Permit CITY TIGARD PLUMBING PERMIT
`1 i & DEVELOPMENT SERVICES PERMIT #: PLM2003 -00150
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/21/03
SITE ADDRESS: 14340 SW 114TH AVE PARCEL: 2S110AB -02000
SUBDIVISION: COLE'S ACRES ZONING: R -4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: NEW 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect existing house to newly installed sewer lateral. Septic tank is to be pumped, filled and inspected.
FEES
Owner:
Description Date Amount
HELLER, REIDAR W JR + ARLENE RAE
14340 SW 114TH AVE [PLUMB] Permit Fee 4/21/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 4/21/03 $5.80
Total $78.30
Phone :
Contractor:
GREG SCHROEDER ENTERPRISES INC
9812 SE WICHITA AVE
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503 - 654 - 4734
Insp existing /capped fixtures
Reg #: LIC 99733 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
Istked By: ..I `EA, � � /i,„( Permittee Signature: 0 Call (503) •39 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbin Per
g mit Application FOR OFFICE USE ONLY
Received 4/ p / . Plumbing p
Date/By: / O� / Permit No.:,3 6e 5n
Planning Approval Sewer
City of Tigard R E C E I V • Pla nning Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ppDD Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 594)402 1 a,/, t (* ' , i Post- Review Land Use
v Date/By: Case No.:
`
Internet: www.ci.tigard.or.us F T _.1_ . � Contact Juris.: ® See Page 2 for
q �
24 -hour Inspection Request: 503 -gf 4LU7AG DiViSiON Name/Method: Supplemental Information.
,
�: �; ,. _ : TYPE OF'WORK c �' . - � '' ''x FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description Qty. Fee(ea) Total
El N ew - `
Addition/alteration/replacement ❑Other: k' 4,`i l 1 & 2 - family dwe . l .
y ��' +'(1nEudes 100 ft. for each utility e. � � ! s ;
'r;4-167:34. r TEGORY OF CONSTRUCTION
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 LOCATION Fire s.rtnkler s' ft Pa :e 2
Job site address: /43.f-6 / /4. A1-1/
-(/ Yscf7: + "` ' 4- 4:101„ - Site Utilities ,, ', z,,,, „
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: 44�� Drywell/leach line /trench drain 16.60
1 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) /Lf Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map/parcel #: Water service (no. linear ft.) Page 2
a % i
. F xtureor; i tem.'
�. ,-, 1. _� ° M rt ,•.t.. 6 . l ..7� Ab sorp ti on valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
0 PROPERTY OWNER `' ,. 2 1 1 Z y ,'\, 1,-).,i; a . t' Ejectors/sump 16.60
Name: ffEl/>r'x / ,P6=ii) i/7l ( t ,4L `---i./Avr 'e1 Expansion tank 16.60
Address: /36 u / //¢ Fixture/sewer cap 16.60
City /State /Zip: r/ ,t -,./� p,C C.7 z Z 3 Floor drain /floor sink/hub 16.60
'f , Garbage disposal 16.60
Phone: F ax: Hose bib 16.60
!ERSONL • €n Ice maker 16.60
Name: Interceptor /grease trap 16.60
Medical gas - value: $ Page 2
Address: Primer 16.60
City/State/Zip: )' p Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACT° !., it,-,. Urinal 16.60
Water closet 16.60
Business Name: 6 , eS „X ?. Water heater 16.60
Address: 96P/z. 56- aliCh /h' Other:
City /State /Zip: /m,l , , o, 9 7z r z- Other:
Phone: g¢ F 6 t Z 2 3 3 3 Subtotal # $
CCB Lic. #: 997 35 Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25
Signature: r'� /1.-Z-e ' / - d 3 Plan Review (25% of Permit Fee) $
6 SlY fi 6- 6=1- State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $
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
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit 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 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
Fixture or Item Qty. Fee (ea) Total. 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 $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains - plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley -
- Commercial
- Service -
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
ORVALL T. LADE JOB INVOICE
BYER'S SEPTICJAN!,SERVICE, INC.
P.O. BOX 549 ��
. OREGON CITY, OREGON 97045
(503) 656 -3326 CUS OMER$ OR NO. DATE OHQ/RED
ORDER TAKEtY DATE PROMISED 0 A.M.
Z ❑ P.M.
BILL TO j . PHONE
ADDRESS .i I/ MECHANIC
CITY CII HELPER
JOB NAME AND L /O`C�AJTION z) L /4 ! - y S L^1. „ � � ❑ DAY WORK
o
DESCRIPTION OF WORK ❑ CONTRACT
❑ EXTRA
QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT
k `- '�
HOURS LABOR AMOUNT
TOTAL
MECHANICS @ MATERIALS
HELPERS @ LABOR
I LABOR
I hereby acknowledge the satisfactory TOTAL LABOR TAX
completion of the above described work.
SIGNATURE DATE COMPLETED I
TOTAL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
C� BUP
Received Date Requested ! ZZ AM PM UP
Location // MEC
Contact Person , .vim Ph ( ) 7 3 PLM 3 - /5
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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 Kfl s Susp'd Ceiling
/at / tJ �. /�r /
Roof ,
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
ANICAL
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 0 Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL