Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2003 -00424
I DEVELOPMENT SERVICES
�' I - - � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/12/03
SITE ADDRESS: 14130 SW 105TH AVE 009 PARCEL: 2S110AA 00200
SUBDIVISION: CANTERBERRY TERRACE APTS. ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Fixture replacement due to fire damage.
FEES
Owner:
Description Date Amount
OHANESIAN, LEE + DONNA
do SKL PROPERTIES LLC [PLUMB] Permit Fee 8/12/03 $83.00
P 0 BOX 230703 [TAX] 8% State Tax 8/12/03 $6.64
TIGARD, OR 97281 Total $89.64
Phone :
Contractor:
WATSON PLUMBING CO
7935 E BURNSIDE ST
PORTLAND, OR 97215 REQUIRED INSPECTIONS
Phone : 256 3720 Rough -in Insp
Final Inspection
Reg #: LIC 111855
PLM 26 -602PB
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
I
Iksued By: - • c /NM& / / f Permittee Signature: 4 , --e--- 4- e--(:‘/A--{._
Call (503) - .39 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
P,Jum.bing Per �1
A�1 FOR OFFICE USE ONLY
N N Received Plumbing �
Date/By: Permit No.: L H ' WO Y 7
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 //Wn \
Post - Review Land Use
u,;N�y Contact Case No.:
Internet: www.ci.tigard.or.us .��I1 D
Contact Juris.: See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 `"-"-"" V --II Name/Method: Supplemental Information.
t(I l , :, . k l - -„ - e:, FEE* SCHEDULE (for special information use checklist)
• New construction ❑ Demolition Descri s tion Qty. I Fee(ea) I Total
11 Addition/alteration /re • lacement ❑ Other: . _ 4. _ s�
(in . es 0 i o ea c" : :c f n ii '
` _. ' ° e _(� '.ti,.. ,,, .' SFR (1) bath 249.20
❑ 1 & 2-Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00
['Accessory Building ® Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATI
T Fire s•rinkler sa ft.: Pate 2
Job site address: Q�, �; .
)4 13 0s (u u �., ;� � q
� � `�� � � ��-
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
r Drywell/leach line/trench drain 16.60
Pro ect Name:
1+' L t r ( L. Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
C, P T Manholes 16.60
OJl-� / �'�✓ Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax ma • / • arcel #: Water service (no. linear ft.) Page 2
` Fixture or Item., ,..,
l')� _O - C rt .i" °$' :: Absorption 16.60
b sorption va
rf v,r(,t./'LL p(..,4 44- 7 Backflow preventer Page 2
(":"7/1-6 .0 ft 0"1 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
:'` § .k. eg l "' a , ". s. ' .. Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/Zip: _Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: _ Fax: Hose bib 16.60
Ki ,PI' l _ '.' ", °,3 =. F Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin / lavatory
Z 16.60 73 u'
E -mail: Tub /shower /shower pan ( 16.60 /6 6 c
' '' ' h ' IL . . Urinal 16.60
�'
Business Name: l f� (- �d A Water closet 16.60 - Water heater 16.60 l 62 C
Address: 7c j &- [L, Other: .
City /State /Zip: p 6I 'Cl - c49 -o 9 7, ( Other
Phone ;90 -3 7 v_o Fa x _ c l 1 v ., ::-'s tYojh ;i) i n
/ O r -6 0,. �� Subtotal 2.50 $
CCB Lic. #: � Pl Li # • Mi n i mum Permit Fee $72.50 $ O D
Authorized / Residential Backflow Minimum Fee $36.25 �3
Signature: (� Dater _ r„ �J Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ 6 fo </
(Please print name) TOTAL PERMIT FEE $ g 9 . (,o y
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information ti
Fee Schedule: Residential Fire Suppression Systems:
S te.U,tilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I 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 - I st 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: 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
Qty. (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item Q y Fee (ea) 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
accuratel re • ort fixtures could result in increased sewer fees *.
t t� 6A • Comments regarding fixture work:
Ba.tis. /Font
Bath - Tub /Shower - - --
- Jacuzzi/Whirl .00l - - --
Car Wash -Each Stall - - --
-Drive Thru - - --
Cus.idor/Water As.irator - - --
Dishwasher - Commercial - - --
- Domestic - - --
Drinkin_ Fountain - - --
E e Wash - - --
Floor Drain/sink - 2" - - --
- 3" - - --
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic - - --
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refri:. Drains - - -- plumbing permit can be issued.
Oil Se.arator Gas Station - - --
Rec. Vehicle Dum. Station - - --
Shower -Gang - - --
-Stall - - --
Sink - Bar /Lavatory - - --
- Bradley - - --
- Commercial - - --
- Service - -_-
Swimmin: Pool Filter - - --
Washer - Clothes - - --
Water Extractor - - --
Water Closet - Toilet - - --
Urinal - - --
Other Fixtures: - - --
i:\Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03