Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00001
Al 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/5/04
SITE ADDRESS: 14285 SW 114TH AVE PARCEL: 2S110AB -03200
SUBDIVISION: COLE'S ACRES ZONING: R -2
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: ADD 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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repaie water service.
FEES
Owner:
Description Date Amount
MARTIN, VERNE S + ELLEN TRS
14285 SW 114TH [PLUMB] Permit Fee 1/5/04 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 1/5/04 $5.80
Total $78.30
Phone : 503 639 - 3912
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 5535 Water Service Insp
Final Inspection
Reg #: LIC 10967
MET 00003528
PLM 34 -42PB
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
Issued By: y/ Permittee Signature: k 4. i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Date received: / ....-4 V,/ Permit no.: PLm �oV?L� Q 0
a• • '' ∎ Tigard City of Ti and
(� `J Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: Bet I Receipt no.:
Land use approval: 1%6 Case file no.: Payment type:
TYPE OF PERMIT
-0 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 14ag 5 61,D 114' -' e Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath _
Lot: I Block: I Subdivision: SFR (2) bath
Project name: i fro m ..(1 -i r1 SFR (3) bath
City /county: \t 50.(c( 106.- I ZIP: Ct - 2.4 Each additional bath/kitchen
Description and location of work ,on premises: Site utilities:
W / ( 4..zt se.Pvii Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: yln t i re ( Manholes
Address: 39 g 5 5 InA ( Rain drain connector
City: 6 1,/4-1Th I State: be I ZIP:9 7605 Sanitary sewer (no. lin. ft.)
Phone: b L3 5 53 5 I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: ti Da b i I Plumb. bus. reg. no: 3 ` . - Water service (no. lin. ft.) ! ,0J 55 , C 0
City/metro lic. no.: 131,3 , Fixture or item:
Contractor's representative signature: 1.4. ` uyo Absorption valve
� Back flow preventer
c..
Print name: Nett He SS Date: 1 3 Backwater valve •
CONTACT PERSON Basins/lavatory
Name: t\ Clothes washer
Address: LC m�' Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Name (print): 'e tine Y V , i 1 Floor drains/floor sinks/hub
address: 1 A$ 5 51..0 l I'`ti' �Q✓� Garbage disposal
Hose bibb ■
City: Ti a 6, I State: I ZIP: C\ 1 �`1 Ice maker
Phone: b 3 1 . 3ci 1.2 I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet _
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call Jurisdiction for more information. Notice: This permit application Minimum fee $ 1 ,.5 0
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within tate surcharge (8 %) .... $ 5 . g b
Expires thin 180 days after it has been TOTAL $ - 78'.3n
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616 (6100✓COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavato 16.60 for each utility connection)
ry One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 46.40 Lavatory •
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3.,
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9 _
TOTAL $
* Minimum permit fee is $72.50 « 8% state surcharge, except Residential Backflow
Prevention Device, which is $36 25 + 8% state surcharge.
* * All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm- fees.doc 10/10/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 1 / L3 2 Date Requested 1 —lam - I) q AM PM BUP
q
Location , Z f S //Z i7} Suite MEC
Contact Person Ph ( � b 3 — SS� I -K,
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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Ro • • - • I
Sani - ry ewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• :
F'•-
PART FAIL
CHANICAL
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
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final D • NOT REMOVE this inspection record from the job site.
PASS PART FAIL