Permit CITY TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00266
c 'I 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/7/2004
SITE ADDRESS: 11565 SW DURHAM RD 100 PARCEL: 2S110DC -02400
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: 3
OCCUPANCY GRP: B FLOOR DRAINS: 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 9 OTHER FIXTURES: 3
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Building fixtures DWV and water piping only. Separate plans and permit required for medical gas and vacuum
system. Other fixtures: (1) drinking fountain, (1) expansion tank & (1) primer.
FEES
Owner:
Description Date Amount
DOUGLAS FRY
2423 REMINGTON CT [PLUMB] Permit Fee 7/7/2004 $504.40
WEST LINN, OR 97068 [PLMPLN] Plan Review 7/7/2004 $126.10
[TAX] 8% State Surchar3 7/7/2004 $40.36
Phone : 503 348 - 2237 Total $670.86
Contractor:
NORTHWEST CENTRAL PLUMBING
2870 SW 221ST
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Water Line lnsp
Phone : 642 - 2067 Rough -in Insp
Reg #: MET 1690 Underfloor /Underslab
LIC 72253 Top lnsp
PLM 34 - 197PB 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 -6699.
Issued By: 4/ . � Permittee Signature: I ` - ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
B kafng Fixtures
Plumbing Permit Appli do C 6 FOR * OFFICE USE ONLY :
City of Tigard JUN 16=, 2(' Date/By: (/f 6/1,9 7 Permit No LM OO V � OD pg
13125 SW Hall Blvd., Tigard, OR 97223 t' L PlanRevieN� l /�
Phone: 503.639.4171 Fax: 503.598.1960 y/aat,�N� . le I ,3 Date/By: t ,Other permit NcSWi�� _ ) g�,/
24- Hour Inspection Line: 503.639.4175 CITY OF TI
Alp
Date Ready /By: Juris: Ei See Page 2 for
Internet: www.ci.tigard.or.us BUILDING Di ivty Notified/Method: /f f q Supplemental Information
� K ,. „�_; ��r �� ,v�. tea � w ° � � � r-::a. �.,,� »,...: ,-
. , N :� ,; ' c arde�. iriz. � , r , '_ � ,. = •�t;;> x'�a; �.�„ E . 1, "art; - „ ,r^ ; .,; , ' `ti
V _ F , U EEE SCH `Eok , s .- .
�^ ,.. d g LFI g O 1:1 rw =r..
o de �� �. -��, . - �zca ��. mas;,, �,. -nab .� . �� �'�a � � e„ �a� �� saw . :.� .. �, ,..,
❑ New construction ❑ Demolition I- e_.e. For special information use checklist.
L Description Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
:,,z -- i SFR (1) bath 249.20 , e , � 4
#C ATEGORY I OF CO ISTRIJC TI ®N F t' ,, ur,'
°.°:�: z � - �s,. "A�s...,�,.�c�.v?- �..� �at '^.:.�:�., kt,> ..a. ;da r,..�.w,.,i..s�=
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
,,.; .,<,,. ; s - x� °F; .J ,-., ,,. Fire sprinkler ( sq. ft.) d Page 2
,% ' �,,10,S1TE IN ORz AND; �®C�ifi l®N „ , 4 n
��.�� � a�, � �-. � �> _�.0 � l Site utilities
Job site address: \` z j Z o 5' S r c.,i 7. IZ 1,, , Tzoi Catch basin or area drain 16.60
City/State /ZIP: 5 L - 4, ), Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
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
t: 3. °s „ .,. , .. t sx Absorption valve 16.60
it A ^.`. ,: � �;. 7 ;* RIPTLO WO ... ,.: ' ,.a, rn Backflow reventer , Page 2
p 3 g 139
, ILO
Lt&soLkain4._ 1 ( Backwater valve 16.60
Clothes washer ' / 16.60 `6.6
Dishwasher I / 16.60 ap
esi n -� r � Drinking fountain 16.60
a ,`;P1iQPEROWNR �� ' s= f >TEN'AN` :ia-,
t ,. x:.� z, w�_.. .6 , . ,- ,�aa, .. .k., 4.. o Ejectors /sump 16.60
Name: '7 , LA `., f Ry Expansion tank / / 16.60 al WOO
Address: ( 9, 4 9_3 p* H 1 3- t) Fixture /sewer cap 16.60
City/State /ZIP: t 1,..4 (3(2, 9-7 Cloordrai floorsink/hub aN 2 / 16.60 % , (90
Phone: (3) 34 g - as 37 Fax: ( ) Garbage disposal 16.60
'<��:r`- ,_��` ' r� ° „ �cr,»aru:,i t , : ,,,. m . 4r,_E;���, � Hose bib 16.60
r, ei 1 i ; iP ; I IC i ' � r coN: A 6-ife BSO F -�
;� .' �; -sue r. - '. ., :T . . -a.,, x _ ,>;� Ice maker I . 16.60 � 74 bd
Business name: \(J
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 1 16.60 / GU
City/State /ZIP: Roof drain (commercial) 16.60 J
Phone: ( ) Fax:: ( ) Sink/basin/lavatoryq" 14:5,q t �ct&A rZ 16.60 .199*"°
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
, . 4 .: N 4 .. E.. v ;m . �ie ltl .. + 3 ' � � ' ' '' Water closet 2 i 16.60 'S . AO '�. - � x ... � `fir a� s its �' r .� ate' .. � � �� m � �. �.���
Business name: N..7.942_ ..a..e . C.e. .\--ta..&. \ 116 Water heater 1 / 16.60 ` , 60
Address: Z cr'LQ. 5,,..., Z Z I S* Other:
City/State /ZIP: 14.:,- Subtotal U`�0/, 10
\ S I�r.?� m'2 `� Z 1 Z Minimum permit fee: $72.50
Phone: (S2,3) 4, '12_ - -zOCe Fax: (5 3) d, yz _ s -q 5 -4-1 Residential backflow minimum permit fee: $36.25
CCB Lic.: 70.,� 3 Plumbing Lic. no.: 3Y -/ i 2 _p i Plan review (25% of permit fee) /A,6 /b
® S/v /p State surcharge (8% of permit fee) A/0. 3G
Authorized signature TOTAL PERMIT FEE 47 0 • 140
Print name: �� 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 ts\PLMF- PermitApp.doc 12/03 440- 4616T(10 /02JCOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
t'OtYM atekajr,
TotaF' "; r
Site�LTtilities,� ; : . ,. _. 1 k:a gluare Footage , . :Fermat hee
Footing drain - 1 s` 100' 55.00 , 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
r 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' 55.00Va'IL1at1O1's
$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
`' ? t Fee ea of I "' additional $100.00 or fraction thereof, to and
X t11re ; Al' Items ' Q yA ei 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 • anji 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
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 * .
• 1-1•440.10 4.043. Quatittly by Ftxlure) Workferfiened
�� R
, e lace l
", Mo iied
� Exsn upped Comments regarding fixture work:
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 E. 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
•
Bradley Quantity Total
- C radley i l 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- PemmApp doc 3/03