Permit CITY TIGARD PLUMBING PERMIT
"k DEVELOPMENT SERVICES PERMIT #: PLM2002 -00006
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/12/03
SITE ADDRESS: 11515 SW HALL BLVD PARCEL: 1S135DA 01400
SUBDIVISION: ZONING: C -P
BLOCK: LOT:. JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 4 URINALS: GREASE TRAPS:
LAVATORIES: 10 OTHER FIXTURES: 4
TUB /SHOWERS: 7 SEWER LINE: ft
WATER CLOSETS: 10 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: ASHRAM: Plumbing work for addition to existing SF residence and change of use as a congregate residence.
Other fixtures are: (1) expansion tank, (2) hose bibs and (1) pressure reduction valve.
FEES
Owner:
Description Date Amount
BRAHMAPREMANANDA ASHRAM /TEMPLE
11515 SW HALL BLVD [PLUMB] Permit Fee 6/12/03 $710.40
TIGARD, OR 97223 [TAX] 8% State Tax 6/12/03 $56.84
[PLMPLN] Plan Review 6/12/03 $177.60
Phone : Total $944.84
Contractor:
DETEMPLE CO INC
1951 NW OVERTON ST
PORTLAND, OR 97209 REQUIRED INSPECTIONS
Phone : 503 Sewer Inspection
Water Service Insp
Reg #: MET 00001986 Top -out Insp
LIC 2510 Rain Drain Insp
PLM 26 - 25PB 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
/01 Issue By: 1, �,�1 , h Permittee Signature:
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next bu -' ness day
610 ' A000 --00 /5 7
lumbingPermit Application
a� n Date received: 5 2 0j Permit no.: ar &ng -+�0. y ,
A > , Ci ty of Tigard , v31
,, �� j , � � �� �,' _ Sewer permit no.: Building permit no.: 0_
Address: 13125 SW H B�1 'd`.Tigatd, OR 97223
City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
.
ry
Fax: (503) 598 -1960 MAY 0 a n a3 Date issued: ' B • a Receipt no.: C
Land use approval: re,ry of T1GABD Case file no.: Payment type:
_ '.''" :.:star_ niVISION •
TYPE OF PERMIT ., ,
0 1 & 2 family dwelling or accessory 0-Commercial/industrial ❑ Multi - family U Tenant improvement
0 New construction 0 'ddition/alteration/replacement ❑ Food service ❑ Other: ( .
''JOB SITE INFORMATION , • „FEE SCHEDULE (for special information use checklist) • ,-
Job address: l�r sw 1 i . Description Qty. Fee(ea.) Total c
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: -. s/tchyttflet. . SFR (3) bath
City /county: j Di , I ZIP: °772/2-3 Each additional bath/kitchen
Descri tion - d loc jjonn � of work on premises: Q� Site utilities:
�'" ' Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain C.—
„? PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
`{ Manufactured home utilities
Business name: bae Ap , CCU • Manholes
Address: (,L
� ) il/ —d14 Rain drain connector _ —�
City: State:X. ZIP: q12,1)47 Sanitary sewer (no. lin. ft.)
Phone: Z 7 . ZigLit Fax: Z7L -7(p *E -mail: Storm sewer (no. lin. ft.)
CCB no.: V I Plumb. bus. reg. no: 24, —L Water service (no. lin. ft.)
City /metro lic. no.: (g 8to Fixture or item: L•
Contractor's representative si nature; N.�-- Absorption valve
i Back flow preventer / 4/4 .4eC
Print name: , 4a Date: , .
7 3 ' Backwater valve
r K ; s: CO TACT PERSON .
Basins/lavatory r ( /44, o
Name: M �1 ( afr fiy1 Clothes washer / (, /6 , (o P
Dishwasher i % /t, ,64
Address:
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E-mail: Expansion tank /6.66
• i ' OWNER , • • Fixture/sewer cap
Name (print) Floor drains/floor sinks/hub 1 /6 .677
Mailing address: Garbage disposal �®
Hose bibb / 2 33 E
City: I State: ,... f ' 12t13: Ice maker
Phone: I Fax I ^E -mail: Interceptor /grease trap
Owner installation/residefifial maintenance only: The actual installation Primer(s) ' Cr th •60
will be made me or the maintenance and repair made by my regular drain (commercial) t
• employee on the property I own as per ORS Chapter 447. (---- `Sink , basin(s), lays(s) l 4 , // An °
Owner's signature:- Date: Sump
.V 1111111111.11.111111=11.1.11=111111 Tubs/shower /shower pan
4,. 7 0 AD
Urinal ,
Name: Water closet •.f.',,' : 1 DJ ( /6
____
Address: Water heater. v
City: I State: I ZIP: Other: • - ki. V 1 ''
A -4. Phone: Fax: E -mail: Total ii%
Not all jurisdictions M fee $ 7/(1 sd accept credit cards, please call jurisdiction for more information. Notice: This permit application (y 0 ❑ visa GI MasterCard expires if a permit is not obtained Plan review (at 5 %) $ / 77.
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ J`r!a. $y
Expires TOTAL $ 9 ink• Sy
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature _ Amount 440 -4616 (6/00 /COM)
•
PLUMBING PERMIT FEES:
,: .• !,) AC " -f:New�1 andi2=famil` dwellings"only: '' - ;s ;: ::' '•.
; ' . <, � . ,� F� „ ; `��,. . s PRICE � T.OT , .:. . � a� � y � �, _ � � 4 � a.
FIXTURES (individual) - ' • - - ''. ',„ (ea) e. , rAMOUNT (includes-all,plumbmg fixtures m , g PRICE e: TOTAL 4
Sink 16.60 .ithe dwell ng and;the - QT (ea) , AMOUNT t
. eac ut ility;c o n n e ction) ` <, .tc e • ,, /`--, ; : , 7' :-T `. " Y'
Lavatory 16.60 One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE '
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL . "'
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine / 16.60 •
Floor Drain /Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 ,, "
6.60 •='Quantity by"Work Performed
Gas piping requires a separate mechanical ^'Fixture Type: k • " ' ; „ New;: i, ` ".Replaced Removed/
permit.
MFG Home New Water Service 46.40 Sink .", .„ • •
MFG Home New San /Storm Sewer 46.40 Lavatory • • '
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet .
Urinal _ •
Other Fixtures (Specify) 16.60 Dishwasher
• Garbage Disposal
Laundry`Roorri Tray , . - ...
• Washing Machine , "`" , ' .
' • . Floor /Sink: 2"
Sewer - 1st 100' 55.00 3 ,. • • •
Sewer - each additional 100' 46.40 . , . , 4"
Water Service - 1st 100' 55.00 . Water Heater -
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
^ Storm & Rain Drain - 1st 100' 55.00 _
Storm & Rain Drain - each additional 100' 46.40 •
Commercial Back Flow Prevention Device 46.40
-
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60 , .
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections ' per/hr COMMENTS REGARDING ABOVE: \
•
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if :- : k-
Quantity Total is > 9 ?:;.,, - " .: °."s , -;, <..- - ',:
*SUBTOTAL `;, 1 ''`a'' ,r,
8% STATE SURCHARGE v^f'` , ` ^ ';W '
a4- ' ... �i "`;� 'M.
**PLAN REVIEW 25% OF SUBTOTAL p` : ; ° ^
m ' ,
Required only if fixture qty. total is > 9 '::' ' `x`.'`.
, TOTAL 0•s ' '! $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25•+ 8% state surcharge.
* * All New Commercial Buildings require 2 sets of plans with'isometric or riser
diagram for plan review.
',\ i:\dsts \forms\plm- fees.doc 12/26/01 .
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