Permit ,. T
r 4 CITY O F TIGARD GAR® PLUMBING PERMIT
�T i DEVELOPMENT SERVICES PERMIT #: PLM2004 -00504
Ail 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/5/2004
SITE ADDRESS: 09955 SW GARRETT ST PARCEL: 2S102CB 03900
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: R -4.5
BLOCK: LOT: 011 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: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Add toilet and sink to closet.
FEES
Owner:
Description Date Amount
JERRIE ROUSSE
9955 SW GARRETT ST [PLUMB] Permit Fee 11/5/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 1 1/5/2004 $5.80
Total $78.30
Phone : 503- 419 -7498
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Rough -in Insp
Final Inspection
Reg #:
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 questi• s to OUNC by calling (503)
246 -66• !. 4 ,
Issue By: �� Permittee Signature: I e
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
,
Plthhbing Permit Application F 'O FFICE 'USE ONLY •
13 y of Tigard Plan Review /' Permit No
Received
13125 SW Hall Blvd., Tigard, OR 97223 Date/By i �" � Q� I�
Phone: 503.639.4171 Fax 503 598.1960 I\ Date/By Other Permit No
24- Hour Inspection Line 503 639.4175. • L�
Internet: www.ci.tigard.or.us 1,11. Date ed /Met S Ready/By Ju See Page 2 for
Notified/Method /1. Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist.
Description Qty I Ea Total
Addition/alteration/replacement ❑ Other New 1- 2- family dwellings (includes 100 ft for each utility connection)
x,. ,.. mz . x , ^ .1 y , x; - 44-1t , >ia. =5. ic= y W* : a l'' .
�.a .� ��s,�r�.�e,. �+ =gay,. >.
; ' `;" 4 '( 'ms' s = 'g ; R ° C ATEGO RY ° =; OFa'AC ONST'RC1 CTtO1 V �_ SFR ( b a t h 249 2 0
`: = = >ar. ,.. =:i* . :art . ro '. -:: _ d:..''3 .: _
and 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/krtchen 45 00
, yam a _ %R y F , 4 ,, Fire spnnkler ( so ft) Page 2
"- ' '� „ ,.IOB SrrE: � i.16. Fi'l�E>T =Z® N.,tAl l/!` Z.l7�A`r)'�1� ; { "s ;�'" "; .' ,�
�ls�fi�:= _��;.�����- . ,�� ^, .- ���� 'R6:� R�.>rA.:_>_ ��' „��:6�x��' "" Site utilities
Job site address: q £ et . ) } .Q Catch basin or area drain 16.60
City/State /ZIP: — it %a 0( O ' 7 (-O-) 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft. ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site: Pa n i 4:___
Manholes 16 60
Ce A. c (t C.P2 ( (J( Q. Rain drain connector 16.60
G (rte/ ) Q __ —( ,Cali (1 „A _ Sanitary sewer (no linear ft.. ) Page 2
ll`` Storm sewer (no linear ft. ) Page 2
Subdivision: Lot no. Water service (no. linear ft.• ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16 60
`'� ” DESCRLP. ,,,, OF , .
PORK y 'e=
s �.�' k , � ate„ mow = °_ ° Back preventer Page 2
Q eP r� 9--t Q 1. Backwater valve 16.60
(' mil) r) e. /7 f— Clothes washer 16.60
Dishwasher 16 60
j , ; ,. a � „ =gym„ y ;•', a "�.�r.<- <^ .; .'.v ._.,
rata `PRO1'Eit�'I i ® AI g : �tx.. i ' illTENANT . ° ' , Drinking fountain 16 60
'..
e .., r3 ,'vn'e..- ,.w - > .r? :fi5.: », "z ,,. , ^.,,, °.. ...... hw `�.,.',�- , ',,c'. -.. ,:. r� za. • .k 9 a..: a.:
„�' " �' Electors /sump 16.60
Name: ` i D A i Q 20 Q.__ Expansion tank 16.60
Address: 9 et Z &_. j-----.4. ) Fixture /sewer cap 16 60
City/State /ZIP: -1-1. t�,�d of --/. + ( '3 Floor drain/floor sink/hub 16 60
(� 1 1 c 1 9 _ , f Garbage disposal 16.60
Phone: — � Fax ( )
' , -m:' ;M e , .., . ; =, ,., -, ;.: - tom ,: =�v;s, u .. >t Hose bib 1660
�i^>ts.d; i ,
Y' ': °`_ 'r _:.,i2 .,,,:APP LGA `,14 ) G ONTAC " - „ . t •;
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
Sink/basin /lavatory P 16 60
Phone: ( ' ) I Fax:: ( )
Tub /shower /shower pan 16 60
E -mail: Urinal 16.60
�.g§,� �.t~ONTRACTOR4
r.,,.. -;z.t s.:it!°:
,rug^:�,�,..'� ° = ".",�s� ":: r�:�i�- '�,,ri�. .:;:!r�: tt,:_ �.rs?`,��s' =,,,.,m: � <- ..Y.sl1: , - � .,_ Water closet I 16 60
Business name: 5 ap 0 le Water heater 1 16 60
Address: Other.
City/State /ZIP:
Subtotal
Minimum permit fee $72 50
Phone: ( ) Fax ( ) Residential backflow minimum permit fee $36 25 /� ' S
CCB Lic.: Plumbing Lic no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ,, eo
Authorized signature:
TOTAL PERMIT FEE 77.
Print name: J - l- l . R ss„e_ Date' t i /(p(o 4 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.
1 \Budding\Permits\PLM- PernutApp doe 12/03 440- 4616T(IO/02/COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:' • Residential Fire Suppression Systems:
t - ° W' ':. a P �§ ; Q y y ° '' Fee (ea} �.� .�Total. a °re
Ste � : 0; c - : ; : . pg1,1„:4.1,.. F9ota <'s :: °' Permitr<Fee:;, .
Footing drain - 1s 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 a • �� s:r' ,
=,aluat><o wAx _PermitFee .
Storm & Rain Drain - 1st 100' 55 00 8"
$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'e (
;a ° :° QtY • ; ea' ;1 additional $100 00 or fraction thereof, to and
1Xt =il')Ce Or ' : ° tt fi 7 o fal:°
•�,<",£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
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 $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 * .
": ,Qiiantit bY(Fiztiire) Work:P6formed °s,
1101 e;Ty pt ' # .r's, Es .07, ,,
.;,:'�N2W `: Repl�a "Ce, g`I
' ' ` '` � z ! ° =' sn; a Comments regarding fixture work:
,' :..�, .`�.'6:. a� �;�:. x �aF;t.,�.�*� &;�•
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
Dnve 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 increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. 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 Quantity Total
-Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
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 \Budding'Pemuts\PLM- PertmtApp doc 3/03
7• •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested L -s
\-\ AM PM BUP
Location � i 1-,R A 5 1 Suite MEC
���
Contact Person —� Ph ( ) ° L1 l 11 PLM a� - ■)9
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: 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 Cr \ \4\1 -- ) C L� \ \,yp
Susp'd Ceiling
Roof
Other:
Final
P� • RT FAIL
PG., .
Post & :eam
Under Slab
Rough -In
Water Service
Sanitary Sewer \
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• ther:
PART FAIL
MECHANICAL
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 Ei Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ` r d\1 Inspector .�Ir 1 / _ - — Ext
Other:
Final DO NOT REMOVE this inspection record fr ti m the Jo . ite.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / ' -3 AM PM BUP
Location Suite L p MEC
Contact Person Ph ( ) PLM — D o c.5zi
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC D b 4 -067 1
Foundation Access: r �
Ftg Drain � c) ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 1 , 14 st Y �r�
it.t. � Y1�'0 'V . r crb \' T o
Drywall Nailing 1 l
Firewall Fire Sprinkler \\\L ; ' ' { \N O% L c-,1" \ � R )t)N)
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS ART FAIL
16
Po t& Beam
Under Slab (,'�`
Rough -In �� ` ^'' V
Water Service \r f i v
Sanitary Sewer r7
Rain Drains 4
Catch Basin / Manhole
Storm Drain -
Shower Pan
Other:
PART FAIL (/
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS _ FAIL
Service
Rough -In 1 (,
UG /Slab �QC
Low Voltage - ,�\
Fire Alarm \,1 Q
Ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
Approach /Sidewalk Date // , 4 2 Inspector AP ' �/� = Ext
Other: -
Final DO NOT REMOVE this inspection record from the :oh site.
PASS PART FAIL
•