Permit CFTY OF T I GA R D PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00366
' SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/11/2004
SITE ADDRESS: 12085 SW 135TH AVE PARCEL: 2S104BA -00100
SUBDIVISION: GREENFIELD VILLAGE APT. ZONING: R -25
BLOCK: LOT: /1)..t.oz.A, g JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R1 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 prevention device for irrigation.
FEES
Owner:
Description Date Amount
GREENFIELD VILLAGE
PO BOX 5668 [PLUMB] Permit Fee 8/11/2004 $36.25
PORTLAND, OR 97228 -5668 [TAX] 8% State Surchan 8/11/2004 $2.9.0
Total $39.15
Phone:
Contractor:
ENSTROM LANDSCAPE MANAGEMENT INC
9304 SW 51ST AVE
PORTLAND, OR 97219 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 260 4807
Final Inspection /
Reg #: PLM 7308
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 OUN by calling (503)
246 -.•••.
Iss -d By: ; - j /� Permittee Signature:
Call (503) 639 -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 6, // Q T� Permit No a les 00 -,
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: / OGl/
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 kapNh I ,'� Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 •' . 7��'
Internet: www.ci.tigard.or.us S t W Date Ready/By: See Page 2 for
g Notified/Method: (10 Supplemental Information
' a . ':z> :w >. ,:. ,. r , ( Wilk �L Yaz €. v yg .,:, , a D.
. . 3 f i/ ,: �TI'PE zW . i: g, �.t . >4�.Y _ ,, E r * y SCH E
_ � „» �' .: � � ,,.� � . «..� aE,...��i.xs, � ��. r a'21 � � 0,:%: .: d> s� � �,� � >M ��- Mg, N ��nn� , � . , .x 4, <r�s ��
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
1r41' Addition/alteration /replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
r .::'�;�'" e� ;. ;; * �s: . ;fi r ;, ; - . - z',s.NMs�:p.�'.:.,; ?.t.�a��a�v�:.a,;; fi: , ; �<^ �,,'" ���r,_
rtr*PI . ,s e ATE O GO STR RsfftbIY, 4 " ` SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building jEl Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
1, . ; :. :. r te., ; .. .., '. , , , ';.x ' = ,r Fire sprinkler ( sq. ft.) Page 2
1 " „„ ` � OB TIE Ii\ TF.OIt1VIATt IQ1 4N L O O,N ,: 1 Site utilities
Job site address: i 2_05s-- S (3 s - v-..._ A. fQ Catch basin or area drain 16.60
City/State/ZIP: ev 0 02 91 1_2...3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: �eaK &$I Project name: 6 , e Footing V e_
drain (no. linear ft.: ) Page ,2
Manufactured home utilities 110.00
Cross street/directions to job site:
S S (` C S C•h-v , 1 I
h 0%-- a T'�i S e� t .5 c A-� I S" Manholes 16.60
Rain drain connector 16.60
� V w I GS S G vp, cs v i `t . S' Sanitary sewer (no. linear ft.: _) Page 2
p '1,6'e._ UNF % 3 5-i Storm sewer (no. linear ft.: ) Page 2
Subdivision: ( .1 / (Fr Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no
,,,.,, , . Absorption valve 16.60
d >,,., . > ,. .. , . , t. ,, a .. , , . , ,.. ,.., �, tgw.m `a ' Backflow preventer X Page 2
1 , A.S k'4 L %1/2_" D C'J t A O ! ..r ,..... L e_ Backwater valve 16.60
1t2 4 A.- 404 '‘7 3fe-,A-A Clothes washer 16.60
Dishwasher • 16.60
WI w i B r� r Drinking fountain 16.60
"tr =Y. ; PROPER SOONER - Al ° . TT c
;;�_= .,.', >a � / »s. , - Ejectors /sump 16.60
Name: Ata14 iedIt t 0 Expansion tank 16.60
Address: P a 3 • / ‘ I GtA / Vrj J C'. Fixture /sewer cap 16.60
City /State /ZIP: 4 14 . 4„ Per-e../1" Cl 9 11-)-.6 D Floor drain/floor sink/hub 16.60
Phone: (760) 3ye - G e6_ � Fax: ( ) Garbage disposal 16.60
R< .PfIGANT ? ' �g it . ❑ CC'I §T D O r, Hose bib 16.60
� ~5 - -- ..- - ADO- ,:,.. ; . &.- ,,0 ~ 1 Ice maker 16.60
Business name: 4 vlA «
�.� n ptko - It W Interceptor /grease trap 16.60
Contact name: (,,,,'DA \ pr ex' j---• Medical gas (value: $ ) Page 2
Address: 11.6e 5 (33 �� 64 Primer 16.60
City/State/ZIP: el, ci ki J/ Gt i L Z 3 Roof drain (commercial) 16.60
Phone: (' 3'- / ,7 I Fax: : (.. 3) (f 7g_ V ayY Sink/basin/lavatory 16.60
lA / Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
„' Water closet 16.60
. Y.: . ; . ,4 -:.:'� ,., .. .ItA ON,TRACT%RPige A . 14 `. �..r ,: 6' > z
Business name: E N g L` s L,�� ,1 . k Water heater 16.60 •
6 94 6\ t 't 64-e..... b 1 Other:
Address:
�n Subtotal
City/State /ZIP:
PC' +1 ` .D O ` ' 7 �t 1 Minimum permit fee: $72.50 Z S*
Phone: cA3) 1 /_ 4 - 1/S 67 6 Fax: ( '1y{ y cf 3
- Residential backflow minimum permit fee 36.2 3 �
CCB Lie.: L, -. . ` a / A _ Plumbing Lic. no.: Plan review (25% of permit fee) f �
State surcharge (8% of permit fee) p �'
Authorized signature: 4 �% 7 TOTAL PERMIT FEE it l;S
Print name: AT 0 n istg -*» Date: 9 ...0. 4 7 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.
i:\ Building \Permits\PLMF- PerniiApp doe 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedul Residential Fire Suppression Systems:
-, K Srte tit> .} �.,. '� �" , WS ' F a ., ,'I ta l, ., j i g .Eermit'Fee:
m care Foota e °t,.
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 ��; ° °�� -ac.p � :�;� -... •� ,�;.�, ; ti 2 � �,.;�, �_:
real_uatio . :". - .:•' 1`-Per'“..0.14I`ee.:
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
t ' % � , w —,, v'')�otal1 additional $100.00 or fraction thereof, to and •
1XtUre Or 1 eIT1; � ;.. ; - J ; ; . 4 , V ... , q 00 :1 including $10,000.00.
a Commercial Back Flow Prevention Device , 16.40,/ $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 5 $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 $50,0001001
Subtotal: $50,001.00 and up .. $742.00 for the first $50 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 reporf'fxtures could result in increased sewer fees * .
antic W zl "r" Yk Perf ` m'
15r . �� �r;:�H':�'�� , ;.� -„`�Q% ty;�',- .- `(>H'� ,e�a?o`• o ed:�' ,
Fi ure'Fype r a . k a , s , -1 , } plac . 4 L .
t k , , _; > JTe g Mot ea r> � i n 4 Capped Comments regarding fixture work: '
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool •
Car Wash -Each Stall • ' - , ' ' `> -1 1 , 1" ,. '''
-Drive Thru
Cuspidor /Water Aspirator l � I
Dishwasher - Commercial i',
- Domestic
Drinking Fountain , -
Eye Wash
Floor Drain /sink - 2" - t
,
- 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 ' ' '
- Bradley Q Total
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 \Pemuts\PLM- PemtitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISIQN Business Line: (503) 639 -4171 MST
BUP
Received Date Requested - ) AM PM BUP
/
Location / 0 8.. 7c� ¥ - l -�z Suite MEC
Contact Person / Q._t Ph ( ) ' 4? PLM e �- av 3( t'
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 1 %�. .� _ ��" /y , ' ELC
Footing 4 !� ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear i
Framing � r Dekb ), leer, 1--h- IV t,-.J
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
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
Ot . - r: i f(
4$
PA = 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
ADA
Approach /Sidewalk Date g 13t Inspector 61 Lrl-t Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL