The URL can be used to link to this page

Permit i k - s CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: P 4/2004 -00199 ..f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/4/2004 SITE ADDRESS: 11475 SW 115TH AVE PARCEL: 1S134DB -02200 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: 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: Approximately 100' of sewer service to connect existing house to newly installed sewer lateral. Septic tank is to be pumped, filled & inspected. FEES Owner: Description Date Amount MCDONALD, ROBERT E + JEANNE L TR 11475 SW 115TH [PLUMB] Permit Fee 5/4/2004 $72.50 TIGARD, OR 97223 [TAX] 8% State Surchan 5/4/2004 $5.80 Total $78.30 Phone: Contractor: OWNER REQUIRED INSPECTIONS Phone : Sewer Inspection Insp existing /capped fixtures Reg #: 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 -000 - ! I I You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-:•99. a Iss • d By: :.;y j= • I. _de Permittee Signature: deeC Call (503) 63 • -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard Received jl Date/By: ;.."„l �i - 01 P No.: , -00 Q / 99 13125 SW Hall Blvd., Tigard, OR 97223 � K�- �Q r/�/) / Plan Review �y ( 2 „ M 4 / Phone: 503.639.4171 Fax: 503.598.1960 / /H,�i /;N�j� I \ DatDate/By: lu(� y: Other Permit G� 4KJ ro,�s 24 Hour Inspection Line: 503.639.4175 A I ; Jura: Internet: www.ci.ti ard.o ...... Date ed /Met Supplemental y: See Page 2 for g Notified/Method: S Informa ti o n i t „, , :. ° R r ,r s E a a ,Q1.'4',--,,,;;4,,,; ` ; , s. 3 3. EEEr * < SC HE DIfLE ❑ New construction ❑ Demolition For special information use checklist. Description Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) t ° k I,VNI'k r d ,' RUI O'N SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 ❑ Master builder ❑Other: Each additional bath/kitchen 45.00 Fire sprinkler (_ sq. ft) Page 2 `i Y r . i e „A w 3 • S it e • ut iliti es Job site address: t i/ y 7,5' S // Catch basin or area drain 16.60 City/ State/ZIP: 7 16 A/2 ©e 9 23 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: M C/) 0 4 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.: / a 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 r Absorption valve 16.60 l - 4 Backflow preventer Page 2 CO A/A/CC7 SE 4/ C/{ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 t= .i Drinking fountain 16.60 ;, .,is ' , 4� _ is . ` Ej ectors /sump 16.60 Name: Ro 2F /1 T £ CA_ O /Vi¢ 4,6 Expansion tank 16.60 Address: /7 47/7.5 S e.,; ! /S ' Fixture /sewer cap 16.60 City/State /ZIP: -77 ARd O R ' 7 22.2 Floor drain/floor sink/hub 16.60 Phone: (503) s0 - 3 Fax: ( ) Garbage disposal 16.60 4 .o r a. Hose bib 16.60 ,Ia. : v 1, < 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 ir 1 . h - ' . .4 ar > 4 � , *? � `,, . _ 'I i : . • �! .. - A, . Water closet 16.60 Business name: () ,e /4 Water heater 16.60 Address: // ( /),5 Se,) X //I Other: City/State/ZIP: I / 7 6 Al2 h Oi ' 9 ? 2 Subtotal Minimum permit fee: $72.50 Phone: (s 3) S 0 , 2G 2 [ Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: 11 t jGlci State surcharge (8% PERMIT T fee) ""��/// TOTAL IT FEE Print name: /O , f . 2 l E m C.6 O 4„Aa Date: m^/ 20 o y This permit application expires if a permit is not obtained within / 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. is\ Building \Permiis\PLMF- PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard , Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: 4 Site Utilities Qty. - ' Fey ea TQta1 Square➢:F,00tage:, 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 • • Fermif Tee:- 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 0 F additional $100.00 or fraction thereof, to and � ii e ,t... ielI r 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 and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 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 * . txt ''arirer. nil al r ae se 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 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 Quantity 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 \Pemtits\PLM- PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 - 4171 MST BUP Received / Z <-( 2 ' Date Requested :5 9 S AM PM BUP Location / / ij 7 S / /,5 Suite ` MEC Contact Person PD/P6 Ph ( ) . � Z(7 y- (7 3 PLM 2) 00/q9 Contractor _ Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC 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: 1,7 , ,, Final PASS PART FAIL PLUMBING Illr -4-- / Post & Beam Under Slab Rough -In Water Service $Janitary Seine ain Drains atch Basin / Manhole torm Drain Shower Pan • r: 6419, 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 fl Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line 977- , ADA Qf Approach /Sidewalk Da "� Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL - invoice GRIF ID'S SEPTIC SERVICE Name 06e.2.7 ,r.' '/ cDcw E b Date (a' 0 1 Address /14/75 5J, /40 A ()e Phone 59 ~ b 3 City / / �'4 b Initial On Acct. State o la ' Zip Code 97223' ' Price Amount 40 act> Fo la A 7A-piA hello 2 CM/ 0,1/63 ZV 'e tA412-1 " NOT RESPONSIBLE FOR DAMAGES PAST CURB LINE OR LANDSCAPING ctb • A service charge of 1.5% will be levied on all past due accounts. Total: 6 2 • Returned check fee is $20.00. • In case suit, action or arbitration is instituted by either party for breach or to enforce any provisions herein, the court shall award reasonable attorney's fees and actual costs to the prevailing party at trial or arbitration, or upon any appeal taken therefrom. Appro al i By: Customer Signature �Ftan r You P.O. BOX 1136 • Canby, OR 97013 DEQ# 37464 (503) 263 -2087 or (503) 632 -6138 CCB# 104320