Permit C ITY OF TIGARD PLUMBING PERMIT
itVi I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00418
A All 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/10/2004
SITE ADDRESS: 11565 SW DURHAM RD 120 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: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI, adding (1) lay, (1) toilet and (1) water heater.
FEES
Owner:
Description Date Amount
MOODY HOLDINGS
5701 NE 105TH # D [PLUMB] Permit Fee 9/10/2004 $72.50
[TAX] 8% State Surcharl 9/10/2004 $5.80
•
Total $78.30
Phone : 503 860 - 0235
Contractor:
CENTURY PLUMBING
2710 E HANCOCK
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone : 538 Rough -in Insp
Top - out Insp
Reg #: MET 00003257 Final Inspection
LIC 19085
PLM 36 -24pb
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 -66' •
.
Issu • d By: i , Permittee Signature
Ci
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 {r l' .- --
City of Tigard DateB d ��ld QC/ Penmt No ' 1 figoper — er ) / gl
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone 503.639.4171 Fax 503.598.1960 /bron y�� l
111\ Date/By
Other Permit No'� . )2 "„q611
24- Hour Inspection Line' 503.639.4175 �`' I Date Ready/By, i °r' B See Pa e 2 for
Internet. www.ci.tigard.or
ardor us , g
S Notified/Method � , Supplemental
- .
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❑ New construction ❑ Demolition For special information use checklist.
Description I Qty Ea Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
:r =� ^�e�' ",,x; °�`�`SV:�.�,�, .�.�,,.,,.. ,.,„flt:r<.,�^�a. ;: :.�'�:..� >",�"Feca�: 0 ^ % �:� >.'> `,. ��i = :,u:; �.
' '�e yk ; ; tCATEGORY.�FCOIsrilli TIO : : ', 1 `: ' i , t :; SFR(1)bath 249 20
'r "�^���°` <"�.• as 3s;5ac^ "3a = �.;�: sz�:; : �.. �- :t " ^ �,:..,_ �:irsw::�.: „'�,�;_ "df'�3: ;'�,': s,':y�» rX�'�i: � =
❑ 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.
r , ,; :.; tx: t i y .. , E �: ,.,' .. " r Fire sprinkler ( sq. ft.) Page 2
_„ w `; - , w i JO O TION 5„ o D t.U CAT'I6 V - . ,
-" ..r"�k. 1 :,f ,, �. '� ,: "^ u•,,:; ,,,,., p ,. ,,..: :; Site utilities
Job site address: /75 5i-) 3 /4 ,c/'e /40 Catch basin or area drain 16 60
City/State /ZIP: ' l t Qc i e/4 .727-.3 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: / Project name: cl�� 'e -
f7 ' Footing drain (no linear ft.: ) Page 2
/ Manufactured home utilities 110 00
Cross street/directions to job site: O 6za ,■;, f' i--. q G-2
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.:
z , ;:, , *, - ' : i . ^ . ° : . :° ,:r >„ . ,,, :: ,'> _,„ , ; +, Absorption valve 16 60
, ` >' t; i : '' 1� , " a, . f , : r DESC • RiVii Nr^.
,i " • • 'Aia.
t r't = ^,::. ,°s'' m �. t. ., ; ,;� . � !tht . i .tt, A,„rt . t” r << git . 4- : s, « Backflow preventer Page 2
Backwater valve 16 60
Clothes washer 16 60 ,,
Dishwasher 16.60
•, ;. , P T Dunkin fountain
16 60
M' err . ,, , Drinking
= „y°^ ;' R ° :u PRO ,Y ®WIYERi' TIM'
� . ` ®` =TENT, e
;A � -.��:. _ ,� -,,. �� ; �� r �- �"�a, ^^ �a� ,� � �, .` ,� ; � , • .,,, .,' �, ,� Ejectors /sump 16 60
Name: ��4x4,I /o /G,✓ r - ' 4 i fie- Expansion tank 16 60
Address: 70 / t 1o.� X via .i'..t 77 Fixture /sewer cap 16 60
City/State /ZIP: rd/' -.c 1 7 g C 7 A20 Floor drain/floor sink/hub 16 60
Phone: (503) $ -- 0zy 9 Fax: ( ) Garbage disposal 16.60
"'z, a 4t,:,' 0:4 - ”: ;i ? ,. ; ":. ,_
- ,ate;; ',• — `. <.,k :age :;�oge Hose bib 16 60
; A - f l- t C AN T V i , : ® C O NT :4 'PERSO
Ice maker 16 60
Business name: •"0 Interceptor /grease trap 16 60
Contact name: GAhrS („9 (( Medical gas (value $ ) Page 2
Address: Primer 16 60
City/State /ZIP: Roof drain (co to - ial) 16.60
Phone: (§b3) $ yQ- es-,5- I Fax: : ( ) Smk/basi l avatory I6 60
Tub /shower /shower pan 16 60
E -mail:
Urinal 16 60
s ; `_ • -1a %:, � ; c�: , d -=- �` w 3,3tG 'r,' . ^ ;. W r ;,3 2 „ € rv . '� , n =� : 's : :.
,. `� : 4S>' CO1VT . CT il'$1, i ' :::r, ' ^, e , -
' i W ater closet
�_' = _.� > � � ^'��s .. , >"`., ,,c�, m, n;.l�': " ` � ,�r ,. ?sa � a: - ,, - ;' „ - . , ' '�. ° & ® ���Rs'1�� �;,t „i.�' .%�[, �< �� 16 60 /
Business name. £ Z gy �( u .�4/ ke , ^ Water heater 16 60
Address: Other
City/State /ZIP: Subtotal
Minimum permit fee' $72 50 "'3
Phone: ( ) Fax ( ) Residential backflow minimum permit fee. $36 25 �Q S
CCB Lie.: Plumbing Lie no.. Plan review (25% of permit fee)
� �� State surcharge (8% of permit fee) 5 , go
Authorized signature. C TOTAL PERMIT FEE -78.. c.Xl
Pnnt name: (]UI #4 t ' S • (.IcJC" /( Date. q'('0 / ' This permit application expires if a permit is not obtained within
` 180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
i \Buddmg\Pervuts\PLMF- PernutApp doc 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
, ri 1; - m a ;. • - 3; r 4.•.; c•;. �;c <,h ' ;�..; � f •= - -
cat :: . _ : ; .,Q. Y 4 ° , .(e ; hrot lw. _ ` `` Per.
.�.. - a; =- .,: Y.��� ° �.; ..: ,��, � .., � �nSq•uare;Footage ,�f� .�,.,,�..� - nt•aFee:
Footing drain - 1 100' 55.00 0 to 2,000 $115 00
Footing dram - 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 al7ll,a loll r „ .. 1Tllt'a 'Ce'
$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
E " Qty additional $100 00 or fraction thereof, to and
Fixtui -e ;U1' felIl;., ' ; °,` ;;; ` . A Fee (ea) =, PL ,�.� T4 a1'
� "� �s, _,� . _ 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
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 * .
jar y: ; ; QuantitUy (Fizkure)WorkiYerforriie' °ilk „:
Fixture y 'M:z,,
4Eq:' 8
.
' a�� r = k o_Mi A-4:04'1, A C,p e 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 Dram/sink - 2”
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refng. 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 2.-
Quantity Total
- Bradley
Commercial 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 \Bu idmg\Permns\PLM -Perm iApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re•uested / 2 i36 AM PM BUP
Location Suite / �- MEC
Contact Person Ph ( ) �Y � -.� PLM 6 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 41,4111.111WAMV
Fire Sprinkler
Alarm �
Susp'd Ceiling ir�
Roof
Other:
Final AP
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sewer 4111/4/
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL 4,
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE , . ' ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line / �.
ADA
Approach/Sidewalk Date ) 3 /7/ d( Inspector Ext
Other: (((
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL