Permit CITYOF TIGARD PLUMBING PERMIT
AIX Ali DEVELOPMENT SERVICES PERMIT #: PLM2004 -00515
�� SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/15/2004
SITE ADDRESS: 10125 SW HOODVIEW DR PARCEL: 2S111CB 01711
SUBDIVISION: HOOD VIEW ZONING: R -3.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacing shower stall.
FEES
Owner:
Description Date Amount
KATHRYN GARDNER
10125 SW HAOODVIEW DR [PLUMB] Permit Fee 11/15/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchan 11/15/2004 $5.80
Total $78.30
Phone : 503 - 539 - 4906
Contractor:
EARL WISDOM
3966 NE GARFIELD
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 122960
PLM 26 -620pb
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 questions to OUNC by calling (503)
246 -6699.
Issued By: J Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
Pl�mbi, �. Permit Application FOR_OFFICE USE ONLY
13125 of Tigard DateBy:7 /� (/ 7 l N � y"v ` ��
Y Permit N o.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 UHe , �� „�,1� l �\ Other Permit No.:
Inspection Line: 503.639.4175
p �
24 - Hour Ins ,.. 'OIL � III Date Date Ready/By: -fur's' See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: I � 0 Supplemental Information
;r �'', _� � h� - _.._ „,, -v„�., �'�yi''+°':a:!Gr ;�� „�,- ,3H;a� rte:= wa , r �� . > -.� ;.;a °i�':.u^'4x� z :r.:,. , ,..... r.- "�:--' °+r�; .p. -. ---
� � -: :.� µ. „a=, TY,EE= OF :WO 1 ; „� . € � -'' , ° `;.F,BE> SCHEDiILE
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❑ New construction ❑ Demolition For special information use checklist.
Description j Qty. I Ea. Total
Addition/alteration ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
a �.�� � t �r�,� f� ; � as _,.x,� °� TIOA � � a� a * -" � � d� 3,,,,441l.-.47H424
SFR (1) bath 249.20 . -
°,, GAfral rte O)~' .78*O RLdC •
KI and 2- family dwelling ❑ Commercial/industrial SFR (2) bath . 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
'1� T O CATION, ' r ` ?3;i
z� , ,, AldS ,it 4,,, .. ,s = ,,,, ., _.._. ,_w �,av,�. :„<4 - 4, - * aa.0 , Site utilities
Job site address: /Q /� .7
5 ��
/ 1 J e , e ) b Catch basin or area drain 16.60
City/ State/ZIP: �, LS:37Zr Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm (no. linear ft.• ) Paget
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
y$; `,+w'�s "" ' 'tiA s'- uiv'::u.: xc¢:': s-"' _, °° .:_ ,g�',�,r.r,. k,:.2 Absorption valve 16.60
1 �G;, , ,mf ,, .;,'" � DESCRH'TION�OF�W®RK .. z,
- °r° --�� °�-�� � ` �:�*��i�`a��, ,ti E�° 7 � _.� " Backflow preventer Page 2
pee �lLG=u< /L-z« .-e ? j Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16.60
: ,r4 . :, . , ;.: , _. i , . t , : ; f '^ r,,itt y rtr ; a , , s;.;, m,�.;, _. ,r; , ,l Drinking fountain 16.60
'' ,A . 0 £PR , OPE R�OWNER /.. .4?•:�' i, ::,, 31 1,... sTE
Ejectors /sump 16.60
Name:
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
=s¥ s1'., . -, 4^• -?.- ;; ....^.; �w,.,: w, o .a ; a ..14i. ;:nT.z. :+-?v '+
' =t '� ^'t���:�h� Hose bib
16.60
APCANT , _ ' ._ ;; "' - �CCIIVTAC G1N '`
°�""' � �=.':40'°" At Ice maker 16.60
Business name: Er _ z,e, /5 D '`
�'YI !�i kr Interceptor /grease trap 16.60
Contact name: L talc
b.vy1
L9 Medical gas (value: $ ) Page 2
Address: 3 9e. i o:).„), C° Primer 16.60
City/State/ZIP: ,41-C 9.7.e?-/--- Roof drain (commercial) 16.60
Phone: (5Q2) _ - .. A ^ 6 S
Sink/basin/lavatory 16.60
E-mail: I ,a�,, Tu" /shower pan 16.60 / 67 0
Urinal 16.60
!"::,:.„:!'''''',-,•:' "" ' a , *11M2RAGTOIt" " , ° :. 5 1 ' ` 'k Water closet 1
a s�.�a�:�-�.... ��:m� -;xa°. , � _ . 6.60
Business name: L 4/(S i i!' O , Water heater 16.60
Address: 394 6, ,�. -- �� Other:
City/ State/ZIP: Subtotal / *t b Q
��� 9 D" Minimum permit fee: $72.50
Phone: X03) sa S 95"S/ Fax: ( ) Residential backflow minimum permit fee: $36.25 7 l ••"D
CCB Lic.:/ 0 Plumbing Lic. no.:o7 - -1apPe Plan review (25% of permit fee)
State surcharge (8% of permit fee) O v
Authorized signature: TOTAL PERMIT FEE ,. ,j 0
Print name: f L � /A� Date:// /r,5 ay This permit application expires if a permit is not obtained within
Zl��- V' 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\Building \Permits \PLM- PermitApp.doc 12/03 440 -4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information'
Fee Schedule: Residential Fire Suppression Systems:
Total S givare Footage 3 , , Permit;Fe
Footing drain - I 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 ''•_ t . :- .,
Storm & Rain Drain - 1st 100' 55.00
8 aluatO,ri �; Permlt F,ee ,
$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 .
y �, all'r= additional $100:00 or fraction thereof, to and
Qt
F1Xt11re OY ItelTl�j ':` ,,_ , " . . _� - icali , tr*' 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 * .
r l ! ` Quanhty�by (Z txturej�OYor Performed
xfur Type ;=._ r _f Replace a
gLOg , y Mo��a e , 3 E x t nn &RIVAL Comments regarding fixture work:
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"
4 "
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig. Drains increase of.sewer EDUs, a sewer permit will be issued and
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:
is\ Building \Permits\PLM- PermitApp.doc 3/03
7 T'
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 4-2 — (g.
AM PM BUP
Location / U S A/?'- Zr tit-C r & Suite MEC
Contact Person Ph ( ) PLM bbd y_ d aSIS
, ontractor Ph ( ) 52 ?' 95SI SWR
BUILDING Tenant/Owner / 20-1;1 ELC
Footing
Foundation ELC
Access'
Ft g Drain C ELR
'
Crawl Drain
Slab Insp >`':n N te er 1 s: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
_Roof - 'for,
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
CHANICAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line f �
ADA l �
(J
Approach /Sidewalk Date C Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL