Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00357
ce 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/23/03
ll
SITE ADDRESS: 13470 SW HOWARD ST PARCEL: 2S103CA -01800
SUBDIVISION: WOODCREST ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: NEW 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: 200 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 200' or less of sanitary sewer service to connect existing house to sewer lateral. Septic tank is to
be pumped, filled and inspected.
FEES
Owner:
Description Date Amount
TUCKER, ANTHONY K AND
JOYCE E [PLUMB] Permit Fee 7/23/03 $101.40
13470 SW HOWARD DR [TAX] 8% State Tax 7/23/03 $8.12
TIGARD, OR 97223 Total $109.52
Phone : 503 - 590 - 3557
Contractor:
A- AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVILLE, OR 97070
REQUIRED INSPECTIONS
Sewer Inspection
Phone : 503 969 - 9548 Insp existing/capped fixtures r
Reg #: LIC 151481 Final Inspection /�p ep- a~rD
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
f
1 ,
Issued By: Permittee Signature:
i
Call (503) 6 : -4175 by 7:00 P.M. for an inspection needed the next business day
•
Building Fixtures
•, FOR OFFICE USE ONLY
Plumbing Permit Applicati • on Received ,i, Plumbing )
Date/By: 7 A, - ■6 Permit No.: 441-ozo -6o35 2
Planning Approval Sewer
City • of Tigard 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 Post Land Use
, .,.\
Internet: www.ci.tigard.or.us ili e 114ild Willit , Date/By: Case No.:
e Contact I.u4s„:.. . rE3 See Page 2 for
24 Inspection Request: 503 "'" '''' Name/Method: //Co: . Supplemental Information.
'1`-,1%iggia0girEIVI.Ati-YiftielYAMORICWRZZZ:::44.inld,ti; Ain1WWWWIWOOMOWODWAROWWW
El New construction ID Demolition Description 1 Q 1 Fee(ea.) I Total
NOM
El Addition/alteration/replacement E Other: wvb,t
Azvaikidionciodes7toolt40..tipactfutility'..etinneetiOn)TWAZ
i'**-OgiatZt:COE,GORX510F;;13CONSUKTION.:0 SFR (1) bath 249.20
O I & 2-Family dwelling E) Commercial/Industrial SFR (2) bath 350.00
E Accessory Building 111 Multi-Family SFR (3) bath 399.00
El Master Builder 0 Other: Each additional bath/kitchen 45.00
1 n!-10:0040-0001TMATIOSITirciltacATIONEiMig Fire sprinkler - sq. ft Page 2
Job site address: 13z/7i' 5 ,p,-, ,,,;;T:m.wogyatlioinc-8-4400.1i
Suite #: Bldg./Apt.#: Catch basin/area drain 16.60
_
Drywell/leach line/trench drain 16.60
Project Name: Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site Manufactured home utilities 110.00
/Z/ ',oh *% af • Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) "a!, Page 2 //, 4
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map/parcel #: Pfi5Ngg*_T.'VAVMPTXarVaFlfghi::nVSN,SiNiMki-VA
qlfgennirrIMPIESVMITONOPIWO<WW.KiMii
Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
OgERlilYitAYN,EgkitRZZ 9EICIORNUMPKIZing Ejectors/sump 16.60 '
Name: r v . 77,,th Expansion tank 16.60
Address: /3 4/70 s ( M 40., Fixture/sewer cap 16.60
Floor drain/floor sinlc/hub , 16.60
City/State/Zip: 77, 4 0,
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
11E1rAYPLIWIZINM2 i, lim CCOVVAWitURSIONYZA 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
Mta.g.AN.::-i'''.::"',44ie.-",;40ONTWOTORWAPIC.ii..i-EAZZiMif Urinal 16.60 _
/ Water closet 16.60
Business N in, ame: , I a 0 li ate_
_ . _ Water heater 16.60
Address: p 0, R 113 Other:
City/State/Zip: /s/w/Z,' 4f9707( Other:
Phone( ?0:77,1 Fax: 5 - 077? _
tiaMfrantaNaliatitirgerliWOW2E41.:4:::aair'L:MI,
Subtotal $
CCB Lic. : /5/vg/ Plumb. Lic.#: • Minimum Permit Fee $72.50 $ 41
-
/o7
Authorized p, / Residential Backflow Minimum Fee $36.25 0
-
Signature: r i Date:7403 rm -
Plan Review (25% of Permit Fee) $
i`C fr nM5 State Surcharge (8% of Permit Fee) $ Y: /-
(Please print name) TOTAL PERMIT FEE $ /t 9, 5 2- _
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 \P1mPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard . -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
r Fe
SiteUtiltttes laQty (ea vocal Square F',00tage::; ,.,., ... PerirutFee: s n :;
Footing drain - l" 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 V alu a tiol l `i" _ _,
:..
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
a Fee ea Total additional $100.00 or fraction thereof, to and
'0,411.74-W1•5!0003 s o ..K a , t,,,) _ ..... _ , 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 *.
f uanttt b �xture Work Performed `' Comments regarding fixture work:
Frxtuee Type � �� �
02441.1' _ � � � ,
.?Move�d .Existing Capped.a
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
increase of sewer EDUs, a sewer permit will be issued and
Disposal - Commercial
- 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:
i:\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 g ! `:° AM PM BUP
Location /3 `f 7D Suite - MEC
Contact Person ( ;_ Ph ( ) q6 9 r '9sLlV PLM 3 - Dor 3L5 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �D jSIT
Post & Beam
Shear Anchors 46 ,C� QZLI
Ext Sheath /Shear
Int Sheath/Shear •
Framing
Insulation
G`iywall Nailing
fr. ewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof / / t: AIN,T '
Other: `
Final y - /
!
PASS PART FAIL •
PLUMBING
- • Post & Beam
Under Slab
Rough -In
WaterS- I -
'ain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O , - .
o r PART FAIL •
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE I I Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date I nspector / Ext •
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL