Permit C ITY OF TIGARD PLUMBING PERMIT
11 Is DEVELOPMENT SERVICES PERMIT #: PLM2004 -00372
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/18/2004
SITE ADDRESS: 15100 SW 98TH AVE PARCEL: 2S111CA -14000
SUBDIVISION: DARMEL ZONING: R -3.5
BLOCK: LOT: 009 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: 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: 50' line work to street lateral. Reimbursement district fees and sewer hookup not paid at this time.
FEES
Owner:
Description Date Amount
BODEA, GHERASIM +
CARMEN A [PLUMB] Permit Fee 8/18/2004 $72.50
15100 SW 98TH AVE [TAX] 8% State Surcharl 8/18/2004 $5.80
TIGARD, OR 97224 Total $78.30
Phone :
Contractor: (A-f-' Y.�7 ivi d am_
Old ' ---
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 questions to OUNC by calling (503)
246 -6699. /�
Issued By: Permittee Signature: ) .- 122.0 1 `� 0 c 4 7
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures . RECEIVED
Pl% Permit Application FOR OFFICE USE ONLY
City of Tigard lUG 8 20 Received Permit am / -i3 � r-2-- 13125 SW Hall Blvd., Tigard, OR 97223 Datersy: . / t No.: JJ pr/r�
Plan Revie
i4„ NI �ii
Phone: 503.639.4171 Fax: 503.598.1960 QTY OF TAG , - L �,N„ µ , %�1�� D ateBy: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 BUILDIN Date Ready/By: is El See Page 2 for
www.ci.tigard.or.us Internet: www.ci.ti G �► V ''
g Notified/Method: / �G Supplemental Information
� ,
i a � ,fi t 9 . i t ., �., ,.M Ef ... SCH.Di7LE
❑ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
E rAddition /alteration/replacement ❑ Other: New 1 - 2 family dwellings (includes 100 ft. for each utility connection)
�* P T QR 7tI ° it>I G PN 1
❑ 1- and 2- family dwelling ❑ Commercial /industrial 350.00
SFR (3) bath
Accessory building ❑ Multi- family 399.00
Each additional .. 45.00
El El Master builder 0 Other:
, �'' „q 1 =r ' ' 1 "Vi 'g D a _ 1 1 li ai 4. � Site utilities
Al■ Job site address: .3 r00 j(/ 0 Y � . 16.60
City/State /ZIP: 7 07 , ,U 0/2 9 7 2 2 or ..1
Suite/bldg. /apt. no.: ) Project name: r Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.;41049 Page 2 L / ,, YD
_
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
, ,. � ' „ . . 3 ` t , 4;'$ , t r ' , :1: t* , , . ' : Backflow preve -r Page 2
e ever 7/2E B ater v s, 16.60
Dishwasher 16.60
.w Drinking fountain 16.60
_ _ / � , l _ 16.60
-
Name: C'��� �C ,42-,f1//•'? J �J r 16.60
Address: /5700 _ V 97 10G 661
City /State/ZIP: 7 f 6'i21) O . 9 7 2 2 •' • • r sink/hub 16.60
Phone: F 3 ,, 6 i C 2 Fax: ( ) Garbage disposal 16.60
.. 16.60
Business name:
interceptor/grease ..1
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: " drain 16.60
.1
Phone: ( ) I Fax: : ( )
Tub/shower/shower pan ..1
E -mail: • •,
Urinal w} . :_ j � . 44 -+ .t • ', ' .. 16.60
Business name: ,,./.3 Q D ,i._- /9- Water heater 16.60
Address: /J' 9. f Y/ c 1 ■
City/State/ZIP: 72 � /2,0 d12 q 7 22 Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7a s
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) j „ ' #
Authorized signature: (X 6:2/e `jam '2 _-Cg:77 e-.-4
TOTAL PERMIT FEE _I
Print name:6.' F l7or7/ 4 OD D Datee,/ 'o- 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:\ Building1.Penni ts\PLMF- PertnitApp.doc 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard 1 •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
,> Qty Tee (ea total
S><e Txl�txe §. S,quare`Footage" :.Permit 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
Storm & Rain Drain - 1st 100' 55.00 ��tlUa0i1. " • Permit Fee:
$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
additional $100.00 or fraction thereof, to and
04 , S :§;AA.0.ii 4 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 * .
•
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 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:
is\ BuildingtPermits \PLM- PermiiApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING _ Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested g Z� AM PM BUP
Location /5700 ?EP �'`�`� Suite MEC
Contact Person Ph ( ) PLM a 4 / — 0 03
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
g Access: ��� r �� & ELR
Ft Drain
Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing ilq_P7e- j
7 1�
Fire wall
Fire Sprinkler
Fire Alarm i
Susp'd Ceiling
Roof
Other: -
Final _
PASS PLUMBING FAIL /� / /�ir4110 j I e ll' I
Post & Beam
Under Slab
Rough -In
Water enacp
is Se
Rain Drains
Catch Basin / Manhole ;s
Storm Drain
Shower Pan
Other:
Final
PASS FAIL
MECHA L
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 /i
ADA Inspector oL ��
Approach/Sidewalk Date eetoir Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL