Permit CITY OF TIGARD
PLUMBING PERMIT
t„,In DEVELOPMENT SERVICES PERMIT #: PLM2004 -00111
DATE ISSUED: 5/4/2004
6.:"' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: SW NO ADDRESS TRACT "C" PARCEL: 2S1106C -09100
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 00C JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: 120 ft
WATER CLOSETS: WATER LINE: 350 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Site utilities for 2 lot land partition
1 catch basin, 60 ft sanitary sewer, 60 ft storm sewer, 350 ft water service
FEES
Owner:
Description Date Amount
VENTURE PROPERTIES
4230 GALEWOOD ST #100 [PLUMB] Permit Fee 5/4/2004 $375.80
LAKE OSWEGO, OR 97035 [PLMPLN] Plan Review 5/4/2004 $93.95
[TAX] 8% State Surcharl 5/4/2004 $30.07
Phone : 503 - 387 -7600
Total $499.82
Contractor:
DP PLUMBING
904 S. CHEHALEM
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503
Water Service Insp
Reg #: PLM 110612 Water Service Insp
LIC 36 - 70PB Storm Drain Insp
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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
9 - 001 -0 i. You may obtain copies of these rules or direct questions to OUNC by calling (503)
46 -6699.
� Issued By: ���Il, �t�d� AIL P ermittee Signature: �! — /
Call (503) by 7:00 P.M. for an inspection need- /' next business day
I Site Utilities RECEIVED
Plumbing Permit Application . FOR O FFICE USE. ONLY
City of Tigard MAR 1 7 2004 DateB d 3�i j MP_ .∎ Pen iit N • 1 . y �M -GO
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review w
Phone: 503.639.4171 Fax: 503.598.>l4�(TY OF TIGARD G x�atw i dllh���0411+l Date/By: Other Permit No.: Kai .. „, ,,, .
24- Hour Inspection Line: 503.639.4?5 ILDING DIVISI 1 _r<.fi' 1. 11 Date Ready /By: luris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
t11A Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' C ATEGORY,dF't CONS N Y ' ' F . SFR (1) bath 249.20
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i".r�w ..�,. �a��ss �s ;,�e��#a �,a,,u _ � +�wx�s- ".a.�z. TAMS ,k� �.i->< _ _,., _ . � ,�
❑ 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
❑ Master builder ea Other:
:. }: .. -. ;a a ` }Y: a :. _: "` a `'ii. .; Fire sprinkler ( sq. ft.) Page 2
��e�ti „`JOB IIVFORMA'PI A L , ; t , . , S u t i l i t i es
t x,� c ���i�,iis -' sa .,, � ,�,.ur L u „�,n. -�. � �t xas
Job site address: c� i \.) 0 ,�}D .D E ,s ie Catch basin or area drain ( 16.60 /6, 00
City/State /ZIP:' „NI- Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: 46 _) Page 2
Suite/bldg. /apt. no.: Project name: 'T‘,,,,a c (N.-ZOO I
Manufactured home utilities 110.00
Cross street/directions to job site:
M4� f \ Manholes s 16.60
%.
�� �x �-‘,y. 7-, Rain drain connector 16.60
‘A,4q, Cc .1 . s _3 Sanitary sewer (no. linear ft.: 4/) ) Page 2 ,55-.
Storm sewer (no. linear ft.: (7O ) Page 2 53-.do
Subdivision: j r n a I� t no.: I SIB -1._ Water service (no. linear ft. ) Page 2 /W.0
Fixture or item
Tax map /parcel no.;6l f e 6 6.0 yeev 09/60 O 7„20 16.60
,,u Absorption valve
1,lO �_ ;. s ,- r-. in ` "DESCRII'TI, v i „�F W®RK w-A ; ' "� ,A5Uibl : ' Backflow preventer Page 2
t , p J• -} C„ r .,-... U (,J pf Backwater valve 16.60
,) ^ 1 A 1--.Ns---- w) Clothes washer 16.60
t
Dishwasher 16.60
r T ri�,� ,� li Drinking fountain 16.60
- ®PROPERTY OWNER ,3,� ,1I='.,P TENANT
..;'�;�. ,.., ,. 1 -" . ,ti. <. , r .:; N:.. Ejectors /sump 16.60
Name: 0 a n fl ice,_e hey ' Expansion tank 16.60
Address: ( ,�zJ '�/1 z, 0 (7 , , J._ \[C„ 1 J Fixture /sewer cap 16.60
City/State /ZIP:: DP-- e j 7) 2)-S Floor drain /floor sink/hub 16.60
Phone: ( ) 'V Fax: ( ) Garbage disposal 16.60
* T. ; _ � :�,. - °tix r *. ... , ,«°, ."_ ,ip rel,f, _ tZ:p :, 2'-XWR , ,:a::; .� t: ''I q - li Hose bib 16.60
., v� ®Appue-A ANT` ; ,, _ - ,, ; ', a,�. ► '� , ONTACT PER . ,t
-r .iii '`� �..>� . - Ice maker 16.60
Business name: Pc./--\.Q ` P 1, iv, - Interceptor /grease trap 16.60
Contact name' J l I 6 (;4, -A,) s ( .- q g3 E edical gas (value: $ ) Page 2
Address: er 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
�.,�S � �: ?� z,'r .,1 *�is E � +.;. �. }:;.�`. m y s- ?'� r �� 1; i.�'1
.� a CONTRAC'POR- t :- ham`' 16.60
��� � ~; �„, ' ma ,,,�. Water closet
' d:°izwa' 'Cv� kr�t rs. :aa'`�'K' � �� " ";±ri�n: fir �e;�t »w�.�rvau;; ? ,.,� ,,t� . , x: .;�. 4A +':e,,,' - .i.� ":� w .. > _,� - r•
Business name: D tt p Q kI n I eA .7 19 7 qL�`' Water heater 16.60
0 poer'� ` - Other:
yk
Address: � + L 1 �T�
/*, ` d ? I. Subtotal
City/State /ZIP: tw1, l Z Min imum permit fee: $72.50 SD
Phone: 3 � 3) ^� y/ Z Fax: (S�) _ ..... 4 . 3 2 f./..,30b Residential backflow minimum permit fee: $36.25 p1;l5
CCB Lie.: ' 10 &I Z Plumbing Lic. no.: 70 -,Jo Plan review (25% of permit fee) 4 ! 5 .-..
State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE 199, g
Print name:.. INS /"■.� ('Q Date: This a" C\ d t/ 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\PLMU- PermitApp.doc 12/03 440- 4616T(IO /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
p '<r
Fee Schedule: Residential Fire Suppression Systems:
•
a Q ,Fee ( ea) Total S Ual'e I+ OOta C PeY mil. Fee
ieU # <2r .��e. �...� if.��._� _q�� . . g...=_ ._
Footing drain - ib` 100' 55.00 0 to 2,000 I • $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 t '' •
evaluation , Pe =mit 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
,gjad itgia ie' S . Z ? ; 4 001 Fee (ea) 1 Total additional $100.00 or fraction thereof, to and
�� 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 * .
'3Zi i ; E' Quantityby (+►xture)'Work.Performed
Fixture Type: r Replace. r a
data % N ell M°vea [15#1.0t c Comments regarding fixture work:
Baptistr
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
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
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 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 \Permits\PLM- PemvtApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING . Inspection Line: (5Q3) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
t
Date Requeste AM PM BUP
Location
T kD T) 12Es S Suite MEC
Contact Person B 015 Ph ( ) 57 - - 2S ' PLM 4;3 -00 / I
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C-() LC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain •
Slab Inspection Notes: _ G �\ c II SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling `(
Roof V /t \ t
Other: V `
Final 1 " rte J � j �( / U ' ` j ,. G \W ‘lc
l c
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
SSA ART FAIL (�
MECHANICAL '" 6 /
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm •
Final El 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: 0 Unable to inspect — no access
Fire Supply Line // /
ADA
Approach/Sidewalk Date g/ .0 /J Inspector - r ? s Ext
Other: _
Final DO NOT REMOVE this inspection record from the ' site.
PASS PART FAIL