Permit •
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00533
call 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/8/03
SITE ADDRESS: 13181 SW CHELSEA LP PARCEL: 2S102DB 04200
SUBDIVISION: CHELSEA HILL ZONING: R -12
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: ALT 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
•
Remarks: Replacing gas water heater.
FEES
Owner:
Description Date Amount
PRUETT, DAN
13181 SW CHELSEA LOOP [PLUMB] Permit Fee 10/8/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 10/8/03 $5.80
Total $78.30
Phone : 503 968 - 2293
Contractor:
OWNER
•
REQUIRED INSPECTIONS
Phone : Misc. Inspection
Final Inspection
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Pe�r> �. `cation FOR OFFICE USE ONLY ,
�t�e Received {' Plumbing
N II
DateBy:,. 6 j9 Permit No.1\0O3 - � 5
CIt Of Tl and Planning ppr v.l Sewer
y g OCT 8 2003 DDate/By: . Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 %KY 5 3T5 ?FA0 Post - Review Land Use
Internet: www.ci.ti arP.1Ill f?ING DIVISION ' 4- ° 'l' ' I Date /By: Case No.;
g ■ �,�,. e'I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 �'" ' Name /Method: Supplemental Information.
:Vt ; . -,, ( f 1TYPEnUF4WURK !;'z..'. - ":<; 4.: _ „ _,. AA5:'_�FEtt.SCFIEDUtiE -( for' t ,' speciatinforinatonlise ; checklis "t) i VZ
❑ New construction ❑ Demolition Description 1 Qty. 1 Fee(ea.) I Total
Addition/alteration/re lacement Other: i2; . ` "W % ` New 1= & 2=famiiy dwettiugs i�t ;ism`=
i
.,s "'.L kf7?"� r i e , rr•4: a :$ ^'F:� w :']- a'T &S ' Yeas p , .;} .a4 9:k' e._.
CATEGORY .CONSTR'UGTION, ' loclud each�utili connection
SFR (I) 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
, hr•z„ir JOB<SI-TEANFORIVIATION and LO@ATION 'ii: . , Fire sprinkler - sq. ft.: Pa•e 2
W '� ;x _ ..„„.. 3�u;
Job site address: )�� 1G5/ 6((.� CiEcLSFd� (_ g = =;�� o" �';E:M:.`4�;�A.. s ..�SiteLtfitit'ie`s: ,rix'�� „�.,,�:<.. �;
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: DrywelUleach line /trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
btl/ im-1- C-ln�( s €-a Le Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2 _
. _ 4.41 =', ,7- ;> °F txtu w :
_, ',. : ` : :: ;DESCRIPTIONwOF:WOkK" ,F_, ; Ym :,r - t.- re;or a <' ''
Absorption valve 16.60
(.2 ft, / Backflow preventer Page 2 • / C � � � � 1 L � ( Backwater valve 16.60
�a-, \R_ l,[/ C.1 Clothes washer 16.60
>I Dishwasher 16.60
4 U. R ,. _ ;'n.':!1,. Drinking fountain 16.60
PROPERTYzOWNER..w . =5 ��e 115lOTYANT;�'�,��i �°.,r�° :.
`��`' � Ejectors /sump 16.60
Name: bi\ vJ l?fLiA. -CA-t- Expansion tank 16.60
Address: k 3 k S l Si,) (` (, e ( S e4 . Lc Fixture /sewer cap 16.60
City /State /Zip: f1 44 ,,, i , ) it__ �' z„,__ Floor drain floor sink/hub 16.60
Garbage disposal 16.60
Phone: ( g6, y- a i 9 3 Fax: Hose bib 16.60
® ="APPLICANT =. ' - _ < ; a; ,:t / ; _„ v ^ =v ';CONTACT -EERSQNk k Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip: Primer 16.60 •
Roof drain (commercial) 16.60
•
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
._rs ..`° n 'CONTRACTOR.:- ' . ,, ,. 5:• . Urinal 16.60
Business Name: 0-7,o-y\ jjt - , Water close 16.60
Water heater / 16.60
Address: Other:
City /State /Zip: Other:
" ;::::-N:;„ ,: �;;:• ,; *:
Phone: Fax: : .. t ,.. :Md ,.,- {: :,
,�. r ix�,:�,, Rla'tn"6i'ti �PermiflFe`e's,�.�s. Y � §�% :{;,:,„�;.
CCB Lic. #: Plumb. Lic. #: Subtotal $
Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25 '73 . SO
Signature: Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ ./ l
(Please print name) TOTAL PERMIT FEE $ •, l
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 \P1mPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information '
Fee Schedule: Residential Fire Suppression Systems:
'E'&Iea ' '
,� .,E_ . �r- ..� •..,�,., ��. - ... � �,E � Square Permit 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
Sewer 3,601 to 7,200 $220.00
ewer - 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 Valuationi,,. •.,
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
$ 0.00 or fraction thereof, to and
- -<.�;; ry additional 10
"` '`° F'izture or'Item �, ,t ' 4?`- MiqtYa 4,F,A(0, MAW, 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
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 *.
u,; °K t ` ", vfi r a " ' E ,Quantity by (Fixtur e)AWoi k Pei formed' Comments regarding fixture work:
1.iture � Aiit ", t , % j• f „ v z
Replace � . "`g
arss«r f aaitt it" New , " '�Movedj 1 1
g . @apped
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 *Note: If the fixture work under this permit results in an
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- 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 Requested 0 -S AM PM BUP
Location 131 fi ` � -/ 1 L � 5,�a, �!' � Su ite ME C
Contact Person 1 CW 1 Pr.J Z Ph (�/� - z Z3' ap 3 - (Zj.513 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: (9/F-7.5-- I /� ELR
Crawl Drain 1 / 7
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 A „
Other:
Final
400
P ASS PART FAIL
PLUMBING
Post & Beam
Under. Slab
Rough -In
Water Service •
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: herr
� %�t�l'
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 LI 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
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF T1ARD •
24 -Hour
BUILDING'°' Inspection L143 -` 175
INSPECTION DIVISION . Business Line: 5 111t MST
BUP
Received Date Requested l I —/ D AM PM /6 /" BUP
Location f 1 181 Suite MEC
Contact Person Ph ( ) 6 Ff - z 2.39 PLM 3 – D 0 LS 33
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear IN \ L 4(02-1 „ t v �\�
Framing V V
Insulation d
Drywall Nailing �/
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling 1 �`
Roof
Other: �
" d�� � C.— {
Final ; � •
P T FAIL
LUMBI, 0
• Post &am
Under Slab
Rough -In •
Water Service —
Sanitary Sewer fu , _� V .
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot -- .
SS PART FAI
MECHANICA
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 ) A
ADA �l v�
Approach/Sidewalk Date WI u Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL