Permit s ,L
CITY TIGARD PLUMBING PERMIT
^i4 I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00094
��'' F���I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/21/03
SITE ADDRESS: 11905 SW 91ST AVE * ** BLDG 1 PARCEL: 1S135DC -02000
SUBDIVISION: VILLA LA PAZ ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
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 250' of footing drain and 40' of storm drain.
FEES
Owner:
Description Date Amount
VILLA LA PAZ LIMTED PARTNERSHIP
BY COMMUNITY PARTNERS FOR [PLUMB] Permit Fee 3/21/03 $202.80
AFFORDABLE HOUSING INC [TAX] 8% State Tax 3/21/03 $16.22
TIGARD, OR 97281 Total $219.02
Phone :
Contractor:
GREGORY PACIFIC CORP
5755 SW JEAN RD
LAKE OSWEGO, OR 97035 REQUIRED INSPECTIONS
Phone : 503 Storm Drain Insp
Rain Drain Insp
Reg #: LIC 66416 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
Issue By: .P , /4(p j Permittee Signature: 17 ��
- Call (503) 39 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit A y�lication FOR OFFICE USE ONLY
1N R ece i ved 2 Plumbing p
Date/By: -4 o3 Permit No.: 1L Ml '3 Z 03i
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
/Q i��d1� ''
Internet: www.ci.tigard.or.us e .I II Date/By: No.:
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
� �� ��`� :,�, #�TYPEOFWORK :;���.,, §��¢�� � � . wi -� `.;��• �.F '�' C., ._.._ , E�(forts ecal mformatton:ust:,checklist);,�� ,
a. -�x�, _ -.� ��,.� .. z��� , � �s� ...� �s., � _ . � _ -° . � ��.nEE��S HEDUL- . p
Description Qty. Fee(ea) Total
❑ Addition/alteration/replacement ❑ Other
111 New construction ❑Demolition p � � _, .
<• Wi: •Newki & 2 f lli
dwengs' , ` ry .
w. �� �,� �,. .. _ f i - : : s il0 0 ft f e Ei , . Q ,
'Maf aA n CAT =EGO1T OF CONSTAWitiiON ,' ,' _ . -_ " ty i
I & 2-Family dwelling Commercial/Industrial SFR () bath 350.00
❑ Y g ❑ il /Id i SFR (2) bath 350.00
Accessor Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
K :. 4O R a B SI,T�E.-IN °F®RMAT �_.....�,_. _..., IO _. , N a N nd IO �,Ip 1 a - ° N�
I,$ Fire sprinkler - sq. ft.: Page 2
��;
Job site address: / /993 (-51.0 9 //r/v ' '+ _ Vl . °S te 'iaiVitirAEfiaS5
Suite #: Bldg. /Apt. #: ,ii - / Catch basin/area drain 16.60
G r u I 4, Drywell/leach line /trench drain 16.60
Project Name:
r 1 Footing drain (no. linear ft.) Page 2 ZS-
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.)- Page 2 l a X
Tax map /parcel #: i ( x� n,: ,„
Water i� a � � ���Jr* ��
ater servt linear Page
��� `�� , _ , _ ?� 4 .� �._ �� � a.. Eiz�tue It � > �.
_� �.... _ SIOESCRTPT�ION�oF WORK c 'EV r'4 Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
�. ? T y,�`, , s ��� TENANT;3; ��� `,
Drinking fountain 1 .60
g. IP,RO OWNER„ , Ejectors /sump 16.60
} '
Name: Vi LLff � Expansion tank 16.60
Address: L / �j} -0-iu . r'/ P447- 110Ele Fixture /sewer cap 16.60
City /State /Zip:�p,/fi -fir 0 t2. 9 7 2--5
Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
APPLICANT;, * it CONTACT`EERSaille„ E Ice maker 16.60
Name: Interceptor /grease trap 16.60 i
Address: Medical gas - value: $ Page 2
• City/State/Zip: Primer 16.60
Y F Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E-mail: Tub /shower /shower. pan 16.60
. v� 5 Urinal 16.60
`.e.,�..i����':�w�`� - r� �.rr �� CONTRACT'OR...�: x:�'.:'� ,... ��,,.��; ��. w.
Business Name:C gp /'f►- F §CD Water closet 16.60
5755 6w • ` � Water heater 16.60
Address: /�.► Other:
City /State /Zip: A.h.gi. OS Q & / d/2-- /7055
Other:
Phone: a35 - ` 9 / Fax: ' x,s .N r a ;i teriMaiinifO rm t�?F s* ,'! D 1015
Subtotal $
CCB Lie. #: 664 1 f p Plumb. Lic.#: Minimum Permit Fee $72.50 $ go
Authorized Residential Backflow Minimum Fee $36.25 OZO -
Signature: Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ /(P • e e9.
(Please print name) TOTAL PERMIT FEE $ , / 9 . e,�
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 \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information t
Fee Schedule: Residential Fire Suppression Systems:
�. Stte Utilities IQ ty F¢¢ (ea) T l t S.CIU , _ s �<a e . _. .., ", Permit Fee. ,�
a Fo
Footing drain - 1" 100' / 55.00 SGr/ 0 to 2,000 $115.00
2,001 to 3,600 $160.00
Footing drain - each-additional 100' A 46.40 ;;:p . SG 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.
Storm & Rain Drain - 1st 100' 7 55.00 55 , a $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
W,f ; ,,, Fixtate or Item '` ; „ Qt y r FeC (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
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 !� w , $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: �pC�� 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 *.
g
g
Comments regarding fixture work:
� �* � � '�` t Quantity by (Fixtu�e).�Work�Pertormed
Fixture T e P ` R'eplace "
YA ; New , Moved 1istin
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 ?— 3 AM PM BUP
Location / I l 0 .S / / .-d 41 Suite. MEC
Contact Person Ph ( ) 76 6 'a' 35 PLM 3 Dov ( cy
`(
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 64---0-- 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: /
Final
C °1-54*--"/ ,
PASS PART FAIL
PLUMBING
- Post & Beam
.: Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Ma_ nhole
Storm Drain
Shower Pan
Oth -
'ART FAIL
M - NICAL
•
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 111 Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line •
ADA
Approach /Sidewalk Date / - Inspector Ext
Other:
Final D • NOT REMOVE this inspection record from the job site.
PASS PART FAIL