq --4 ?7 PLM r3(104
r , i
Contractor ; _: ' rte! Ph ( ) SWR
BUILDING Tenan Owner !� // f 4 _ , ELC ise Footing ' . � ��`/ � I ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam .Q--• i.�Q -tY `�f / 'f --,, v A
Ext Sr Sh ea Anchrs
th /SSh ear Poi e,( p � 1
Ext eah/h '�'['�• i I '
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling '
Roof ,w —.7.../ Other:
Final
PASS PART FAIL •,.
P, L- t� �IABIN - ,"
�� eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth
S PART FAIL
CHANICAL
Post & Beam . 1 . „i,i I '
Rough -In
Gas Line _ = r
Smoke Dampers .
Final
PASS PART FAIL
ELECTRICAL ; i,
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 1, -
ADA
Approach/Sidewalk Date / L Inspector � ,' Ext
' r
Other: s?' i. t .
Final 1 • NOT REMOVE this inspection reco f the Job site
PASS PART FAIL _ _ r - -