Permit 4 CITY OF TIGARD PLUMBING PERMIT
. DEVELOPMENT SERVICES PERMIT #: PLM2004-00223
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/19/2004
SITE ADDRESS: 11090 SW 95TH AVE PARCEL: 1S135DB -10500
SUBDIVISION: ASHBROOK FARM ZONING: R -4.5
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: ALT 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1 water heater.
FEES
Owner:
Description Date Amount
COMSTOCK, JOSEPH R
11090 SW 95TH AVE [PLUMB] Permit Fee 5/19/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchan 5/19/2004 $5.80
Total $78.30
Phone:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : 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
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 questi. . ! VIIIIII I C by calling (503)
246 -6699. I ssued By: '�--' Permittee Signature: \
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busines``-.
Building Fixtures
Plumbing Permit Application FOR OFFICE . ' USE ONLY - -
City g of Tigard Plan Received Review Dom : i, Pemtit No.: rp t9
0174 4, 3
Date/By: [
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /.t5il4101 Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 '61 Date Ready /By: �I ° f la See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: J L L./ Supplemental Information
., -N z tx t ;: � F ,W.P. x M ry I -i r i r A. ,. a t SCHEDiII;E' .. .
N ' " l �,,,, s ra ,w ,l ' '. 'e�d � .. OF,hWORK, .;air^; ,..-, i '.t^l,'�.I:' ^',:' .,Ar. .. . . „, ,, . ;i i , x FEE* ' .. s.,
❑ New construction ❑ Demolition _ For special information use checklist.
Description I Qty. Ea. I Total
Addition/alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection)
„; ^^as:.4.;�. ..;.3 s, '..°:€rs;, : >e r+rrs�.' rtu ;atiqu'ci ;,, r::q,:s'�;1;, ° fru'i`t;.'.: -riii a w'T - . .'W
,. SFR (1) bath 249.20
,ii �kc R i?a yk> rgbii ,riCATEGORY QF ;CONST,RUCTIO p -: 16 ,,. r^� . ' , x q . a.. ( )
161 I and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building
❑ Multi- family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
e -a : _<s ;• 'a ..ts:: ^:�:e:se':' n:,a,:. : ;rs ;y w mviiimiii � ii,oi akui fil , i ii- , ° , --'
^ i i � ' 46131 1TE IN SAND zLOCATIONtf� r i , - <f, Site uti lities
Job site address: ! I 0 9 p sy ., 9 S'i' • Nvt Catch basin or area drain 16.60
City/State /ZIP: ; � f ,�.0 O q, • � Z , L3 Drywel1, leach line, or trench drain 16.60
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
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Lot no.: Water service (no. linear ft.: ) Page 2
Subdivision:
Fixture or item
Tax map /parcel no.: Absorption valve 1 6.60
-.,. - =T- - ;
'� *' .a, � i ^. ..�§ lmow =-.,• :::0:rr1i '�- ti'a.;x.; +;; u;', 's ,,•,,,„„,,,„ ' r
eki� . DES C RI PT I ®N��OF W®RK � t , v f
�, , �, � , �. , � �� �'� ,..r._ t ;�; ;,< . „ �vA� Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
„. .., ;,, Drinking fountain 16.60
. ` • OPERT�I' ,OWNER ;� I . TEPIANT , . ... 16.60
Name: \
�... � r..., .,<i_�..__.. . r ,..,&a -. Ejectors /sump
Q A'0 \1/4..\\. Expansion tank 16.60
Address: 11 0 6.5‹) S''' r .). - \. ��� Fixture /sewer cap 16.60
City/State /ZIP: +14 (" tales. '� Z � ZA Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: ( ) Fax: ( )
L. 4= eiza - ,.,,, ; -. m Y' ^,,„fiAtt sit; .,r ,F4r,oN..,:. - ,4P. ^r ;, : ;, \ ,�.: , ,tiF; Hose bib 16.60
t . -4 f ; PAICANT '. m`.' i a: �,. * 'A.9- TACT EMERSON : ...Aa Ice maker
16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) - Page 2
Address:
Primer 16.60
Roof drain (commercial) 16.60
City/State /ZIP:
Sink /basin lavatory 16.60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E-mail: _ Urinal 16.60
`; rte x, :.,C. c t, t+-v .c .t € v: r �
' t �CONTItACTORxA , , ; r �.� ; , ; , W ater closet 16.60
Business name: 0 W O .J Water heater ' 16.60
Other:
Address: Subtotal
City/State/ZIP -
Minimum permit fee: $72.50 `
Phone: ( ) : ( ) Residential backflow minimum permit fee: $36.25 7�- J mbin Lie. no.: Plan review (25% of permit fee)
CCB Lic.: \ g v
State surcharge (8% of permit fee) S O
Authorized signature: TOTAL PERMIT FEE N. .?.,O
Print name: Date: 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.
is\ Building \Permits\PLMF- PermitApp doe 12/03 440- 4616T(l0/02/COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information °
Fee Schedule: y
Res><dential Fire Suppression Systems:
S1 E'i� 111f 1eS� � . K . ` .; g Y ;E ee (eu) , T " , S e FO tag,C ... : Pe F ee ,
F oot ing drain - 1 st 100' 0 to 2,000 $115.00
Fing an ' 55.00
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 Va1 uati'o n i, Y Perllllt Fee . A ; '
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 .
m'. e e a ` 1 Tota additional $100.00 or fraction thereof, to and
KT, ><x k ,.. ;: ; , Q�; . .� .,k ,, .y 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 orfraction 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 $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
n } €$, k � " 0 3 Quiiiiii by' Effiire)4%Ef Perfrmed)
Fixture? e E
P ik A yp g:%:,-.:'', , 71 t Pari timed pt moil Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall .
Thru y.
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 - 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:\ Bui lding\Pertnits'PLM- PermitAPP.doc 3/03
Y OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business 1;i e::, (503) 639 -4171 MST
BUP
Received Date Requested t'1V'
2 AM _ PM BUP
Location l / �� �'✓ 9S Suite MEC2-'4 _ co 2-
Contact Person —�� Ph ( 3) / O / — PLM 00 22- 3
Contractor tc Ph ( ) SWR J
BUILDING Tenant/Owner ELC 2 „ 0 - 002-7
Footing
Foundation Access: dye, a.)j/LC/Iu ELC
Ftg Drain s P fe”. _ zg _ � �� ELR
Crawl Drain —'� �J '- ' .1 ���u•
Slab Inspection N. es: % 4f-z'
Post & Beam S7-00-77>4641.5,,
Anch
Ext Sr Sheath/ors
h ea t h /Srs Shear �/� /Y6N ���
Ext eah/ �V
Int Sheath /Shear
Framing
Drywall ll Nailing / A(/ , / F
Dryll N l� �V � / ��"
Firewall 2 ✓ 5�� C- 2-00 3 ° CDS100
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
• • :T FAIL
:m
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / anhole
Storm Drain
Shower
Other:
rr : T FAIL
NICAL
a asgh a ''TAE i (E v t �S PT
as me
, S�'• • - Dampers
FAIL
L RICAL
GJSlab
Low Voltag R(4-1•16E___ l f affitL___ _ I G / •
Fi e Alar
-
i!L7J PART FAIL Reinspection fee of $ required bef next ins tion. Pay at City Hall, 13125 SW Hall Blvd.
SI El Please call for reinspettbalA I p L Unable to inspect - no access
Fire Supply Line
ADA �C
Approach /Sidewalk Date S-12-4 l
6 Inspector &AR Ext
Other:
Final DO NOT REMOVE this inspection r cord from the job site.
PASS PART FAIL