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Permit
CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2004 -00338 �'I 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/20/2004 SITE ADDRESS: 11765 SW 98TH AVE PARCEL: 1S135CD -14900 SUBDIVISION: KALAMOIIKA NO.2 ZONING: R -12 BLOCK: LOT: 016 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: Irrigation backflow preventer. FEES Owner: Description Date Amount J &S CONCRETE, INC. PO BOX 516 [PLUMB] Permit Fee 7/20/2004 $36.25 DUNDEE, OR 97115 [TAX] 8% State Surchan 7/20/2004 $2.90 Total $39.15 Phone : 503 307 - 0236 Contractor: GROVER'S LANDSCAPE SERVICES 26485 S. MERIDIAN RD. AURORA, OR 97002 REQUIRED INSPECTIONS P RP /Backflow Preventer Phone : 503 678 - 1796 Final Inspection Reg #: LIC 11807 PLM ALL PHASES + BA 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. • OUNC by call' g (503) 246 -6699. Issued By: _ L Permittee Signature: f ' Call (503) 639 -4175 by 7:00 P.M. for an inspection need -d the next business d!y Building Fixtures RECEIVED P Permit Application 2 0 1 04 FOR OFFICE USE ONLY City of Tigard Received i ) y 4 Permit No.: �,�/ yl r � X338 13125 SW Hall Blvd., Tigard, OR 97223 GITY Of- Deiv ! Phone: 503.639.4171 Fax: 503.598.1960 ��© %N %2 N Date Plan BRevie y: Other Permit No.: B V 24- Hour Inspection Line: 503.639.4175 �j,� q p; Ali/ • funs: Internet: www.ci.ri ard.or.us �.. Date Ready/ See Page 2 for g Notifie ed/Method: # T/4 Supplemental Information ew Construction ❑ Demolition For special information use checklist. Description I Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1 2 family dwellings (includes 100 ft. for each utility connection) ' -R QR 'ila ��TIOI -A 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 ? >: _ . r Job site address: /7 7 Site utilities L r S � • Catch basin or area drain 16.60 City/State/ZIP: 7 l6-4- 7 -2.-- O d")-1-0E Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _) Page 2 Cross street/directions to job site: (9 �/�� fit-/ > Manufactured home utilities 110.00 9 .....,7.7-4.___ Manholes 16.60 a Rain drain connector 16.60 Sanitary sewer (no. linear ft.: Page 2 Storm sewer (no. linear ft.: _) Page 2 Subdivision: 1 Lot no.: /G Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no Absorption valve 16.60 -7 # ;> t , , � m . 0� , .. Q't> .,_ . j : ackflow preventer Page 2 rX-J - 5---:i S'/ .e Backwater valve 16.60 / "2" -•-� Clothes washer 16.60 Dishwasher 16.60 - s. Drinking fountain 16.60 .'X i * - . . , l w., ,. Ejectors /sump 16.60 Name: ( 0 S I Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/ State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 F Hose bib 16.60 Ice ma 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 Phone: ( ) f Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: ' tf � Urinal 16.60 '" 41 #9 ' - Water closet 16.60 Business name: ic t� , rJ1$c -(+' -L Sl��,,ces at heater 16.60 ( l Address: ? Ca S S . /?/, �,�; �i ( 4-n/ A (A . Other: i City/ State/ZIP: v2c� 2,/� _ 6 1 2 , t' v O Subtotal O ( Minimum permit fee: $72.50 0 41 Phone: (93) G 74- 7 g 6 Fax: ( ) .S� i -r Residential backflow minimum permit fee: $36.25 ,3�p s ` 1 / Plan review (25% of permit fee) .7 � CCB Lic.: �6 7 ei bing Lic. no.: . ` Q V _ X State surcharge (8% of permit fee) a d Authorized signature: TOTAL PERMIT FEE 39• /6" Print name: vf.o._ 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. i:\Building\Permits\PL tuff- PermitApp.doe 12/03 440- 4616T(10 /02/COM/WEB) ! • ?' S 1 t g 5 l ` dL I I •'�P 1 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Stiltis Q� <ea} . Total a Square Fo © ta gs :. Pe • Fee 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 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 Permit 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 1tfrIta r�s ( areoai additional $100.00 or fraction thereof, to and 0Xittif � ; ...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 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 * . ept iiagtejr4 � a snag � �pp� 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" - 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 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: I:\ 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 BUP Received 7A , - Date Regnested/ AM PM BUP Location 1/ 7(05 5A) % j' Z Suite MEC Contact Person C =� Ph ( ) 9.% — d qio PLM o q,---61.19339) Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC _ Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final / 4 1 /1-17.-7/ PASS PART FAIL =7 Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan r: , 4- rlc.9/9f f in- i �•' S : 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: 111 Unable to inspect – no access Fire Supply Line ADA Approach/Sidewalk Date 7A#2117/ Inspector 77"-- Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL 1