Permit A - CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00305
--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/5/02
SITE ADDRESS: 14365 SW 114TH AVE PARCEL: 2S110AB -02700
SUBDIVISION: COLE'S ACRES ZONING: R -2
BLOCK: LOT: 013 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: 40 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect to public sewer, 40 feet of sewer line
FEES
Owner:
Type By Date Amount Receipt
PHAM, LAN N + PRMT CTR 8/5/02 $55.00 27200200000
NGUYEN, PHUONG BICH 5PCT CTR 8/5/02 $4.40 27200200000
14365 S
14365 SW 114TH AVE
TIGARD, OR 97224 Total $59.40
Phone 1:
Contractor:
HOLLENBACH + HURD INC
3000 SW 174TH AVE
ALOHA, OR 97006 REQUIRED INSPECTIONS
Phone 1: 591 -5987 Sewer Inspection
Reg #: LIC 121807 Final Inspection
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: ,4 Permittee Signature:
Call (503) 63 -4175 by 7:00 P.M. for an inspection needed the next b siness day
Plumbhn Permit Application FOR OFFICE USE ONLY
Received u Plumbing
Date/B : U SI / 6 }- l � Permit No.: ' / .Z • -&D 3 •
Sewer
City of Tigard T est Form Date/B : PermitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Planning Approval
Date/B : Permit No.:
Phone: 503 639 - 4171 Fax: 503 - 598 - 1960 /a6,111 Post Review Land Use
A 1 Date /B : Case No.:
Internet: www.ci.tigard.or.us - ^ ^'�y�'�' Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Su lemental Information.
�oDa - o boi
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Xmolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
I & 2-Family dwelling Commercial/Industrial SFR (1) bath 249.20
® Y g ❑ l/Id l 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 LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: / /j J 5 4� l/ y Site Utilities
Suite #: J Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line /trench drain 16.60
1 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
n � ,(� Rain drain connector 16.60
�'v v /�1�� Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map /parcel #: Fixture or Item
DESCRIPTION OF WO Absorption valve 16.60
(T 01)A) -g i 4 7 e l
PLC 1 C Backflow preventer - Commercial 46.40
„5 Q (re Backflow preventer - Residential 27.55
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Name: (..--,47/U / Ejectors/sump 16.60
Address: / 5 / 3 & S 5 � / � `/ Expansion tank 16.60
City /State /Zip: Qtc _ Fixture /sewer cap 16.60
/' Floor drain /floor sink/hub 16.60
Phone ' q Fax: Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Name: s /fr e` 7 e ) 9 5 zeJlt) ei p _ Ice maker 16.60
Address: Interceptor /grease trap 16.60
Medical gas - value: $ Page 2
City /State /Zip: Primer 16.60
Phone: I Fax: Roof drain (commercial) 16.60
E -mail: Sink/basin/lavatory 16.60
CO TRACTOR Tub /shower /shower pan 16.60
Business Name: & -4 .e�� - �L24 Urinal 16.60
Water closet 16.60
Address: & y 6, f9 5 f c) „Re? x- Water heater 16.60
City /State /Zip: / 9494A .fig , q' 7 2 O 2 Other:
Phone;.9'/ � j /g - 7 Fax: 69 '3 2 Plumbing Permit Fees*
Subtotal $ j.5
CCB Lic. #: / t7 7 lumb. Lic.#: Minimum Permit Fee $72.50 $
Authorized L Residential Backflow Minimum Fee $36.25
Signature: c _ ! Date: 15 r b Plan Review (25% of Permit Fee) $
,,/ State Surcharge (8% of Permit Fee) $ L 6V
/ 1 _J E 67. / -ei'i U TOTAL PERMIT FEE $ ` j ' f)
F (Please print name) Notice: This permit application expires if a permit is n6t obtained within
All new Commercial building require 2 sets of plans with isometric or *80 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
riser diagram for plan review.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information `
Fee Schedule: Residential Fire Suppression Systems:
Scj uaY� .1t *otage -',
-° � . � �: Pertnit�`ee
� P� .. � ,: 0� . �_ .ter �i w� � , � �� .._ 0 to 2,000 $115.00
Footing drain - 1 100' 55.00
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 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
additional $100.00 or fraction thereof, to and
fi v , ar° %' - r a : . r �s:+`* ?'�� `' 4a Q °"
`��„„� �, Flittt�e�rp�tem _ „ �, ��,� � ,,. � . �� -;�u � � ,� °� 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: 5, €° each additional $100.00 or fraction thereof.
2t4A) en- 3 3S
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 *.
uanh Litiife 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 *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./Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures: