Permit •
C ITY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00438
Ali DEVELOPMENT
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/18/03
SITE ADDRESS: 13157 SW GRANT AVE PARCEL: 2S102CB -07700
SUBDIVISION: POOLE MLP2001 -00003 ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SFM 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of new gas water heater.
FEES
Owner:
Description Date Amount
POOLE, PHILIP & DARLENE
13144 SW GRANT AVE [PLUMB] Permit Fee 8/18/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 8/18/03 $5.80
Total $78.30
Phone : 503 670 - 8254
Contractor:
310 e 2-
REQUIRED INSPECTIONS
Phone : Rough -in Insp
Final Inspection
Reg #:
EN o
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
Issu -d By: 2.0a#4,-/t Permittee Signature: ) W, 0
Call (503) 6394175 by 7:00 P.M. for an inspection needed the next bu iness day
Building Fixtures
Pluin bii Permit application - FOR OFFICE USE ONLY • -
Received �/ / 1 Plumbing 2 1_.5
Date/By: X U _ Permit No . t t i� ooh --a) T
Planning Appr.val Sewer
City of Tigard Date/By: Planning 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
//9ap�dl� �' I �� Date/By. Case No _
Internet: www.ci.tigard.or.us ' I Contact ® See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 Name /Method: ( Supplemental Information.
:I q _ - �r:' `. Zi 'S `F_EE*.SCHED111%E for *s ecii Einfokmation-'usech0.10t °"`�
�`° �,�� „ .;��3:, ���,a.,r:�z�;;5:; ; �:.:TY�P.E�O.F:WORK =: _. z��.. x��� ,,�, �.� ..� -. .. �, - _ -- � , � . _ ,. _ ( . P .e, );:�° ��:g
❑ New construction ❑ Demolition Description Qty. I Fee(ea.) I Total
ent Other , '''''K
''W4i ° ,• ',WOW' : - :family. dwellings `, . . . °: :
El Addition/alteration/re lacem ❑ :� V , tk °- • ii A f ` ° `•
Addition/alteration/replacement ��. �f.m
� ,(inelude`sF100�ft�for. utility ,connection }`��, � � ,,, „? ,
it `. ' ` ACATE OE CONSTRUCTION �` p � `" :. 3... ,
`�'� � '-- `� �'�� SFR (1) bath 249.20
❑ 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
', k it ?JOBtS1= TAE - INFORMATION and,LOCATION + :E .e:, Fire sprinkler - sq. ft.: Page 2
Job site address: / 3) ,� S uJ, &f�/� '- . "�,�; gaAm , .� .l ; ,' I �
r,� a •.r:�:. °,, r','�' Ste�Uti►ities- �= .�'�� M� °; :��.#;s�, �,� �,'n' .� „=
Suite #: I Bld /A t. #: Catch basin/area drain 16.60
Drywell/leach line /trench drain 16.60
Project Name: �` �, p� J 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
P a ( K Sf. Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map /parcel #: , . ,.,„ _., :. a .' E f i .i i;... °,<* i . ; ; .:
b . .� < -,; � �' � >'Fixture;or�Item'�, - ": �,.,,, _" ., �- ;
,_ , �,. tliASOMP: ON OFV,ORK" ` I n �: ° ., .: : , i a l ". ;
- �' -��"' = w � NY�;t ,�-. ��°' ����' " "` Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher - 16.60 •
Drinking fountain 16.60
PROPERT ^OWNER ''�,:: I! ❑' TENANT. <`' / s' ° ` ;: s r Ejectors /sump 16.60
Name: . A / 1 ` Qar6vn i ,ham Expansion tank 16.60
Address: 131? ,> uJ, 6-/4/6, Fixture /sewer cap 16.60
City /State /Zip: 7 ` a rd 97, 3 Floor drain/floor sink/hub 16.60
/ Garbage disposal 16.60
Phone: G70- �SrQ ( s/ Fax: Hose bib 16.60
t 0 =APPLICANT fib. -; :° " ;Ai'; l 1,CONTACT PEtWix- 3 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 16.60
E -mail: Tub /shower /shower pan 16.60
3'7A::":':I",°:n;z1C4 ° -CO RAC' Tf2R 'ElW, ,
Urinal 16.60
`` Water closet 16.60
Business Name:
o<e� Water heater 16.60
Address: „6/A yye/ Other:
City /State /Zip: Other:
Phone: Fax: , ...: "!°-*: : ," ` >Pluiribing ,er�iiffei'O , { °_- ' '
Subtotal $
CCB Lic. #: • P1 b Li #:
4 Backflow Minimum Fee $36.25 Minimum Permit Fee $72.50 $
Authorized i l p Residential B /2 • Cr '
Signature: �., ; 1 j /i l Date: e-- a3 Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ • $Gi
(Please pnnt name) TOTAL PERMIT FEE $ 7 y,'- 50
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
ISO days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
:: \Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Information
Fee Schedule: Residential Fire Suppression Systems:
Y , i s ,.,, . lT , = ,:
mks : „ ite 3 Jtilities .:. .w , Q y,. ''`Fee (ea) =uta..4: ; S uare Foiita ei`_ ._.- , : , =Perriut ? *..44
Footing drain - l' 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 Val ;''Peritiit
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
'z" „;" t, ° F,iXfk i Iiem ` c ` A %Ml Qty :ry , Fee:(e) 4 Total° including $10,000.0
_ _ _ ��� includm 0.
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 *.
'= gantity, ti„ { ' ,zture =workPerfocmedr Comments regarding fixture work:
}.. ':p + ,,: '.,F. R' epla a
Pi ' ; W
Fixture Type. .�` '_`� > � �, _' �' �:` �,� " %
. �
? .i�;New .,.. Moved E iistingr'i f .` Capped i<
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
increase of sewer EDUs, a sewer permit will be issued and
Disposal - Commercial
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach /Refrig. brains 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