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Permit fi CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2003 -00210 � II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/20/03 SITE ADDRESS: 13305 SW HOWARD DR PARCEL: 2S103CA 00900 SUBDIVISION: WOODCREST ZONING: R -4.5 BLOCK: LOT: 012 JURISDICTION: TIG CLASS OF WORK: OTR 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install approx. 100 If of line work to connect house to sewer lateral. Septic tank to be pumped, filled and inspected. Reimbursement district #22 paid. FEES Owner: - Description Date Amount OTTERSON, JACK W /ESTHER M 13305 SW HOWARD DR [PLUMB] Permit Fee 5/20/03 $72.50 TIGARD, OR 97223 [TAX] 8% State Tax 5/20/03 $5.80 Total $78.30 Phone : 503 - 520 - 6098 Contractor: A-AFFORDABLE SEPTIC SERVICE PO BOX 1130 • WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Sewer Inspection Phone : 503 969 - 9548 Misc. Inspection Reg #: LIC 151481 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 • me Oregon Issued By: _ ` dA . �� - ` Permittee Signature: • 1 / Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin-ss day Buckling r ixtures Plumbing Permit Application FOR OFFICE USE ONLY - �� Rece Q pp Plumbing Date /By: 6 8P Permit No.: 3 -6 D Cit of Ti and Planning Approval Sewer Y g 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 a. _ d 1 .., ,.k Post-Review Land Use � 011 ' 1( I Date/By: Case No.: Internet: www.ci.tigard.or.us em u- �. I Contact Juris.: ll See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 '- Name /Method: ) 6 Supplemental Information. !AMMO f.. ,, y�. - -- - a;;"�.. *Rr,: - '.. #, . . "sv'�.A:.,a >�:s :"^- '.kY.^ ts.• :^- aa,S�; d�T^,..,s, °, °�3-,: � ::c• �� p < ',, »� g.4,: :�' ; M = ' ' ; m m M , ., ° 'lxs 2 y , *h IIouti (for speeial informaiiih use:eheckliiis _• F ? , � .�. � ,. «, `��,;TY &E�OF�'1'�® ..���.���" �;.v '���y..�..� s�.�F'EESC �_._.. �:�,,. ❑ New construction ❑ Demolition Description • I Qty. I Fee(ea) I Total � I ' Newel ¢& 2 f ly dwelln gs� � , ,� � `' Addition/alteration/replacement ❑Other � �s " ' ;,_ A Yi »OF CON TAR �ION4 ' ` , ;. a _:. '' � m Oncludes�100Fft:ifor each� utdrt connec tion) ;s , o z TEGOR• _.' , S U.,GT _ _ m... .�: >,�.. . 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (1) bath 249.20 SFR (2) bath 350.00 Accessory Building El Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 haVnt JOBTSITE?IN'FORMATION and ,� ` ' Fire sprinkler - sq. ft.: Page 2 Job site address: /,3 5 ca /4i. s. , ;„-' : ° ctsm '` viS tixoitie s .t ; :t._ ' :" , Suite #: Bldg. /Apt. #: Catch basin/area drain ` 16.60 Project 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 /27 -i, 6�-� � lrG� low Manholes 16.60 6� / Rain drain connector 16.60 • Sanitary sewer (no. linear ft.) • Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 . Tax map /parcel #: Water service (no. linear ft.) Page 2 A ;�;� �� �' ��;D�SCRIP�T�ION®FMWORK��� ,��� � 14.' .^�`.�° t•k r v' =° �- uiture or'�Item= .� `�;'!�, ��, ki'- it -i'. l`� : •� ,=aI E; Absorption valve 16.60 i_ tI ./..02A__ _._ .1 PL . ,� ji . Backflow preventer Page 2 L C • _ . M Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 5 la 4PROPERTY:OWNER `z' '` _z = "': ""` . � ., `i in .�vy�4` Ejectors/sump 16.60 Name: e_ E- c � Expansion tank 16.60 • Address: . / 2.2 ,/) t--q / f.- Fixture /sewer cap 16.60 . City /State /Zip: . zi � Floor drain /floor stnk/hub 16.60 / � - ©/ 9722 Garbage disposal 16.60 Phone: (/ Fax: Hose bib 16.60 =- WieIC* . (, ;= il„t k pJ .�° `- .C®NTACTFPERSON,e Z. Ice maker 16.60 Name: Z Interceptor /grease trap 16.60 Address: . Re,, 0 /430 Medical gas - value: $ Page 2 Cit /State /Zi Primer 16.60 y P: /'. i/7.�� 4 , ' 1'7' 70 Roof drain (commercial) 16.60 Phon : 90 ' rg I F`ax:,S77- 0 77? Sink/basin/lavatory 16.60 E -mall: ) Tub /shower /shower pan 16.60 a ter: „ rtet .; , a , ., s ,., c ,.. ; <.s Urinal 16.60 �_°�`•�;�.�_;��;;::., � "'CONTRACTOR �. � - tom .�• °t' Business Name f� G ,j4, "* 7�n �p,,y,•', -e Water closet 16.60 Water heater 16.60 Address: 1 2 0, ,,I few //O Other: City /State /Zip: 49,s oil, 0, 976170 Other: ,� f _ " 'I. Plgmbrr Perm�t3Fees* <� `` Phon(c. #: sp b 7 7' 9 7 - 77'y _< ,, .. u, >; , �/ l fg� ' lumb. Lic. #: ' Subtotal $ CCB i 7 Minimum Permit Fee $72.50 $ 3 Authorized Residential Backflow Minimum Fee $36.25 0 Signatur : /L • Date: yo/o3 Plan Review (25% of Permit Fee) $ -Kirk . State Surcharge (8% of Permit Fee) $ `' , (Please print name) TOTAL PERMIT FEE $ £ 5 1 3o) 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. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: l ; Qe3 ' t) S uare Footage y I' t Fee Srte Utthties Fee ea Totals _ - , : nat . . -. _ ._ Footing drain - 1 100' 55.00 0 to X000 $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 - • 3 �� Valuatitn:.:. • Pe "r „ „mit 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 .. c lXtUrCOt TfCTII P1.0- °, e',(ea)r Totals:, 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for 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 *. t tRat t Qu ntttyby(Fxxture)work= Performed Comments regarding fixture work: g10xture Type :V ' itiffir4.46 - Replace' 12 , ,., 9. agi_ . ,„ , ..a -: s 1?Iew ?. 1Vloved ExMii •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\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested tea S AM PM BUP Location /3 30 R Suite MEC Contacterso. Ph ( ) 4 76. f PLM 3 -e6 /D Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Acgess: wow Crawl Drain U Slab Inspection Notes: • — SIT- - Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing • Firewall JAP ..' � � ,��� t`L Fire Sprinkler `� - Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab / Rough -In - - Water Service Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fin `ASS PART FAIL EC ANICAL • . t & 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: El Unable to inspect — no access Fire Supply Line ADA 2 Approach/Sidewalk Date O _.. Inspector i Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL