Permit • CITY OF TIGARD PLUMBING PERMIT
N I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00070
' � I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/28/03
SITE ADDRESS: 07560 SW BONITA RD 036 PARCEL: 2S112BD 00100
SUBDIVISION: TIFFANY COURT APT. ZONING: R -12
BLOCK: LOT: 065 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: 12 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 12 ft. sanitary sewer line.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 2/28/03 $72.50
#200 -L, MS63 [TAX] 8% State Tax 2/28/03 $5.80
HILLSBORO, OR 97124 -3082 Total $78.30
Phone : 503 846 - 4794
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDS DALE #8
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone Sewer Inspection
hone : 239 239
Final Inspection
Reg #: MET 00003082
LIC 00049418
PLM 26 -533PB
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
4
Issued By: ` �1 � /'f / . _ Permittee Signature: __.---7 /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
N Received Plumbing
• DateBy:02.---25a--49 5 Permit No.:11_rn0. 'cr-7D7,r
City f TI and Planning Approval Sewer
Y g Date/By: 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
//H�uvd1 " � DateB Case No.:
Internet: www.ci.tigard.or.us el � I' Contact Juris.: El See Page 2 for •
24 -hour Inspection Request: 503- 639 -4175 "" W Name /Method: Supplemental Information.
x' `w d ,. y '"°. .'S' .�:; �� ..:�" ^, .: t +fy .�`.� -.s ;.� .�.', - ° �._�.,. si��.;x,.,_�..v,.-s�-Pk^ :r - .v",,.+��� s
z1 �,;" �. ,;.��;;�::�TYP,E®F�W,ORK�:: ��. �'` for ecial information use checklist .'_�
. �.. ':h�- ,,r.,:;.t_ ,�`;FEE P � � ) ..,
❑ New construction ❑ Demolition Description ( Qty. 1 Fee(ea) 1 Total
❑ Addition/alteration/replacement ❑ Other: r f d oo auuly� w ent gs - rx
i (in W &
c u es I , rft for4 ection) A ,Ig 'v.i
Z - _ i= ECATEGORY,OF CONSTRUCTION „x.,. . „:. SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 .
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
i ° „g JOB SITE ION. t = t ` 3 Fire sprinkler sq. ft Page
Job site address: ' (, 0 Sty) ` r.. 4. V24g, ila - ,> tte;Tltilities°
Suite #: • 7__;„, -. Bldg. /A.t. #: 3. Catch basin/area drain 16.60
Project Name: (3U t) /11(_, 1 \ Drywell /leach line /trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
t a 1 ^0- k r k. Rain drain connector 16.60
Sanitary sewer (no. linear ft.) 1 - '2_ Page 2 35
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water map /parcel #• service (n in linear ft
ater (no. e Page 2
RREM � DESCRI.I'TION 4OF WORiai :. . , , . x
Fttn °or Item '� �� `'` 1: �'
" Absorption e 16.60
e 9 \o r e C� 12. C- \ C-C- C," Backflow preventer Page 2
Se`" k‘v■ • Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
` TROPERTV OWNERw .r , IR ENANr ° .,..;> Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
i. ANPPLIC °`A`NT .. ' E .: TI ,.i 4. EVCOMAMOEWONViaii Ice maker 16.60
Name: e- - &- ) N.-01s- Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City/State/Zip:
Primer 16.60
P Roof drain (commercial) 16.60
Phone: q6, i - 02 'r Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower, pan 16.60
.¢F . ` i .:3CON;TI2` eit0R` 4' S,,g .. .i Urinal 16.60
Business Name: \t) ` (-.-)(Nek, Water closet 16.60
Water heater 16.60
Address: 22c )9c ' UV to , k - '(i\5 ke .50,\ Other:
City /State /Zip: t\c2:5w, t� 7c)-(1), Other:
-
Phone: 3c( _ ) .cg - \ Fax: go 5 8 - itata . t .. tiiimb>:ng.Permi Eees* _ , Rgam; ; . _
CCB Lie. #: I ( Plumb. Lic. #: 2,6-533 Pb Subtotal $
Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25 7(9\ . 5
Signature: _ ice - Date: GZ - 2$"-03 Pl Review (25% of Permit Fee) $
9 n `',r (J v"` S 4 e t e c State Surcharge (8% of Permit Fee) $ . 54
(Please print name) TOTAL PERMIT FEE $ `7S( W
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
•
Fee Schedule: Residential Fire Suppression Systems:
t Fees ea �,,Tota
(`�y) Square Footage:, , , „ Permit Fees
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
s _ additional $100.00 or fraction thereof, to and
N ,� _Fixture or,Item >� _ , ; QtY ,,, _ <Fee.(ea) Row 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 *.
Comments regarding fixture work:
� � _ ,� Quantrty by ( Fixture) Work P,erfortned�; g g
A .
a O . s owed ' ; . Gapped = ==
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
increase of sewer EDUs, a sewer permit will be issued and
Disposal - Commercial
- 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:
is \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 R9quested AM PM BUP
Location - 75 7 C C I T/ 4* 3(0 Suite MEC
Contact Person Ph ( Ao 3- c 7 ()
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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
Post & Beam
. Under Slab
Rough -In
Water Service
iary ew
ai
Catch Basin / Manhole '
Storm Drain
Shower Pan
- T FAIL
ANICAL
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 Please call for reinspection RE: E Unable to inspect — no access
Fire Supply Line
ADA '3 Approach /Sidewalk Date ! l Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL