Permit f .
. CITY OF TIGARD
PLUMBING PERMIT
' "'`i DEVELOPMENT SERVICES PERMIT #: PLM2003 -00193
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/12/03
SITE ADDRESS: 10175 SW INEZ ST PARCEL: 2S111 BC -00800
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 019 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of approximately 100' of sewer line. Septic tank is to be pumped, filled and inspected.
Reimbursement District #13 fee paid.
FEES
Owner:
Description Date Amount
W.A.KNIGHT
10175 SW INEZ [PLUMB] Permit Fee 5/12/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 5/12/03 $5.80
Total $78.30
Phone :
Contractor:
77/27664,1/116 /1)
/O_ L oz 34/6
/C D, 0 , 0 REQUIRED INSPECTIONS
Phone : 3V3- 68y. 74' 70
Sewer Inspection
Final Inspection
Reg #: LIC 152663
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
Signature: Permittee Si m�/��
Issued By: �J,uf� � !c1� �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures s
•
Plumbing Permit A lication FOR OFFICE USE ONLY
N� Received Plumbing
Date /By: 5 10? 0.3 b y Permit No. ..7.
fncvos - OO /
city f TI and Planning Approval Sewer
Y g Date /By: Permit No.: t2 j - De9/
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
tilA9l�q��wlE" ( Date /By: Case No.:
Internet: www.ci.tigard.or.us Ili e�!� 1 Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
;,, _ re. ',:TYPEOF, =w._ORK`.;: _. " 4 FEESCHEI)JI;E (forksPgcial informationuse checklist):
❑ New construction El Demolition Description I Qty. I Fee(ea) I Total
5 NCW l t� -1 fn'hllly iiii gS�.. i s
ID Additio al placement El Other: t
L _ -, & , ' (include s �100 J ft - ;for ea util connection .n,- „i.:4
il fe.,'e , . > QRY.OFlCONSTRUCTION , °.n _ - .:... SFR (1) bath 249.20
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
.0,,, JOB SITE4NFORMATION4aid LOCATION ';-;ff Fire sprinkler sq. ft Page 2
Job site address: (O(75" S1Al 1n(EZ ST . ` :' 'K =I Site' Utilities ,' 144 . ,.. .;
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
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) /OD Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: service ce (no linear Page
�: �MInkii; , grit ,'iw ; r
Absorption valve 16.60
/ 00 FT o F L (NE 6,r ofe. Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTM AWiVEI : ;TENANT,, .„ `e ,
Ejectors /sump 16.60
Name: In4 t L. F 2 eo A 1(14( & &t-IT Expansion tank 16.60
Address: %0/75 S W / N Z - ST Fixture /sewer cap 16.60
City /State /Zip: 7 )6A R A O R 77224- Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
. Phone: Fax: Hose bib 16.60
-- i' EfOOLITCANWMWAARZIN I IN CONTACT PERSON Ice maker 16.60
Name: f1� 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
. iii; ,„ : -', . ;_t.. ;CC NTRACTOR, :: n :. >A . ,..' >, Urinal 16.60
Win,=
'Business NameTi t'►f3elitif 4 E EY CAVAV xt 6 Water closet 16.60
Water heater 16.60
Address: T.10.130$ 21 23 G Other:
City /State /Zip: 7 1 - 1, GAP 01i T728 / K 3A-1F, Other:
Phone: 503 -.8 4 - 7970 Fax: A `
,,' ,Plumbing Permi ;Fees *,; „ ,,�
CCB Lic. #:1521063 Plumb. Lic. #:i 5Z463 Subtotal $
Minimum Permit Fee $72.50 $
Authorized / �p , Residential Backflow Minimum Fee $36.25 -7„2_-5Z, Signatur/�t Date: /Z "AY a3 Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ 6 JO
(Please print name) TOTAL PERMIT FEE $ - 7 g . 30
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:
h £ Site Utilities Qty Fee (ea) t otal Square Fcj'titage:° • °;Permit • .
Footing drain - 1s` 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 - •
• ; , , `Pe
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
. ..._,:_ T including $10,000.00.
. Tixture otal' ._
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 *.
g
ar
re
Comments regarding fixture work:
� r ��€, 3 � Quantity by (�xtui•e) Work�erformed'� g
Fiitefe Type t, s "Replace `' . .
SM:h ".:?En d a, ,e pa ped _
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"
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:
i:\Dsts\Permit Forms\P1mPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -41 MST
71
BUP
Received 7 ?,1 Z Date Requeste - C 3 AM PM BUP
Location S� 5 - t ,, / Cdk Suite MEC
Contact Person / ��',�?a'/ Ph ( 5- l7 Z��l S" PLM a "
Contractor �Gt✓444//itS Ph ( b g 7'' 7" SWR
4
BUILDING Tenant/Owner 14 .G i 6t ELC
Footing
Fou ndation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: O jt ^ SIT
Post & Beam (
Shear Anchors
^
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof -
Other: ;i''� ✓/�
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan c
Other: `�'►
A 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 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call or reinsp-ction RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date i Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL