Permit CITY TI'ARD PLUMBING PERMIT
`I DEVELOPMENT SERVICES PERMIT #: PLM2004 - 00385
4 13125 SW Hall B Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/24/2004
SITE ADDRESS: 13750 SW 118TH CT PARCEL: 2S103CD-07500
SUBDIVISION: CREEKSIDE PARK ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of backflow device to replace individual AVB valves.
FEES
Owner:
Description Date Amount
SCOLES, HARRY C + BARBARA
13750 SW 118TH CT [PLUMB] Permit Fee 8/24/2004 $36.25
TIGARD, OR 97223 [TAX] 8% State Surcharl 8/24/2004 $2.90
Total $39.15
Phone:
Contractor:
CONCEPT LANDSCAPES INC
PO BOX 1583
BEAVERTON, OR 97075 REQUIRED INSPECTIONS
Phone : 646 5781 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7040
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 questions to OUNC by calling (503)
246 -6699.
Issued By: �. �' ),,,77T Permittee Signature: _Le nip
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
'' Plumbing Permit Application EC V FOR OFFICE USE ONLY
City of Tigard Date/By: i( ,�� (L { `ii �� Pem,itNo (V� day Q j 3 �
13125 SW Hall Blvd., Tigard, OR 97223 AUG A l 4 Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 h* 'r , ip:;' t Date/By:
24- Hour Inspection Line: 503.639.4175 CITY,! 7' 1 � 12 Date Ready /By: p r _ El See Page 2 for
Internet: www.ci.tigard.or.us - NotifiecVMethod: I Supplemental Information
x 4 5 1' t � , M 3 ,1 a , t '. \ - 7 FEE* SCHEDULE
❑ New construction
❑ Demolition For special information use checklist.
Description Qty. Ea. Total
[ Addition/alteration/replacement ❑ Other: New 1 2 family dwellings (includes 100 ft. for each utility connection)
ez,. . ;,'' .',: L:. � , r ` Q , u ,ix t ' 0 1 ( 1 r 7 "" :' . 4 >` . ,' . SFR (1) bath 249.20
❑ 1 and 2 family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
El Accessory building
❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder i Other: 1jl1,1t4LQ,PE.Tl2{Lt 64+1-101.3 Fire sprinkler (- sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ‘5 S L 1 j j TM' c!--, Catch basin or area drain 16.60
City/State/ZIP: Ti df12D LV, .**-)2:2A Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: C C,IL;t-fj ( ,
Manufactured home utilities 1 10.00
Lan street/directions to job site: � l -- k. t - A o1= S ) Manholes 16.60
1 4A.Q. _ SI- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Lot no.: Water service (no. linear ft.: ) Page 2
Subdivision:
Fixture or item
Tax map /parcel no.: Absorption valve 16.601}.
�Y
� � � - - , �� ,. Backflow preventer Page 2
3(.25
`:I�, v � U , Yae 6. ( a§ 1 3 K fi g °TC 1�3+ _ S i 1' d .. e.6
? & ,� ve 134.< O ' : - _ La/ \ 1 L w , Backwater valve 16.60
I ti�1�1e:'- !kit IVNW \ 2 L7 V /i $., • Clothes washer 16.60
Dishwasher 16.60
,,, , :-t,,- .-- , ‘
Drinking fountain 16.60
. OFER Q ` [] . TENANT
..F TY � t Ejectors /sump 16.60
Name: FAat L' `� e E C,.oL - _Expansion tank 16.60
Address: i 3-7 5 0 S `1B (- . Fixture /sewer cap 16.60
City/State/ZIP: fl i / 9/L3 Floor drain /floor sink/hub 16.60
Phone: ( i3) jgg - -7g,9 Fax: ( ) Garbage disposal 16.60
N ''' � r -, ` ' f 1: s ® Hose bib 16.60
r. ,�. �- ,,�, �� . t _ ."� �,'�,,:' 1°' �� 0 � Ice maker
Business name: lifer i LsflSLd1 1,iG , Interceptor /grease trap 16.60
Contact name: L14PQ2,I' A e _ v _ m o,, k i Medical gas (value: $ ) Page 2
Address: Z/4, NW A,UILi aL'' EZ, DI Primer 16.60
City/State/ZIP: 1'L 1 LL Q , [ 2 g ? )� Roof drain (commercial) 16.60
L Y 5 tor / I ^ /
Sink/basin/lavatory 6.60
Phone: ( ) I / L � Fax: : ( Id /446 ..........z. L�(�+
Tub /shower /showewe r pan 16.60
E-mail: n r C_o1i - •fi w • S € V11511 AA Urinal 16.60
qlr` �,: _ ,. � : 1 ., . ,, i s , ,, , , a, Water closet 16.60
Business name: CT ■ DSCAPIfLS� ,I Water heater 16.60
Address: 0, V) 0I• i Other:
Subtotal
City/State /ZIP: , ),, c g , b---/ Cr) 5 - Minimum permit fee: $72.50
Phone: (' ?3 f , - 57 gl Fax: ( 5'03) ‘ -2_ c, Residential backflow minimum permit fee: $36.25 2 ( . L'7)
LB Lie.: 7 04o , Plumbing Lic. no.: 1 174 3 Plan review (25% of permit fee) .---
T State surcharge (8% of permit fee) 2 , 9 Q
Authorized signature: ` TOTAL PERMIT FEE 3�j 1
Print name: r , / . \ � . � Date:Og 21 b 41 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 \ Permits \PLMF- PermitApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information , . -
J .
Fee Schedule: Residential Fire Suppression Systems:
Site LTti Qty •, lies (ea) Tota Square Footage: Perm Fee:
Footing drain - 1" 100' 55.00 0 to 2,000 $115.00
2,001 to 3,600 $160.00
Footing drain - each additional 100' 46.40 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
T� 0e Q ' e _ (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
each additional $100.00 or fraction thereof, to
Residential Backflow Prevention Device rr 2 ZS and including $25,000.00.
(minimum permit fee $36.25) 4. 27.55 3 w • _ -
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 $50,001.00 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 * .
,- Quantityby (Fixture )Work Performed
,X#1 a place ,
,N M - Replace 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"
-
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial _ increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refrig. Drains _ fees assessed for the sewer increase must be paid before the
Oil Separator (Gas Station) _
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall -
Sink - Bar /Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service
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:
is\ Building \Pcrmits\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 Date Requested 7— a AM PM BUP
Location '4 '- Suite MEC
Contact Person _ Ph ( ) PLM 4j00 ,, 7` jj - c3 g: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 / . P ✓ ��..r1 —�+ F I L..• �.C�.1 :at . 4- � . e'_4 7 Reps `no
Firewall
Fire Sprinkler C1 , 0 I °J A i`� l"10' d t� loc+tiv" r
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
di'. PART FAIL
MECHANICAL
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 J Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date S12 -0 `'1 Inspector (- -Th
Ext
i
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL