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Permit r • • CITY TIGARD PLUMBING PERMIT I ,�' �', III 1° DEVELOPMENT SERVICES PERMIT #: PLM2004 -00236 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/26/2004 SITE ADDRESS: 12109 SW ANTON DR PARCEL: 1S134CB -13600 SUBDIVISION: ANTON PARK NO. 2 ZONING: R -7 BLOCK: LOT: 063 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: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Move toilet & shower drain for bathroom remodel. FEES Owner: Description Date Amount LEWIN, KAY F + JAMES S [PLUMB] Permit Fee 5/26/2004 $72.50 12109 TIGARD, OR 97223 SW ANTON [TAX] 8% State Surcharl 5/26/2004 $5.80 GA Total $78.30 Phone: Contractor: OWNER • REQUIRED INSPECTIONS Phone : Rough -in lnsp Final Inspection Reg #: 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 952-001 ! 00. You may obtain copies of these rules or direct questions to OUNC by calling (503) 24 : -6699. is. ued By: _ A. I ; � Permittee Signature: Call (503) • • -4175 by 7:00 P.M. for an inspection neede• the next business day Building Fixtures , 'r Plumbing Permit Application FoR OFFICE USE ONLY :,f r lr. . City of Tigard Received 13125 SW Hall Blvd., Tigard, OR 97223 P a Re mo d/ i Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Aa�aar I ��� Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 f =-„ - , Date Ready/By: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: _ -- � (/JQ Supplemental Information r �. ., 1 t.� a.'� a ?.� ;�a4�s'�a. R er �k� ?r i � ?� , �,:;� � : a.F .;n `�:�;.: a(« - t °�,. - ;: ',,..�� t, 7 .. y ;,�:,. F Y Y)v () ` d,', f F � �� >_a .. 1,.� �`M: s ��..� ��a!:c „..:- ta �'� .�'i�'` -.. „�f�':_n`�;�sx'�; �';: 's' °. ,. Wrfa _.4 .',;, -.., ,.. " ' -, El New construction El Demolition For special information use checklist. Description 1 Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) 'ti;.:.`- 3f E "':,�'`�';::- �.�y,° ,::la�?i�' �. ''r�.;wa�''� > ". t�', L °?T,s'i,��t;��;a«-.k - °h".:;�^- ,..f,: �;•, -< "mod' " • .��z�.�_ : p'�;'_`< =�,r SFR (1) bath 249.20 r ATEGO OF Q S�TR'U`C'1t10N 1 K � ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 El Accessory building El Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler rinkle 2 . x dOB'SITE I 'ION�AND LO4TpON z a t p ( sq. ft.) g r s t. Page Site utilities Job site address: / 2 / Q 7 s "9n X `M 5. 2' • Catch basin or area drain 16.60 City/State /ZIP: L 771., of •-..-/ / S Z Drywell, leach line, or trench drain 16.60 • Suite/bldg. /apt. no.: Proj ct name: / Footing drain (no. linear ft.: ) Page 2 .4 t° 4.- i h Manufactured home utilities 110.00 Cross street/directions to job site: Sc 4cif- .' 4. c / .c7` Manholes 16.60 U ✓t i Z / £-P. / !Z ,•45... ,( p ` 1...., '.Y. /Ott AD r'G4 . Rain drain connector 16.60 2t' i In r d ✓"N. � ' I..., � Sanitary sewer (no. linear ft.: ) Page 2 (/ Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 X 11_. t .. . .F... . i e ��Z Baekflow preventer Page 2 / v � 0 "� e -/ , Backwater valve 16.60 NNW ""��� Clothes washer 16.60 Dishwasher 16.60 �:��. ; Drinking fountain 16.60 I, PROPER ', � IER i._r w. a... �.._;' ..,...��g mod_ a� Ejectors /sump 16.60 Name: 1<a Y ,i,...• w , ,--, Expansion tank 16.60 Address: / a / V 7 s-, t-e.-. "9,7 ,e,,,, 5 / &. Fixture /sewer cap 16.60 City/State /ZIP: 7, .0`� chi ? 2 2/ 1 c Floor drain/floor sink/hub 16.60 (s V � S -s �3 Fax ( -� Phone: Garbage disposal 16.60 °s<�';�� .;yet, :� ":~�s ,�.,,.t:� � <_:. =��•;� ?t Hose bib 16.60 t; ❑ LIG Art ; „ :, �CIONT PERS©N tee 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 (commercial) 16.60 Phone: ( ) Fax: : ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan / 16.60 /6 • Go E -mail: Urinal 16.60 _ ? CONTRACTOR ,4 l .. : ` (� U 3.;: __t „ ° . , 43 ; , a� Water closet 16.60 / • Business name: � `../ Water heater 16.60 Address: // 1 � �� Other: C� Subtotal City/State /ZIP: Minimum permit fee: $72.50 �a Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) , Authorized signature: �y TOTAL PERMIT FEE g ?J' C) Print name: i% -a p.,.^_� 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\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: Slte Ut111tIes _11,64 'gy C. 4 ..s _. Qty e (ea) Flaw; # Sq iare Footasge; , :, Pei init 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 �� �� a � �` ,aluati<oi Perml< Storm & Rain Drain - 1st 100' 55.00 � V $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 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 specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the e 0.00. first rst $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees «� ,I � � � 'Quantify by,�h'lxtur���rklPerformed� Fi ure +"$p a e4 f gi eplace� i 4 o, 44.01.. .s " N,ew ffi o = xs,n x � pedk' Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi /Whirlpool Car Wash -Each Stall -Drive Thru • Cuspidor /Water Aspirator • Dishwasher - Commercial -Doiii siie I Drinking Fountain Eye Wash _ Floor Drain /sink - 2" -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 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\Permits \PLM- PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING `� ` Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line:.. (503) 639 -4171 MST / BUP Received Date Requested / J, � ' AM PM BUP Location ©l G �/y(�}� Suite MEC Contact Person Ph ( ) PLM ra © c - - Contractor Ph ( ) SWR BUILDING Tenant/W sa � ��3 3 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 PASS PART FAIL PLUMBING,LL Y` ' . Post & Beam Under Slab Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan t e- PA PART FAIL CHANICAL 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 �j Approach /Sidewalk Date V Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL