Permit CITY OF TIGARD
PLUMBING PERMIT
...',
E:� ,.�,, Irr DEVELOPMENT SERVICES PERMIT #: PLM2004 -00375
'' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/18/2004
SITE ADDRESS: 15405 SW ALDERBROOK DR PARCEL: 2S111DB 08000
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 326 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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate water heater and shower, add 2nd lay in master bath.
FEES
Owner:
Description Date Amount
MIKE BRADY
15405 SW ALDERBROOK DR [PLUMB] Permit Fee 8/18/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 8/18/2004 $5.80
Total $78.30
Phone : 503 639 - 0959
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 Top -out Insp
Final Inspection
Reg #: LIC 87852
PLM 34 -166PB
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
952-01! -: 40. You may obtain copies of these rules or direct questions to OU C by calling (503)
24..699.
AP
Issu , • By: -�1J1 y / _ dj , / Permittee Signature:
Call (50' .39 -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 REiew ived / 1 p erm it N
D lb 13125 SW HaBlvd. Tigard, OR 97223 P
Phone: 503.639.4171 Fax: 503.598.1960 b& + t�
Date/By:
Other Permit No.:
Allr �I�'
24- Hour Inspection Line: 503.639.4175 r , Juls:
ard.or.us �.. Date e d /Met o: Supplemental See Page 2 Information
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist.
Addition/alteration/replacement Other: ew - i - a y dwellings g (includes eludes 100 ft. ac utility y connection
)
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Description Qty. Ea. Total
N l l f mil d 'n s in fore h lit c n
I . ' ;'& ,q "Gr*; Y QI?. OPISTRU,tv1 4 `' ) ;ha ll sv Z „ ` i' SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
• ❑ Master builder ❑ Other:
3 , ,. 3 � ;• A , , Fire sprinkler ( sq. ft.) Page 2
,.. a tw t oOB S1T ; AlYD z OGATION #. p
- � �,.E, �- .
�/ �� Site utilities
Job site address: 0 s' S J., J ` / h i r t% '.4 ) Catch basin or area drain 16.60
City/State /ZIP: i • Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
r
� u 2 k, 7 '7 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: •
W, .n;: x'z�z : >.::: '.x: �;.E,w a .a..c:.,y =,M, .3; =; i�� Absorption valve 16.60
iii i DESCRIPTION v W'a , ,, e r fi. a
O?♦ , CORK ' t
,�. -�-� � .�.,. � , ,. ��. :, �a�,� a.�.� ,x._,. , ...,n.,� � .,o � �� �, � Backflow preventer Page 2
2 /' / 2L/e. j. Z _ , C !� -� 2_ . Backwater valve 16.60
se /i-7' 9 � � t) ,�J� /� A Clothes washer 16.60
d i/ / f ' `'v - / ,� /" 'L 1 '/ f t' / - Dishwasher
1660
a, t � Drinking fountain 16.60
t r �giOP,E ..;. - M ER�, . „ .I -�, A - , �:�EN `:It . ;..
x ' , "°`` ° ` Ejectors /sump 16.60
Name: 4' 72"-‘,7,...„.., � Expansion tank 16.60
Address /, !/Q J / 0X_ Fixture /sewer cap 16.60
City/State /ZIP /J � ,�, �7� Z Floor drain/floor sink/hub 16.60
Phone;rf) &' �/ � Fax: (' ) Garbage disposal 16.60
' r;.n @::'• -_.,r a F° . a - r: >, � . :. ,:, '� Hose bib 16.60
;tn kn ` � : " F- i M,A wk , , TACT PERSONI , .-
3a- - .., Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (com- rcial) 16.60
Phone: ( ) Fax: : ( ) Sink/bas��vator / 16.60
Tub /shower /shower pan t 16.60
E -mail:
Urinal 16.60
.g g;n ,'ss ztl �-.. ; °a;,: + . > mss' h •`� :r .. e- �ynar =
W t z
OT RA CTOR; 1 4M P 'v..' Vx x
;::�:�:� >��`�,, >'��. -; >_ ' � 1- �. F>x:..'f���, � »x. ..E�� � �,�1� ".'�'�,����� Water closet 16.60
Business name O�� �/ _Water heater i, 16.60
Address: ll �� Y o _ j Other:
City/State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential back/low minimum permit fee: $36.25 7,01 '
CCB Lie.: ' . 4 �' lumbing io.: Plan review (25% of permit fee)
iv Authorized : a �. / State surcharge (8%o of permit fee) 5''(V
� / r TOTAL PERMIT FEE / i . 3 L)
Print name: Date: 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'i Building \ Permits \PLMF- PermitApp.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:
S>tteUt><l>tt>tes �. 6
fin't To tal`" SgareFootage , :,4.. iPermt t.Fee ..
Footing drain - 1s 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 �� ° � � � . �� �°. >•, ��� -°~�� --
Valua ><on Perm><t;Fee: ,
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72
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
1 ,; i : jk' e? _ additional $100.00 or fraction thereof, to and
4,,
Fixture oItem ... W = Q , ret
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 0.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the e first $50,000.00 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 report fixtures could result in increased sewer fees * .
WilINVOW Quanttty by (Ertyre) ,41kitiVi med
F ie A14,51e-tw,g;ALr E* Sa Pm .glt¢p ace¢' ,
ui cappaa 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"
-3"
- 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 Quantity 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:
is\ Building \Permits\PLM- PemutApp.doc 3/03