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Permit
V CITY OF TIGARD PLUMBING PERMIT of DEVELOPMENT SERVICES PERMIT #: PLM2002 -00320 � ' I + . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/14/02 SITE ADDRESS: 10415 SW HIGHLAND DR PARCEL: 2S111CC - 12100 SUBDIVISION: SUMMERFIELD NO.4 ZONING: R - BLOCK: LOT: 172 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 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: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of residential backflow prevention device for irrigation system. FEES Owner: Type By Date Amount Receipt PRISCILLA JAMIESON 5PCT CTR 8/14/02 $2.90 27200200000 10415 SW HIGHLAND DR PRMT CTR 8/14/02 $36.25 27200200000 TIGARD, OR 97223 Total $39.15 Phone 1: Contractor: OWNER REQUIRED INSPECTIONS Phone 1: RP /Backflow Preventer 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 -0080. You may`obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. . Iss d By: i %h de.0 �_i Permittee Signature: , �P'� Call (503)-69-4175 by 7:00 P.M. for an inspection needed the next business day f , ii { ii. FOR OFFICE.USE ONLY Plumbing Permit App Received c ,, ! Plumbing A Date /By: 0 I7 . � 1 Permit No.: / e, r� 2ooa -oo3.2,0 C . of Ti and Planning Approval Sewer Y g Test Form Date /By: PermitNo.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date /By: Permit No.: /ako j Ph one: 503- 639 -4171 Fax: 503 - 598 -1960 Btj� Post - Review Land Use Date /By: Case No.: ��.�., ' Internet: www.ci.tigard.or.us �"� ��'' Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. , a,# �:�,,��0 4: ,, ,.-3 �rTYPE1OFIWORK= ,- SWI nggalrK. a-,1�FEE * "SCHE,DULE,(for special✓ infor' mation6se ,checklistVr' -, ❑ New construction ❑ Demolition Description I Qty. I Fee(ca) I Total ❑ Addition/alteration/replacement ❑ Other: . '`C # p Nery 1 &�'2family;dweilings7 kt -a*` ,;,,:`," .i' i'rlcl"udes,100 ffkCor utility;,connection) '� -, , <,. `,.CA §TEGORI' OF:(CONSTRUCTION -, , ;,, : a SFR (1) bath 249.20 ❑ I & 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 ; y v :: '=m°Na4JO$:SITF tNFORIVIATIONNa ""dALOCATION' e t, "i d , Fire sprinkler - sq. ft.: Page 2 Job site address: 1 0 o 5 5k) \-1 \ n c t � r .. ' U ;' ,. r at '°,:.:= ``n1 "S. it ;:.c. `* UtiiitieS„ .. 3�.: E � . €s; ,x: Suite #: Bldg. /- t. #: Catch basin /area drain 16.60 Pro eCt Name: Drywell /leach line /trench drain 16.60 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 :#: ? Future orNItem ibt o ` . ° i 1 'ketitSCRIPTIQN;OCW:O NAV _ ,? TRig. Absorption valve 16.60 • Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROP.E tokOWNER:: .i -i' ' 0. Drinking fountain 16.60 nta' 16.60 ®,_: ` Ejectors /sump _ Name: - 7 7 , - . i�c 11 A . 4Y)r i - e S 0 Expansion tank 16.60 Address: (©LH S S () 4(6 )4i- - Fixture /sewer cap 16.60 d Floor drain/floor sink/hub 16.60 City /State /Zip: i,t{ OP--- . Garbage disposal 16.60 Phone: 9 ( , R ? 4 0 Fax: Hose bib 16.60 APPLICANT 4 t , ,4 CONTAGTi ERSON' ° . 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 h, 4 4 -, t~ `k5Sf;,.%'CONTRAC ; _w 'w.,, a .. Urinal 16.60 �� .) � i'/ Water closet 16.60 Business Name: /` Water heater 16.60 Address: Other: . City /State /Zip: Other: Phone: Fax: P1umbmgPermit Fees t Fi Subtotal _ $ CCB Lic. #: Plumb. Lic.#: Minimum Permit Fee $ $ 36 a 5- Authorized Residential Backflow Minimum Fee 36.25 p�,2� � Date: Plan Review (25% of Permi e $ Signature: W State Surcharge (8% of Permit Fee) $ A • 9e.) TOTAL PERMIT FEE $ 3 9, / 6 (Please print name) Notice: This permit application expires if a permit is not obtained within All new Commercial building require 2 sets of plans with isometric or 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. riser diagram for plan review. Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: QtS ea) Squ IdotikeV 04, xamt,1 Footing drain - l 100' 55.00 0 to 2,000 $115.00 2,001 to 3,600 $160.00 Footing drain - each additional 100' 46.40 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 $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 v1.00m 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 $100.00 or fraction thereof. Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes", please indicate work'performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Pgail*W;',,prIgniA IMitiaiiiiii:iliMaii(i'e)MorkIPerformed Comments regarding fixture work: NuieR,4t 0$ifittt 74 ;1',414 geNWO sMoyed i Existing AcipiTia 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" 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: CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST . Bale Received Date Requested U 1 d AM PM BUP Location a ■ . Suite MEC Contact Person Ph ( ) - as a q PLM ' c� d .3a 0 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler 41 0 Fire Alarm Susp'd Ceiling Roof Other: Final ; RT FAIL A • n. er Slab Rough -In Water Service ._ Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan F Other: Atro PART FAIL ANICAL 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 / ~� ADAoach /Sidewalk Date Z G ` I inspector Ext PP Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL