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Permit C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2003 - 00572 l l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/3/03 SITE ADDRESS: 09360 SW EDGEWOOD ST PARCEL: 2S102DC - 02000 SUBDIVISION: EDGEWOOD ZONING: R - 4.5 BLOCK: LOT: 018 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: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: 1 TUB /SHOWERS: 1 SEWER LINE: 170 ft WATER CLOSETS: 1 WATER LINE: 200 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Other fixtures: Ejector pump. FEES Owner: Description Date Amount BRADY, TWYLA FAITH 9360 SW EDGEWOOD [PLUMB] Permit Fee 11/3/03 $302.40 TIGARD, OR 97223 [TAX] 8% State Surchar! 11/3/03 $24.19 Total $326.59 Phone : Contractor: SORENSEN PLUMBING 19010 SW BONNIE MEADOWS ALOHA, OR 97006 REQUIRED INSPECTIONS Phone : 503-642-2110 Sewer Inspection Water Line Insp Reg #: LIC 116063 Rough -in Insp PLM 34 - 415PB Top -out Insp 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 Issued By: AI ' — Permittee Signature: 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 • . • Received `t�� Plumbing , ,� �7 Date /By: 1 + ' .2j iQ 2t `/ Permit No.1 i-1/1/1 5 {/ 3 "©057 P- City Cllt of Tigaard Planning Approval Sewer b Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date /By: Permit No.: Phone: 503- 639 -4171 Fax: 503-598-1960 4,406_,I, Post - Review Land Use Internet: www.ci.tigard.or.us II Contac Case No.: `�W Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: -- r7 G Supplemental Information. • - "•VetiOEiN ORk: ," f . - : .r ' `FEE* SCHEDUtiE ^(for, special in'form3tiioli use cliecklis`t)"Yn5"' ❑ New construction ❑ Demolition Description I Qty. i Fee(ea.) I Total ❑ Addition/alteration/replacement ❑ Other: ' ' ... „ New.t`= & ; family dwellings - i ";' `- -; . : CATEG 7; • . - ��•` • +.. ' ;.,,Mincludes;100 for. e ut c o n necti o n ) , :., '.a, == " >' ' s- `���. "' 'Y 4 . : - K�� : ORY .O .0E "w ,�,. SFR (1) bath 249.20 f] 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 - JOB "SITE INFORMAT +ION:ind'L'OCATION - Fire sprinkler - sq. ft.: ; g Page 2 p Job site address: 1 360 S. 6--DC C - e , v o ,(� o . r:7`Laq ::.;'`' : ": s _°,a;-y;�`.'Site:IUtiiittes ` ""'F "' ;?". '8' ::'' =4'. :N '.'t Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Drywell /leach line /trench drain 16.60 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.) 7 Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) ) Page 2 .. ",1 ;DESCRIPTION'OF °WORK , "�`„ Fixture oc €Item:;,: <:a =(U Absorption valve 16.60 A) b t m (5 0) /' j 7Ni_o °'" 1 ch-- Backflow preventer • Page 2 f, f i -& S , (z 7 L"•)CI 5 n fr,c Backwater valve 16.60 u r('tr 1� l� . Clothes washer 16.60 Dishwasher 16.60 '4 Drinking fountain 16.60 ;: ®' PROPER=TY ;OWNER' ;: : ® TEN °ANT:;:: : ::.,... ' ' .. .. _•_ ,.. , Ejectors /sump ( 16.60 )to.&-0 Name: Expansion tank 16.60 Address: 3 t V • 5. 1) Ew vo t] Fixture /sewer cap 16.60 City /State /Zip: -T 6,, p/Z Floordrainlfloorsink / hub 16.60 i Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 , ii4PPLICANT.' 'Y:a ° , ; ; _ ." „,- s =_❑RCONTACEPERSON :,.,,,i't 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 Z 16.60 „wp E -mail: Tub /shower /shower. pan 1 16.60 // _, . CONTRACTOR ..- , i ;;:''''' ,.:'..-`1,,=-' Urinal 16.60 Business Name: 6 �OlLE„ , iS gs-( f �La 6m.1� Water closet I t6.6o j/../,,,,) q Water heater / 16.60 / &p� Address: f S 0/ O 5' e o,,, r p / 1 t-.a' L 4 Other: y City/State/Zip: o / 02 1'76 Other: ' Phone: 23 _�y� -21 1 O Fax: ..• , r t. _ SG i.. � ? ' 4, "e x '= , 'k , ''P1Umtiiii PQKitii FCeS*'° .'i "' :rar L ;_ CCB Lic. # :; o G umb. Lic-.4:- ,3t' y/S P(.7 Subtotal $ 440 ,11 Authorized / � Minimum Permit Fee $72.50 S \ / C 22 - 0,‘\'' Residential Backflow Minimum Fee $36.25 ate: Signature: /r' 7 Plan Review (25% of Permit Fee) $ PAu L Sn// rW S Ej 4 State Surcharge (8% of Permit Fee) $ ,;"j,./. /9 (Please print name) TOTAL PERMIT FEE $ :3,D( 57 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. 1: \Dsts \Permit Forms \PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: , ; w ' a y Site,Utilrttesr s - M Q Fee (ea)4 Total' Square Footage: 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 - 1st 100' 3,601 to 7,200 $220.00 /o . n 55.0 C 7,201 and greater $309.00 Sewer - each additional 100' 46.40 44 yb Water Service - 1st 100' to 55.00 6- - Medical Gas Systems: Water Service - each additional 100' (6� 46.40 „../6 �l� Valuation:., Permit - Feet • 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 additional $100.00 or fraction thereof, to and x <s.Fixturegor_ Itemsr "' *: <.. ``Qty, > rF.ee (ea)..'_ ;Total` 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 *. ;, , "; _ Yx a s` ; , r" Quanti by "( Fixture)iWock Pei formed`.' Comments regarding fixture work: Fixture Type 9 % R eplace' x s ' £New,g .,;11loved .: - Eaistin t' C Peed >`s 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 *Note: If the fixture work under this permit results in an Garbage - Domestic p 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`(n (a 5 Date equested 277 ' 7 70 (" AM PM BUP Location T 3 b .��717 Suite MEC Contact Person Gf r l� Ph (__D_ _S Z 7 r ®6 _3 - OY) 572 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 Fire Sprinkler Fire Alarm / 6 Susp'd Ceiling / r Roof Other: Final PASS PART FAIL PLUMBING C _ Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan - Ero AR FAIL CH AI L 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: 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