Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00476
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/9/03
SITE ADDRESS: 11205 SW GAARDE ST PARCEL: 2S103DC-00813
SUBDIVISION: ZONING: R -3.5
BLOCK: LOT: 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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of (1) water closet, (1) lay, (1) shower stall & (1) water heater.
Owner: FEES
Description Date Amount
ANDERSON, BRUCE KENNETH
HELEN ANN CATHERINE [PLUMB] Permit Fee 9/9/03 $72.50
11205 SW GAARDE ST [TAX] 8% State Tax 9/9/03 $5.80
TIGARD, OR 97223 Total $78.30
Phone :
Contractor:
REQUIRED INSPECTIONS
Phone : Rough -in Insp
Top-out Insp
Reg #: 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: Via Ale . Permittee Sign.
Call (503) 639 -4175 by 7:00 P.M. for an inspection e • ed he next business day
.
Building Fixtures
Plumbing Permit Application FOR OFFICEUSE ONLY . - .
(
_ ,
e Received q 4 /
Date/By: ( ' Plumbing )
Permit No.: &NM -6614/7
C of • Tid Planning Approval
Date/By: Sewer
ity gar
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 ,\ : Post-Review Land Use
Internet: www.ci.tigard.or.us L . 10 1 111 Date/By: Case No.:
: -5T Contact Juris.: Z See Page 2 for
24-hour Inspection Request: 503-639-4175 "s" - ' Name/Method: Supplemental Information.
rtiliZaW;;ZinTiVOTOMOMMISPFAii,IEMVISW-42 RnWttgCUEWifirs:lraiafaa%irMM4TfataA'h:.
1:1 New construction ID Demolition Description . I Qty. I . Fee(ea.) Total
0 Addition/alteration/replacement K Other: 42:4
,- , ..., v _ A , Asia
gttaVAPVMNKV*Ktb:N:a:R:VeaOT43:flnn 1- ,A0AP-4“_ssa_xt-mgoiguotity,..gsm:.e.tpagyAc ,,,
SFR (1) bath 249.20
10 1 & 2-Family dwelling 0 Commercial/Industrial
SFR (2) bath 350.00
'Accessory Building 0 Multi-Family SFR (3) bath 399.00
0 Master Builder 111 Other: Each additional bath/kitchen 45.00 .
tfrilnVt.: Fire sprinkler - sq. ft: Page 2
Job site address: 1 I. 7 05 S. LA) • (.7.'A A- i--..-,4 e ,-57,-- • Mlict,m,:t
Suite #: Bldg./Apt.#: Catch basin/area drain 16.60
Drywell/leach line/trench drain 16.60
Project Name:
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: Lot #: Storm sewer (no. linear ft.) Page 2
Water service no linear ft.) Page 2
Tax map/parcel #:
4-. ti,:irWrtNvrt-Z7,WiffilAtRiariSt
OANIEMMEMOMMKONOINCIVenenVir,gt - - - ---‘'` -- - `- - ' '''' .----''''" - -t--- - - ' - - - '''"
Absorption valve 16.60
get 114 4'‘ ex 04 Backflow preventer . Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinlcing fountain 16.60
.16:10WO.R.KaNglat f Ei 10,,E_, INMS.441A
_ Ejectors/sump 16.60
N a m e : 7 1 4 . i x e 0 . 4 id C 1 ;241 01.) Expansion tank 16.60
Address: I 1 2-4 6 .. 3 .Lt) . GikIrti4 'If ' Fixture/sewer cap . 16.60
City/State/Zip: 1 Aicd . Ar , T72 20 Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: $ ':-.,: 6 71 bt 63 Fax: Hose bib 16.60
iCiakkiWASIVACCIM PA re:WOMMOVIi Ice maker • 16.60
Name: Interceptor/grease trap 16.60
Address: Medical gas - value: $ . Page 2
Primer 16.60
City/State/Zip:
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory I 16.60
E-mail: Tub /shower /shower. pan 1, 16.60
EfritAP:-4-'1'.iataiaiieMta.M.gtigtif*tat'Ctf#16ti, Urinal 16.60
Business Name: N 1 Water closet i 16.60
Address: EA0 ij bC_ her:
water heater
Ot 1
16.60
City/State/Zip: Other:
Phone: wax: itaiW*14
CCB Li - : r. 9 lamb. Lic.#: Subtotal $
Minimum Permit Fee $72.50 $
v - Authe_ ze ..A., Residential Backflow Minimum Fee $36.25
. „
/ - 0 43
(\._ _ Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ '(j
fay • - (P ease print name) TOTAL PERMIT FEE $ 7 ic .. 5 c)
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.
i:\Dsts\Permit Forms ThnPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
t
F.. :. t e1 nlLtt�es �... ty� ire ( 3 of l t ca T'oota e ' . vz Pgrip t ee r . ,
Footing drain - 1 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
P exrr> t Fee . at , -,1
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
�tare:o.,„T�CiIf` =, ��. additional $100.00 or fraction thereof, to and
3h'' >° t t
ww �.s... �lfi §'�J:�'��ee, ea)� '
' _ � � '� MVO 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 $37950 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 *.
A`(reiiitti(F4fre1�'(to�erto ,i 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"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
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:
i: \Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03
CITY OF TIGARD A 4111,"
BUILDING DIVISION PERMIT #: PLM2003- 00i176
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/9/2003
Phone: (503) 639 -4171 b
Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' !+� � I..
INSPECTION WORKSHEET FOR DATE: 4/5/2005 TIME: 7:09AM PAGE: 55
SITE ADDRESS: 11205 SW GAARDE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ANDERSON
DESCRIPTION: Installation of (1) water closet, (1) lay, (1) shower stall & (1) water heater.
OWNER: ANDERSON, BRUCE KENNETH, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message ,
399 Plumbing final 003702 -02 503 - 539.0013 N
Corrections /Comments/ Instructions:
c ..", (..../
/ )!. Y '/ / .'
•
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�/ C
�
Inspector: — l Date: / .—t J Phone #: (503) 718 -