Permit CITY OF TIGARD
PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00395
a=� � II- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/30/2004
SITE ADDRESS: 10732 SW 127TH CT PARCEL: 1S133AD -11700
SUBDIVISION: AMART SUMMER LAKE NO. 3 ZONING: R -7
BLOCK: LOT: 173 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: ft
WATER CLOSETS: WATER LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water service.
FEES
Owner:
Description Date Amount
JUSTICE, CLARENCE J + PAULA S
10732 SW 127TH CT [PLUMB] Permit Fee 8/30/2004 $55.00
TIGARD, OR 97223 [TAX] 8% State Surchari 8/30/2004 $4.40
Total $59.40
Phone:
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 - 5535 Water Line Insp
Final Inspection
Reg #: LIC 10967
MET 00003528
PLM 34 -42PB
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 • • - - ions to OUNC by calling (503)
246 -6699.
Issued By: ✓% Permittee Signatu - C
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed e next • usiness day
Building Fixtures RECEIVED
ED
Plumbing Permit Application FOR OFFICE USE ONLY
spy/ /�
City Of Tigard ) i,t 200 Received �!/ v y /� Permit No' l � _,.103
Date/By: W
13125 SW Hall Blvd., Tigard, OR 97 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OFTIGr °a Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 BUILDING DI ,,,...,t.. Date Ready /By: Ians: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 1) bi Supplemental Information
ik ,'4 r z lq4, ? ,fie a -* 1 r w ,.. FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. Ea. I Total
i Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
t
)'. ft ' s ,,,..: ` � t � l " 4 . . , g a e , SFR (1) bath 249.20
,8'1= and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building
❑ Multi - family
Each additional bath/kitchen 45.00
0 Master builder ❑ Other:
t
s= Fire sprinkle ( sq. ft.) Page 2
r s t. a e
4 7V 0 t '13 e, i 6a ' 8 s gF, gag
� � , e .• + �.B � .. � y .. Site utilities
Job site address: ' 0 1 3 S a1' C -r Catch basin or area drain 16.60
City/State/ZIP: - \C f 3 Drywell, leach line, or trench drain 16.60
J � f � l ��aa Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:
Manufactured home utilities 110.00
Cross street/directions to job site: - 1 ( t 'f'
J,_ 1 nC) h Manholes 16.60
O a lc C-4-0--, Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) , Page 2
Subdivision:
Lot no.: Water service (no. linear ft.: j Page 2 ` 55, 00
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
? .., - . a ` . 6 m . t t .: 1 � a "•° . ;,`,. <, a, .,_ t „ . Backflow preventer Page 2
1 1 / 4 4 /n O,� lls Backwater valve 16.60
`� Clothes washer 16.60
Dishwasher 16.60
N^ F p Drinking fountain 16.60
-3 x • c � 0 i P *s i4c di € ¢q -0 s , j
, ' '.< 3 ; '' ` t , . us : „ d E /sump 16.60
Name: V a � J u b 4 t we Expansion tank 16.60
Address: tai 3 a sup I a1' � Fixture /sewer cap 16.60
City/State/Z : �1 a r G ( o f ct a a 3 Floor drain /floor sink/hub 16.60
Phone: (503) 5 esC.-.\ . 31 i Fax: ( ) Garbage disposal 16.60
�, M 1 _ . 1 ,,-• Hose bib 16.60
It. }
, ." ®� kg Ice maker 16.60
IP
Business name: K•Q ' (\r „" -1 . 1.0 % n _Interceptor /grease trap 16.60
Contact name: t Sag C5 , f r n Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: 8, Q r cl -1005 Roof drain (commercial) 16.60
Phone: 603 (y-3 5 5 3 5 I ( ) Sink /basin lavatory 16.60
1 , Fax:: Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
a 0 g ',, Water closet 16.60
Business name: Water heater 16.60
Address: e j -I A `- Other:
6100
City/ State/ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
O Plumbing Lic. no.: 3L - L I e 8 Plan review (25% of permit fee)
CCB Lie.: l 9 / g
t State surcharge (8% of permit fee) i t l 0
t,
Authorized signature: �� c , TOTAL PERMIT FEE 159 , C
55 8 i t30 r b , r This ermit a lication ex ires if a ermit is not obtained within
Print name: h Date: V t 4 P PP P P
1 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Permits\PLMF- PennitApP.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:
Site Utiliti Qt . Fe (ea Total Square Footage: Permit Fee:
Footing drain - l' 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' 55.00 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
j 4 Qty Eeg Total additional $100.00 or fraction thereof, to and
1441II Q.Qr�A1. .,'. s , . , ;,;!- 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 * .
s , ,:*Quantity by (Eiiitiire),, biltPerforined
E1ZtnI cType. Replace
31*kiti; rovea E>as6ag 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:
i:\ Building 'Pemtits\PLM- PermitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 PN1. MST
INSPECTION DIVISION Business Line: (503) 639 -4171
r.00 BUP
Received Date Requested - 3 ( AM PM BUP
Location ) 73 /oZ 7 Suite MEC
Contact Person Ph ( ) PLM o6)/3
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
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
dM
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
CP 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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line �i
ADA
Approach/Sidewalk Date 6 )3' P 4 Inspector + i 1 5\--4. Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL