Permit rr N
CITY O TIGARD PLUMBING PERMIT
r I DEVELOPMENT SERVICES PERMIT #: P PERMIT 482
*_I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/21/2004
SITE ADDRESS: 13575 SW CRESMER DR PARCEL: 2S102CC -00313
SUBDIVISION: CRESMER HILLS ZONING: R -4.5
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacement of 50' of water service.
FEES
Owner:
Description Date Amount
BRENNAN, WILLIAM L + BARBARA J
13575 SW CRESMER DR [PLUMB] Permit Fee 10/21/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchan 10/21/2004 $5.80
Total $78.30
Phone : 503 639 - 2503
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone : 503 Water Service Insp
Final Inspection
Reg #: LIC 81837
PLM 26 -445PB
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- ;••.
is ued B 1, =!.: Permittee Signatures /1/ %
Call( 13) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
,,,
Plumbing Permit Application FOR OFFICE USE ONLY'• •at,` . Receive
C ity of Tigard Date/By: d 4 A/ O ' , Permit No.: L fFI/i/ p� tr ..e4 7 0 -
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 A . DateBy: Other Perm t No.:
24- Hour Inspection Line: 503.639.4175 W Date Ready/By: H See Page 2 for
Internet: www.ci.tigard.or,us Notified/Method: - / tV, Supplemental Information
. , �.� r �"W, :n s�:�. +z- „* _ ., q.� ^`. �w�',== s�.�x,. .. »�x i,E. y �., rzLan '
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New construction El Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
` ' ''Wl` _ CATEGOR OF � alfiTT d OlY b" ,
: ,x» _. i. 05 . ,<..�, {,, .V . SFR (1) bath 249.20
211- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building El Multi-family SFR (3) bath 399.00
Each addition bath/kitchen 45.00
❑ Master builder El Other:
_� o Fire sprinkler ( sq. ft.) Page 2
v P 4SP < . 13VgifE II ii M O A WO 1 ' Site utilities
Job site address: /3,5 7$ 5L) Cr es V✓1 4 _,_ j) 2 Catch basin or area drain 16.60
City/State /ZIP: '� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ``� 1 Project name: 1 l f �jjl Footing drain (no. linear ft.: ) Page 2
• r t Manufactured home utilities 110.00
Cross street/directions to job site: 4 i
Manholes 16,60
Rain drain connector 16.60
W ��� t(AAA e o 1 - 2 503 Sanitary sewer (no. linear ) Page 2
- `, Storm sewer (no. linear ft.: : ) Page 2
Subdivision: Lot no.: Water service (no linear ft.: S' z) Page 2 55-,00
Fixture or item
Tax map /parcel no.:
v ' - ,, , - g; , ; ,,,. , - , , :; . ;, :: x w ;a• s : 1:: - Absorption valve
Ab orpt� 16 60
y »' r ' ; e 8 �'7 . 11 . � i.:Frt K'� <.?:,a' ', rit da d '* {.:» a : 4'� W . i ; " , ^ <.' � C K.<.
* ' . . max & ;' tl D SCl2 T S WO RK ,: , iai m „_. x . ,k ,g2 Backflow preventer Page 2
( �,��...„4y t 0_4_1 C f _„...-- _c J(� e_ e _ A Bacicwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
„ fit. r x , .. v x w w5- r' Drinking fountain • 16.60
-- ®. P t®P .I2 , ® tr „ ;taw.),,. , ,,:t s ` I'ENtAl\' . e. a
�� �, *�.�..,._.,;,. -w,„ , �.., �F� ��d, ,:• <. .x� -��._ Ejectors /sump 16.60
Name: - t�Q 1)0 < Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
Phone: (503) ec, 2 ..a 6 Fax: ( ) Garbage disposal 16.60
m _` eigsgr, - r =_ - ; ,r ,.. 3,54 ro , p i - :;-,1 :: alt 1 Hose bib 16.60
k �� . ' . , �� ' )z._.:4 n k i d CON ERSON ,
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
i , ^ N T 1 CTOR. F r a
�,� ,��� �s �n : �.� ta� 1 . X m 4 -� Water closet 16.60
Business name: /3 Yv "Py.. �l ,y f y
p / ie Water heater 16.60
Address: O , e 2 3 9, es Other:
City/State /ZIP: •--, ��._2 a /� Subtotal
-r` Minimum permit fee. $72.50 72_ , �'�O
Phone: (5,)Y 6,2_ y 5,r v Fax: (S 3) �� e... 7 3 Residential backflow minimum permit fee: $36.25
CCB Lic.: e3 "-7 Plumbing Lic. no.: 26: ,- c/y� ,ff Plan review (25% of permit fee)
Authorized signature: ■ _ / State surcharge (8% of permit fee) S r
�
T OTAL PERMIT FEE 7 ' 3 ._.
t r
Print name: t�'/� �rif��� Date: ,0 2 p � This permit application expires if a permit is not obtained within
GG llll��� [ 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Permits\PLMF- PermitApp.doc 12/03 440 -46 t6T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
' S1terUt ltles``� t A; r? a t,O Titym oiviy.,trzoiatt .
;:$41tagoilrogika gg , .
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
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 valuation r _. „ Permlt '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
:_ additional $100.00 or fraction thereof, to and
F1'XtUY 1' Ol' Iteln,k Qtx g awe*, Total e ;
- � �._.� : � ti��� 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
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: $5.01001.00 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 * .
f ''�QuanL� )Y (Mature) WorlcPerfo ne
tune TyP ; t � , R ,t�§ `L
._ I , r : w °wR > ! ; aL MAW 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 - 2"
-3"
-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
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:tBuilding\Pern its\PLM- PennitApp.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 Requu ld Z Si AM PM BUP
Location ( 3S - 75 C /? o a/}�12�/L.� Suite MEC
•
Contact Person Ph ( ) PLM d e V e-goZ
Contractor Ph ( ) c off '" `MO SWR
BUILDING Tenant/Owner ELC
Footing (p ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain - .- _! n
Slab Inspection N SIT
Post & Beam /
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - l
Firewall i J
Fire Sprinkler
Fire Alarm p�� 9? d'
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL J •
;
PLUMBING /'
Post & Beam
Under Slab - -
Rough -In
r� ---
Sanitary Sewer i f %l
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin _ i►�
PA dr , ( � FAIL
CH . . 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 /0) 1:-326 ( ,
Approach/Sidewalk Dat Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL