Permit ,
•
CITY TIGARD PLUMBING PERMIT
AI; DEVELOPMENT SERVICES PERMIT #: PLM2005 -00053
` n_� I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/10/2005
SITE ADDRESS: 14465 SW 114TH AVE PARCEL: 2S110AB -02500
SUBDIVISION: COLE'S ACRES ZONING: R -2
BLOCK: LOT: 011 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: 140 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 140' of sewer line.
FEES
Owner:
Description Date Amount
MOSER, ROBERT & CHERYLYNN
11465 SW 114TH [PLUMB] Permit Fee 2/10/2005 $104.40
PO BOX 230716 [TAX] 8% State Surcharl 2/10/2005 $8.11
TIGARD, OR 97281 - 0716 Total $112.51
Phone : 503 443 - 2278
Contractor:
Al DRAIN AWAY INC.
12511 NE FOURTH PLAIN RD.
VANCOUVER, WA 98682 REQUIRED INSPECTIONS
Phone : 360 - 260 -1368
Reg #: PLM 37 -536PB
LIC 156455
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 questio s t• OUI3 by calling (503)
246- 6699. '
Issued By: _ _� " Permittee Signature: At Ale/1110
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b siness day
Plumbing Permit Application FOR OFFICE USE ONLY
CI of Tigard Received Petmit No.:
13125 SW
13125 Blvd., Tigard, OR 97223 DateBY j� -as- ��� �`�� ��� �.t'1 s
Plan Re ew
Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 `i l' J i,
_ , Date Ready/By ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: I (r Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
arl- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: Pi w 4,5 s (,) (--{` Catch basin or area drain 16.60
City /State/ZIP: O-1r , O K Drywell, leach line, or trench drain ■ 16.60
Suite/bldg./apt. no.: I Project name: 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: ! I U) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2
i I o ..s. 10 L; Vt ` - Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
E 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I F es:: ( ) Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 4 / D rep`, h Awa Water heater ■ 16.60
Address: PPo ., L S2- /0 4, Other:
City /State/ZIP: (J j .&y71 p U I / (,J pL 9 b 6 a z Subtotal
Minimum permit fee: $72.50 a
Phone: (5 25a- 5 Fax: (360) 9y 766 Ly Residential backflow minimum permit fee: $36.25 j / • z
CCB Lic.: /5-6 _I SS Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ■ , ) )
Authorized signature: TOTAL PERMIT FEE / / 2 . .57
Print name: W {--\- S' ,j75 y\ Date: - - p� This permit application expires if a permit is not obtained within
r 180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
i:\ Building \Pertnits\PLM- PennitApp.doc 12/03 440-4616T(10/09/COM/WEB)
ti
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 - l 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' r 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 Valuation: 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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: each 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 *.
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped 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
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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
Q uantity 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:
i: \ Building \Pennits\PLM- PennitApp.doc 3/03
r . --
. p .
. AALLPUIVIP SANITATION SERVICES - .
Dalk 9Corp.
F 13023 NE Hwy. 99 *7
r 1, Vancouver, WA 98686
(360) 887 -2969 Port. (503) 285 -5838
t CUSTOMER'S ORDER NO. PHO DATE 1
.
NAME a i -Mt
S
ADDRES
! - fie 4' 5 //
.
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RETD. PAID OUT
QTY. DESCRIPTIO PRICE AMOUNT
C
�� V
., _
t
44,..AA4404
,, ,,... , , ,:i
it ( r ..._
Y--
•
w--
Payoff this invoice.
NET 30 days. A finance charge of 11/2% per month
( 18% per annum) will be charged on unpaid balances. TAX
Collection fees will be assessed if necessary. i .
RECEIVED BY ,,
TOTAL , 1 /
All claims and returned goods MUST be accompanied by this bill.
/Aess/ To Reorder. �A You
I 800-225-8380 or ne2bs.00m
E
L—
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
b BUP iipt 2
Received P Date Requested V / S AM PM BUP
Location / 4 Li ‘S // 14 Qzi Suite MEC
Contact Person L Ph ( ) '7 ' - 027 PLM o2 06) --C -666 -571)
Contractor Ph ( ) SWR ,2 s -- O (S
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspectio otes: , 4 t) SIT
Post & Beam 1 "'
Shear Anchors / /1 Ext Sheath/Shear ! l //Pr l A J
Int Sheath/Shear
Framing
Insulation
ea
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �/�
Susp'd Ceiling mil // , i , / / / Li Susp'd
Roof /
Other:
Final
PASS RT FAIL . - .ef��
LUMBI
earn
Under Slab -�. - .77 s� // -
Rough -In
Water Service
'S`anitaryewer
R ain n � - --
Catch Basin / Manhole /
Storm Drain r,.
Shower Pan
z , 1 .
FAIL '� /� // AL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL t
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date .-- / / 3 Inspector / Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL