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Permit
CIT OF TIGARD PLUMBING PERMIT 4 DEVELOPMENT SERVICES 003 -00121 Ai- DATE ISSUED: PLM2 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: PLM2 SITE ADDRESS: 12040 SW 116TH AVE PARCEL: 2S103BA -00125 SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R -4.5 BLOCK: LOT: 039 JURISDICTION: TIG CLASS OF WORK: REP 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: 38 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace approximately 38' of water service. FEES Owner: Description Date Amount HUTCHINSON, TERRENCE E + CAROL V [PLUMB] Permit Fee 4/1/03 $72.50 12040 SW 116TH AVE [TAX] 8% State Tax 4/1/03 $5.80 TIGARD, OR 97223 Total $78.30 Phone : Contractor: OWNER REQUIRED INSPECTIONS Phone : Water Service Insp Final Inspection Reg #: 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 // � Signature: �� ` Permittee Si sued By: - .;! �,J.' �_ 9 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 Received A Plumbing U Date/B : I Permit No.: ` r/ ` '�ld City of Tigard Planning Approv - Date/B Sewer Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/B : Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 / /rx : Post- Review Land Use f � � , ta Internet: www.ci.tigard.or.us . (� •' I Date/B : Case No.: Contact Juris.: O. See Page 2 for ^ 24 -hour Inspection Request: 503- 639 -4175 ' ' Name /Method: Su . . lemental Information. , s .. ' T Y]PE lrWORK FEE* SCHEDULE (for special Inforaa ton uise chiecklfiti `: New construction ❑ Demolition Description 1 Qty. I Fee(ea.) I Total Addition/alteration/replacement ❑ Other: New 1- &,2 f ydwell gs (includes100 ft ' i 7rz hi utility onnection). 4 w r° � :GOIt�'O1±Ue 4 UC1`r41l1.;.:; SFR (1) bath 249.20 "g 1 & 2- Family dwelling • Commercial/Industrial SFR (2) bath 350.00 Accessory Building • Multi- Family SFR (3) bath 399.00 0 Master Builder N Other: Each additional bath/kitchen 45.00 2 J+ :' StrtIWFOR1OC O rid G .ION ,,. _ Fire sprinkler sq. ft Page 2 Job site address: /2040 S W • /1 6 T•74 AVE fi. ,p,, . I itii S _ ; . ;i;n` : Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell/leach line/trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 CA TM g / / t4 ii Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: .Elul ge (644.T5 ;tt24. Lot #: .39- Storm sewer (no. linear ft.) Page 2 Tax ma •/. arcel #: 2 S /O 3 LiA -00 (2- 5- Water service no. linear ft. ; / Pa • e 2 Absorption �a 'k rJ `< „,. awe ,.- : ..1 6 a , te _ ° . ', , y..... do n valve 16.60 tio ieEPLA CC G/qL v 4 Jul i z-g' (� f / P€ Backflow preventer Page 2 / /vi 57 T TO No 05E Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 3 ' , Yridliii , i. v 7: t „ 4,a: E. i v 16.60 Name: T g . /- f/TC/y //ySOM Expansion tank 16.60 Address: /2010 Sal 16 774 A i/ Fixture/sewer cap 16.60 City/State/Zip: 776,4 R p R Floor drain /floor sink/hub 16.60 i 9 7 2 2 3 Garbage disposal 16.60 Phon: $2 $2-/-12. y ax: Hose bib 16.60 . `;" ' erg ;. Ice maker 16.60 Name: SA Ai AS A$O V -. Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory 16.60 _ E -mail: Tub /shower /shower. pan 1 6.60 4r s i : "4 Urinal 16.60 Business Name: a ©e v e ' _ Water closet 16.60 Water heater 16.60 Address: Other: City /State /Zip: Other: , Fax _, a` . ,- i r v� . ,,, Subtotal $ CCB Lic. #: Plumb. Lic. #: Minimum Permit Fee $72.50 $ Authorized , l Residential Backflow Minimum Fee $36.25 7 2 ' sip Signature: 7 • �. H Date: I// /O 3 Plan Review (25% of Permit Fee) $ T e . //L 7 CN /N S O N State Surcharge (8% of Permit Fee) $ SO (Please print name) TOTAL PERMIT FEE _ $ 1 fr • ! ) 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\PlmPemiitApp.doc 01 /03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information r Fee Schedule: Residential Fire Suppression Systems: Site tilttes " 904 Fee( 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 �?ixt a or Item Qt!` += `', oejelonfTiitik 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 *. Comments regarding fixture work: �..3aaYv�3` 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: i \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION - ' Business Line: (503) 639 - 4171 MST BUP Received Date Requested h 17 ' AM PM BUP Location a 1 O I!(e qt t— Suite MEC Contact Person /11,014 1X - ri-/ A-T Ph ( ) ��o�� / 23Q P � Mj' , - /4 Contractor Q Ph ( ) 06 1 ( BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain � ELR Crawl Drain Slab Inspe. . J otes: 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 Rough -In Rain Drains Catch Basin / Manhole Storm Drain Shower Pan a r Other: Fin: • 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 0 Please cal for reinspection RE: Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date - i Inspector 2/ Est Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL