Permit CITY TIGARD PLUMBING PERMIT
A'AVI I& DEVELOPMENT SERVICES PERMIT #: PLM2004 -00154
" 6 III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/9/2004
SITE ADDRESS: 09725 SW DURHAM RD PARCEL: 2S111CD -00400
SUBDIVISION: ALDERBROOK FARM ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: A2 FLOOR DRAINS; 4 TRAPS:
STORIES: WATER HEATERS: 3 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: 5 GREASE TRAPS:
LAVATORIES: 11 OTHER FIXTURES: 6
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 10 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: interior plumbing for addition & remodel. Capping: 2 lays, 1 toilet & 2 urinals. Other fixtures: 3 hose bibs, 2
primers & 1 bapistry.
FEES
Owner:
Description Date Amount
SOUTHWEST CHURCH OF
CHRIST [PLUMB] Permit Fee 6/9/2004 $680.60
9725 SW DURHAM ROAD [PLMPLN] Plan Review 6/9/2004 $170.15
TIGARD, OR 97223 [TAX] 8% State Surchari 6/9/2004 $54.45
Phone : Total $905.20
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 503 - 639 - 5296 Underfloor /Underslab
Top -out Insp
Reg #: LIC 2439 Top -out Insp
PLM 34 - 29PB 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
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 -6 -L
Issu d By: Permittee Signature:e //0.g4914
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• v\ O r7 *1 : :: ., FOR OFFICE USE ONLY . f " 7,,:
� /
Plumbing P mi: i Appl ication
Received � Plumbing
p Date/By �/� t� Permit No.: L--Yh d`��` C4 `J `�
PR •� is
City of Tigard APR L-U04 Planning ppro ./ //a SP
�/ / � ,
y Date/By: p i 0 1, Fermi (J 1 `i a, 7 b y/ j
13125 SW Hall Blvd. +i, P . Other , CIT OF TI �r RD ^' Date /By: Permit No.: I i
Iii rt t t(i �1v��7�� ff
Phone: Tigard Oregon 503 - 639 -4171 97223 f a 03- Post Review Land Use 1960 /� , I V , i e''� Plan Review Date /By: Case No.: }l '
Internet: www.ci.tigard.or.us _, " . e r a I' Contact ® See Page 2 for :,.
24 -hour Inspection Request: 503 -639 -4175 � ' Name /Method: 19 Supplemental Information.
i1
1
,.. t:- t s ecial info( a lAiTIOe
.. TYPE;OF�WORK�. r §�
...;. .., ..:,"• . ,;..,.: _... :.� :.... .. ... �- ..s!EEE * =SC;EIEDULE (�'9,. _ .. .. : ;
['New construction 11 Demolition Description Qty. Fee(ea.) Total
ii
�. a', t ', sa :. ; .i Vi �1?2;w�.% i : r IAVAI li a mii evelltn s r, .
►1 Addition/alteration/re lacement II] Other: .t i s < ;.., }� i � st .i••,,5:,�a ..�t,,••�t�� =taxa• >P �s� ,± ar:. :::,, ction i,ki- ,, i ,-: _ •s;:' . .
,
;.
p .;1;;f;;r;T i4irt �:;;-fi. incl udeS for.F ,till c ;;_,,:.:..
CAT'EG :00;0F,'•:CONSTRU:CrnoN :,*,:''a ; :i, :2` ; ( ty nn )'
" ` ` SFR (1) bath 249.20 /
El & 2- Family dwelling / Commercial/Industrial SFR (2) bath 350.00 •
Accessor Building ❑ Multi - Family SFR (3) bath 399.00 ■..
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 .
JOBzSIT E'. INFORMATiION 'andlI:OCATIOIWAV,:': <,', Fire sprinkler - s ft.: Page 2 •
Job site address: t i , , ; k ... •.b�€-��i:.t, l:s;". r• �;3 ° ° . .
���� �`' ill 1�;lRNRm �n „'��;i�. sk ���i'. iE;. �SIte�Utilit' ie s. �= .����:a.�.;�.�:�.�,� :�:,4�:�:t
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell /leach line /trench drain 16.60
Project Name: Ad O•HINE5r CROA ,-f OF C/'I RISr Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00 •
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 1 Lot #: Storm sewer (no. linear ft.) Page 2
Tax map/parcel #: se • Page 2
�.�t e�� . linear ft) �•��/ , ^
Water i
V - , .,r,r,. 102 tTi.kseRI•UDrtION OF: WORK`':Vi e �.:. Y t .
i ' e V `
F ;
�';j,'.::�a ;t•Y l�T 4 > .'..71 ti'v kf.' % .i lea. a; ,
Absorption valve 16.60
*LA , Lo C • Backflow preventer Page 2
/t .,Tlgja Backwater valve 16.60 . ,
Clothes washer / i 16.60 /.loe I i
Dishwasher 16.60
Drinking fountain 16.60
Q EROEERTY OWNER ,;,...,.:, :C) TENANTS , . = i g:M«,', •R.,' Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: • . -wer cap ,i '; 16.60 83 .oO '
City/State/Zip: Floor drain/1 oor sink/hub ii _- 16.60 (04 , 40 i.
Gar•a• - disposal 16.60
Phone: Fax: Hose bib / 3 16.60 y9. gO
1® sA'PRLIC'ANT>i,.-.. _- ` ' 'r ik:c4.-ERSOri ` :_ . Ice maker 16.60
Name: Interceptor /grease trap 16.60 •
Address: Medical gas - value: $ Page 2 •
City /State /Zip: Primer / 2 16.60 33 .a0 ,
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory i q 16.60 ,49J . Ve.)
E -mail: Tub /shower /shower pan , j 16.60 /4.410 ,
' ;-' ` , 7 0P :; .. r:. ' ",x k • .y.. U r i na l � 16,60 4 9. rO •
':` �:_.; t,..� <" , :. �CONT• RACTORi .k� "':``..�s +ci, '��: c���:i'- ••
Business Name: Water closet el 16.60 iy9,Ve •-
�e -regN Flom %NG lbw, Water heater .3 16.60 y q. TO
Address: pg6 4&i/ 6Ag,0 r' I» t /G/ Other: 13 %STA . I /6, 4
City /State /Zip: fl(/(z,D cK 972:2 Other:
Phone: .gin --6:39 729E Fax: 03'-1;gy -Yale ,' *°� , :r,-i,_.
,� "`:l;a.�.::1�"iv,� �- .t�P(unbin �Permiti. ;ees�,�:. ,�; � r u �.7_�::•.�.
Subtotal $
CCB Lic. #: t./:.39 Plumb. Lic. #:3 y2(iflt3 Minimum Permit Fee $72.50 S / .., 60
6
Authorized Residential Backflow Minimum Fee $36.25 CO C t
Si �,(„c , &- Aj.[✓ Date: 1Z--cg t Plan Review (25% of Permit Fee) $ / 70 a / b
g ) &1 /Az_c) ..S, - /il /LZ- - 1 State Surcharge (8% of Permit Fee) $ 5 . 9 5
(Please print name) TOTAL PERMIT FEE $ 9c • a`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. riserdiagram for plan review.
*Fee,methodology'set by Tri- County Building Industry Service Board.
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