Permit , tri
A , , CITY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00547
�,�, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/2004
SITE ADDRESS: 13776 SW ALPINE VIEW PARCEL: 2S109BA -08800
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow preventer.
FEES
Owner:
Description Date Amount
HEIGHTS CONSTRUCTION
PO BOX 91249 [TAX] 8% State Surchari 12/8/2004 $2.90
PORTLAND, OR 97291 [PLUMB] Permit Fee 12/8/2004 $36.25
Total $39.15
Phone : 503 291 - 2550
Contractor:
THOMAS CONSTRUCTION
P.O. BOX 91283
PORTLAND, OR 97291 REQUIRED INSPECTIONS
• P RP /Backflow Preventer
Phone : 503 690 4925
Final Inspection
Reg #: LIC 6361
SUP ALL PHASE & BA(
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 OUNC by calling (503)
246 -6699.
Issued By: / _(��Z. Permittee Signature: ' �1�,..
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
RECEIVED
Plumbing Permit Application DEC 0 8 001 F OR OFFICE USE ONLY • , ,
City of Tigard Received la /s� JUy gj .7��Vf
PermitNoAn . 9 00 ' 7
13125 SW Hall Blvd., Tigard, OR 97223 UN OF
Plan Review
BUI L DIN f,;wa���;N�,
Phone: 503.639.4171 Fax: 503.598.1960 R ��; I -W i+�N Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 4 Dat Read B y i 8 B See Page 2 for
Internet: www.ci.tigard.or.us y /
Notified/Method: Supplemental Information
,use ,y, ..r:P� =,�} a;.:. a „ '. Paa ':Fn r; «�c:; S,,:.��i. �+v "-2@ze° >,
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❑ New construction El Demolition For special information use checklist.
Description 1 Qty. Ea. Total
El Addition/alteration/replacement El Other: New 1 2 family dwellings (includes 100 ft. for each utility connection)
WW ;;zi. � ���''�''- $,�r�.t - ,.�.:.�,� .;:: draw« �.,,. ��`> k .� °;;�ss.„a. � e:e:= s �.�c:.n?- gc :•;,v�s ::a �::r;Y;," ,y
W r li CAT);G GI=Z '`_ : r ` � �e ° SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
1=1 Accessory building El Multi-family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
El O ther:
. - ';- r:u;t�,: ,:R.. .. u m 2,�. ,. Fire sprinkler ( sq. ft.) Page 2
S . �$ SITE TNFIJRNFA�ION D L�OCATTO a a t
�# �."'`.€ � ��, . �: a. ,.- ,�.:��a�.. ��s..,a.,. �sz�.. >.,. >Rs,. *.,.. ...» ..., x i..�. -,�� S utilities
Job site address: /3776 4/, / ((f e U w Catch basin or area drain 16.60
City/State /ZIP: -
/j� .'g �j' Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: / 9 4 "4 / /� Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
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.:
:.
Absorption valve
" ,,'i Y:, .�`?>a. °- ` 1i n n i� s a` i ft, ' w'.. ` J;h - s `.a :-:.rxj �, - i`t:.i: "3�T F ° 3 ° ; ^ y „:r i
� t, t nESC r LO v o o _ x 4 s :� u , kfl
-
q -x .n . ..: . r:�.. >.- 1, -a., Backflowpreventer Page 2
/lCeY J✓ah /�4A.a -t Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
: a ' r .4 f, Drinking fountain 16.60
s ? ,;' ' P ®PER.TXY (,Idi , , a .. _Z AK, .. T TE :' : :: „ „IMffi g
Ejectors /sump 16.60
IA n
Name: +-+ 4t ( X31' \.S Expansion tank 16.60
Address: ?c *0 p, ° ` a3.1 Fixture /sewer cap 16.60
City/State /ZIP: ' 7 `�),. O` t C Floor drain/floor sink/hub 16.60
Phone: ( 3) a3`(, c ST b Fax: ( ) Garbage disposal 16.60 .
F r "'' eT ca ° , a
'.i``� ~ t I , t _ .�, ®'CQ4ITiiAG` PEI2SQN 1 Hose bib 16.60
i,.
P�.� � �.�:e�:��:, . e . �. � , � � >;c�.HI,.,��� ..��. -:�.._ -� Ice maker 16.60
Business name: 7L, , ,h�o.S „„z.„.94,..,6„, Interceptor /grease trap 16.60
Contact name: S7e4,, 7Z40-76...1 Medical gas (value: $ ) Page 2
Address: AO ,064, �j�1ej Primer 16.60
�
City /State /ZIP: l 7ov / ®A 7.29/ Roof drain (commercial) 16.60
) �5C 7 ,21 ( ) Sink/basin/lavatory 16.60
( 5 , 3
Phone: I Fax: :
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
�- _ .1 .. .,. .. , .P4 n , T „ r w -K.�, ; .. , : j z r : W ater closet 16.60
Business name: `i f � j �� j ,,,. t Water heater 16.60
Address: /10. 50k 9/2�3 Other:
City/State/ZIP: 6,�' Subtotal
/� �� � ��5 / Minimum permit fee: $72.50 /'
Phone: (S ) o ei - 9.9 / j Fax: ( ) Residential backflow minimum permit fee: $36.25 36.,, L)
CCB Li 436/ A! •> I p 5 Plumbing Lic. no.: �/1 Plan review (25% of permit fee)
'' � i �� `" State surcharge (8% of permit fee) • 96r
O
Authorized signature: TOTAL PERMIT FEE .0-1 1
• Print name:4o 7 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:\ Building \Permits\PLM- PemutApp.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:
1 S](te Vt111tIC5 ' fi � " 5Qty1 Eo al, Q g ..
Y«; ,,�� „�� � � �S ar �oota e - Per Fee
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
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
Fixt
, ure or ; : az *°.f` ite a m , <,Fs' " T =` °' "t " - xlFee' eaF '" : jTota1a additional $100.00 or fraction thereof, t� and
° '10ttsir.T11 ;; .K ...:,.:
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
Subtotal: $50,001.00 and up $742.00 for the 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 * .
0 ,01 r Q ifntit 'by (Frxt>r e) Wort Perto ined�
Ftxfare ype F" Replace'`
M° ed . r.V n .Itca j , 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 Quantity Total
-Bradley Isometric or riser diagram is requ if fixture quantity
- Commercial
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 \Pemuu\PLM- PermitApp.doc 3/03