Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00003
l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/2/03
SITE ADDRESS: 07565 SW HERMOSO WAY PARCEL: 2S101AB -01502
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: ALT 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of approximately 80 ft. of sewer line to connect to sewer lateral. Septic tank to be pumped filled
and inspected. Reimbursement District #15 fee paid.
FEES
Owner:
Description Date Amount
ANDERSON, ROY W ESTATE OF
7565 SW HERMOSO WAY [PLUMB] Permit Fee 1/2/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 1/2/03 $5.80
Total $78.30
Phone :
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Sewer Inspection
Misc. Inspection
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
' Gl ,
Issued By: �, //' � . ���' � Permittee Signature:�, �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.� FOR OFFICE USE ONLY '
Phi i;in� Permi
l.. , .
A l Received Vii Plumbing
.i" " Date /By: lG,. - Permit No? j -66003
City of Tigard Planning Approval Sewer
Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ar Post- Review Land Use
tip' e Date/By: Case No.:
Internet: www.ci.tigard.or.us
g ir . Contact Juris.: El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
41:: :' !: _ > ERIY:PE 'SOKWORIC . „, r.Y , :: i4i. IEEE* SCHEDULEI( for., Vaialinf .11114 t0nlase;etiecklist)
❑ New construction ❑ Demolition Description I Qty. I Fee(ea) I Total
❑ Addition/alteration/replacement ❑Other: ,( n Chi ae s 1 0 f & e u`t f ii ge'cti , ''x
1:,- ,, , , : £ rCATEGOItY;tif.;CONSTRUCTION . _;'. m SFR (1) bath 249.20
M 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
r4 JOBFSITE aINFORMATIONraad OCAT1ON , . Fire sprinkler - sq. ft.: Page 2
. . " %d; 7' t,; r- 7. '; -if'gr q:`�sg, t SItC�Utiiitie•S `�,.�s. " t .'5r .., ,!. t� r`,
Job site address: Jf(, 5 S ll ) q(/g wt� s4 "
`J
Suite #: Bldg. /Apt. #: Catch basin /area drain 16.60
Project Name: Drywell /leach line /trench drain • 16.60
l Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
7a' d R L, e._, Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) g) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 _
Water service (no linear ft.) Page 2
Tax map /parcel #: : € :,'; zi .- Fixture irt(em , „K t', ' 4'"
'& tn1 , -;'DESCRI:PT1ON OF WORI{ , _ N,, .,:g*'= 16.60
Absorption valve
I- /Ne /.0.0K r6 /1/46-Z'T 1 / a Backflow preventer Paget
7i LA_ - P) Backwater valve 16.60
Clothes washer 16.60
` Dishwasher 16.60
Drinking fountain 16.60
'' fi 140"1 OWNER R : I E TENANT , ` P ' E: Ejectors /sump 16.60
Name: ARz& // (2 „ V1 d o „2. se vi Expansion tank 16.60
Address: 7,5-4,6---m/ d _p 14,26 s i 2/141, Fixture /sewer cap 16.60
City /State /Zip: 7 �, Yz ,j f 9 7 ,a Floor drain /floor sink/hub 16.60
� 9 16.60
Phone: 43Ifgsag Fax: S _ Hose bib 16.60
Anil* ANT,., : , : , : r.;.., A i`° ®:CONTACT PU ON .
[� I ce 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
� 16.60
: . :x s; . !.; ,,, : .: ' Urinal
=i_�t� g�`: m ;CONTRACTOR���'.x: =':= ��a,.;.�: 16.60 -
Business Name: iC) (,O N(= Water closet - -
2 Water heater 16.60
Address: Other:
City /State /Zip: Other:
,e 3 . � * �..,,. ,: � i
Phone: Fax: .., ..
',w' ,: Pluniti' ipgE= PermittFtees��� .�,_:; >�;���:,'�_ 0
Subtotal $
CCB Lic. #: Plumb. Lie. #: Minimum Permit Fee $72.50 $
Authorized 7 Residential Backflow Minimum Fee $36.25 /A, '50
Signature: t w �� ! - �/� ate: l la p 3 Plan Review (25% of Permit Fee) $ r�
State Surcharge (8% of Permit Fee) $ . ' dv
(Please print name) TOTAL PERMIT FEE _ $ 7K,
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.
is \Dsts \Permit Forms \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
, Site iJt>Lties
49#15-11:1 Fee (ea) Tota . :Square °Footage:; Pe'r,`mit Fee:
Footing drain - 1' 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 Va lu "anon: - Permit „-Fee:.,
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
!-:"1 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 *.
f1. Quant�tyby (Ftxture)workPerformed Comments regarding fixture work:
Fixture Typ Miz,K9 NReplacet
p n New 1VIoved Ex�shn� Capped ""
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
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:
is \Dsts \Permit Forms\P1mPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection /A: ,e (503) 639 - 4175
INSPECTION DIVISION -- Business L 1(503) 639 - 4171 - MST
BUP
Received Date Requested AM - ( M BUP
Location 75-60S- 41-) Suite r MEC
Contact Person Ph ( ) PLM Q 2603-6 ° 0 °3
Contractor Ph ( ) �gf) -q1.31/ �� - 00 --voca t
BUILDING Tenant/Owner ELC
- Footing
Foundation Access: ELC
Ftg Drain 7.2 N� 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
Fire Alarm Ce f� r/C /1/ 0 f r
Susp'd Ceiling •
Roof
Other: •
Final
PASS PART FAIL
PLUMBING
' Post & Beam
Under Slab
Rough -In
Water Service
iary ewe
Rain ra ns
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
S S "P ART FAIL
\s\
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line )
ADA Approach /Sidewalk Date Inspector Ext
Other: fff
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL