Permit CITY TIGARD PLUMBING PERMIT
4� I DEVELOPMENT SERVICES PERMIT #: PLM2004 00101
,�I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/17/04
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114A0 00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: El FLOOR DRAINS; 2 TRAPS:
STORIES: 1 WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: 20 ft
WATER CLOSETS: 2 WATER LINE: 120 ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Set fixtures in portable classroom. Other fixture is (1) hose bib.
FEES
Owner:
Description Date Amount
TIGARD - TUALATIN SCHOOL DIST
13137 SW PACIFIC HWY [PLUMB] Permit Fee 3/17/04 $305.80
TIGARD, OR 97224 [TAX] 8% State Surchan 3/17/04 $24.46
Total $330.26
Phone :
Contractor:
OREGON CASCADE PLUMBING
PO BOX 12127
SALEM, OR 97309 REQUIRED INSPECTIONS
Phone : Sewer Inspection
Water Service Insp
Reg #: LIC 127 Rough - Insp
PLM 24 - 33PB Final Inspection
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
ors .
Iss d By: ,;;I� %� _ l/ �,; Permittee Sign ature: �� � d i,,4.0,
all (503) 639- 75 by 7:00 P.M. for an inspection needed the next business day
r
Building Fixtures "C)
P1'Umbin Permit / / F OR OFFICE` USE ONLY - -- • ,:' ,., : ,.:
.v
City of Tigard Received Permit No
13125 SW Hall Blvd., Tigard, OR 9722 1 �oo Date/By / (� c 1.
Plan Review
Phone. 503.639.4171 Fax: 503 598 19 ' I %%-A G e � w � q � , � , 0 1 l i I \ Date/By Other Permit N o '_, g/
24- Hour Inspection Line. 503 639 4175 O , i\S, . L Date Ready /By I °r' Q See Page 2 for
Internet: www.ci tigard onus t (LN Q Notified Method ,/ 10 Supplemental Information
° , rah` :':it ` . i e r ,u; ; . 14 ` , ;' r ,. „,...t„; SCI , e E;
�S 3a` � .�' , r �4 :.P+��. _ - � ���_ :',,t �is= , ; ,, ; , ':. a ,�,,.u�� , v�,_,., ,� ,..,x.. , .�n_—
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. Ea Total
"I-Addition/alteration/replacement ❑ Other. New 1-2-family dwellings (includes 100 ft for -each utility connection)
.l r - ° CATEG "OR C rTSiFRW'C, ; a -. r . Y: `,
E
� � � � - -,. ,. Y ' 'AO ,i ° 4' � _,. SFR (1) bath 249 20
❑ 1- and 2- family dwelling 0 CommerciaUmdustnal SFR (2) bath 350 00
❑ Accessory building ❑ Multi - family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
0 Master builder 0 Other:
,. �, _ . x .• 1 .: x Fire sprinkler ( sq ft) Page 2
.:�-
' =s ,:,.�.J4B' INF, O R r , : .- O 4 d. € . ,_' ° ' '' ,
.,,,. N � Ex<., �:��. r � . ..4. � •'.s: ��,, ,= ate* , �.�' "� t '.� .. Site utilities
Job site address: ' ' j 5 e J 7 if �` ,/�� ` D Catch basin or area drain 16.60
City/State /ZIP. l'../. ' - / i ,O O d � 2 ■ 7 Zl [� Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: ARE 5‘4,90t- / &ZTA 5 Footing dram (no linear ft. ) Page 2
V Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft.,/'0 /) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no. Water service (no linear ft / p'10/) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16 60
, 1 ; " , ' - b S G IZIPTIQ N, ; = OF VVORI * „ -,n t ' i, :.t
�,.�'? r tr °,: ' ''i'� "3 , �: a�, s � ; � € ;��.w .p , ���,r;�: 'g, / �� :v,' „,: =. Backflow preventer Paget
R CP / l c;/(1/6 [_ iE sCC[ /_ Backwater valve 16 60
C L4 S 5 edeffil Clothes washer 16 60
Dishwasher l ' 16 60 ` .
r, r °. ::; • .. - , .a.; , , „,,,,, ., - ,_ ,> Drinking fountain 16 60
WNER 1. -' i� ,;. T E =� =;.�'ro.
ry. � . _ ,, ..:. �s� - -, ti'.:° Electors /sump 16 60
Name: —r " ��4L r!// SzAk t
/� Yid,[ 17ta5� Expansion tank 16 60
Address: ‘ CI �a s S. gV 5,1m7 a s r. , cap 16 60
City/State /ZIP: 7 (s4'f red l // , 9'7 2....2---- rg-e—v;aior sink/hub all 16.60 3 Phone: ( ) V Fax: ( ) disposal 16.60
r. . , -i ,' a .: ,:. ` w';..' . -'. +. 77 Hose bib ! 16.60 /6. 6 a
° ; ,,j , A,, 41 Ail' 1111`<'; G O TACT ,PERSON, .
x / �A / Ice maker 16 60
n
Business name: 2C L Cow C CI. e4pE PL/J � n
, c '� �. C iV c- I nterceptor /grease trap 16.60
Contact name: /re iiv .5 r I' (. /( LEY Medical gas (value $ ) Page 2
Address: P- g4-1( / 'z t Z 7 Primer 16 60
City/State /ZIP: . 4 LEA 0 A , G� 73.69 Roof drain ( 1) 16 60
r � �`° f CO / tpan , 0
Phone: ( j3 ) J O - O 35 � i Fax:: ( 63 ) 3 q . Z 76 16 60 ,
E -mail: Urinal 16 60
:, : ` it „,„ 4 ` ;� li *4 Water closet ..2- 16 60 _.
Business name: Water heater 16 60 j
Address: Other. St:OE / '., 10
City/State /ZIP: ,.//-- P S h 6D a Subtotal 3 6 g0
Minimum permit fee $72 50
Phone: ( ) Fax ( ) [ ,I Residential backflow minimum permit fee $36 25
CCB Lic.: / 9,7 1\ ),.. , � , 4 Plumbing Lic. no.:,, ? ' ✓ ✓/ 46 Plan review (25% of permit fee) A1r'r6 6 /5 6 / 6 4 State surcharge (8% of permit fee) ,2 z/ . it/
Authorized signature: TOTAL PERMIT FEE
c
Print name: � i) Date //5' 4 This p ermit application expires if a permit is not obtained within 47
9--f�'t =Y 180 days after it has been accepted as complete. g7 •
- *Fee methodology set by Tn -County Building Industry ServiSoard
i \ Budding \Perrtuts\PLMF- PermitApp doe 12/03 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
'''' a •i , `": `4 fan ' „,� ..: , > : r,., �; t ° s ; ee e`a ' § o1arn , ° 3 ;, ,. - .
ie tT ><es. . >£q ". , 1 = Q , " F ( ,;; ;:5 , ua r '' oots e.�£ s - { PermitFe
x..� �,.. t =e:� �_:..�; � � �..�� . „.�,.. ,. ��:.�...n .�� �.. � .A �z , q� ,..,.�F� ..�d � g�... ti � x ,�.. , � _ � . , . �ti..�. � -_, ..
Footing dram - l 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' 4 / 55.00 ,'r,',S^ 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' /Bpi / elf 55 00 65.00 Medical Gas Systems:
Water Service - each additional 100' po/ 46 40 Y�
'�{ valuatio ; ..- „ Permit; Fee • .
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
qr s „ ,E , additional $100 00 or fraction thereof, to and
xture; eTri' `: ::. i : a lti e (eaj; _ Total;, .
u ?.�,. �� <ar��.� €;� �'„ :r',�,� '.��� „� 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 incluuding $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
� ", x.i =Y 'r uautitt`�ti'`d'(Fizture �'Vork:Ye'r'formed
Fixtur ' : U, : g ` Repl'ace ,,�
�n �
g�- Capped`�r i Comments regarding fixture work:
.a � ? ^�N.&,'�'� _
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 ain increase of sewer EDUs, a sewer permit will be issued and
Ice Mach /Refrig Drains
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 required 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
t \Buildmg\Permits\PLM- PernutApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
R 1 `
4 11;16 Date Res uested — - S-' O AM PM BUP
, Location Suite MEC
Contact Person /1t€, Ph ( 5 9 2 2 ` 3 3 Z , C --(7d / 9 /
Contractor Ph ( ) SWR
BUILDING Tenant/Owner GGt . 2 S 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 d../7/
Fire Alarm
Susp'd Ceiling
Roof
../ /,„04
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
R � ugh - In
ter Servi
sanitary Sewweee
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other;
Fi•.1
AS - PART 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE:
/7 ' Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Dat� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL