Permit ` ' 'a
of n
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00270
E'l) ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/13/03
SITE ADDRESS: 10135 SW INEZ ST PARCEL: 2S111BC 00700
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install irrigation backflow preventer.
FEES
Owner:
Description Date Amount
MCBRIDE HALL, JANET M
10135 SW INEZ [TAX] 8% State Tax 6/13/03 $2.90
TIGARD, OR 97224 [PLUMB] Permit Fee 6/13/03 $36.25
Total $39.15
Phone : 503 639 - 0030
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : RP /Backflow Preventer
Final Inspection
Reg #:
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
Issued By: 41100 S l Permittee Signature: �.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed next business day
Building r fixtures
Pluinbin Permit Application FOR OFFICE USE ONLY
:. - �� Received Plumbing
Date/By: a -1 3 ) ) Permit No -Y l a0c' 3 -e25 76)
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 u Post Land Use
,��m�� IRk it Date/By: Case No.:
t
Internet: www.ci.tigard.or.us ^. 1 �t Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ' "- Name /Method: 77Q Supplemental Information. _
•
t r. : aYirEIOF WORK: ; t `c� t
� � £ '� ��< a " °'���- '� � �� �`�� �" FEE* SCHEDULE fors eclat ,�nformatton use checklis � �:
❑ New cons ❑ Demolition Description I Qty. I Fee(ea) I Total
Additiol 7alterat placement LI Other: `: n N i,& 2 fawtl dwe � � _£:
"t'=T r �. ,�,.» .. ,,. ..._... + � a a ' „�. t - � - m , � *.•, ;i. = (¢ U d44670 t�,fof.'C.�Ch}Ltoity�e0iliiCC iN a <:aa� .:.�'
i , ,,:,, kft(�ORY OFiCONSTRUCTION �W .� 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
LI Master Builder ❑ Other: Each additional bath/kitchen 45.00
�' Fire sprinkler - s ft Page JOB $ ITE ' =INFORMATIQN�and�L®CAT p q• e 2 g
Job site address: -
/0 1 3 S - �ry.V •- �-1'�f Z � 7 ZL ' � � .`,> � � , �� �s 1S1teUt i hties mmia ' = -i oE,;z;,
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.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #
Water service (no. linear Page 2
ae ear n
r L 7f 'naMI' iXtnr61' Itetii :TlitWR '�'-`- M
;, ; ; . , , t)ESCRtPT't®NN OftVyo ,. ._ : .. .- .. Absorption valve 16.60
� ii_ 6,,�J4)) Backflow preventer Page 2
( /0,A1/1./.1--t i1 aA , Backwater valve / 16.60
Clothes washer 16.60
Dishwasher 16.60
�� Drinking fountain 16.60
. P ROPER VUWNEkal 3, ❑ TENFAVM a`; : a3 Ejectors /sump 16.60
.
Name: 1 //4 // ,/ Expansion tank 16.60
Address: _,/ Fixture /sewer cap 16.60
City /State /Zip: ' / i /r' ID alt- / 72 Z Floor drain/floor sink/hub 16.60
` Garbage disposal 16.60
' Phone: 6o 3 CD 0 Fax: Hose bib 16.60 •
APPI IC :A ,'Itri is A. `.. CONTACT initSois,ai . Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
•
Cit City/State/Zip: Primer 16.60
Y P Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub/shower/shower pan 16.60
riatISVEDZINtsVgeOitia-e-TORKM-rtatatolip.,-E Urinal 16.60
Business Name: [97 ,t/Y� Water closet 16.60
Water heater 16.60
Address: Other:
City/State/Zip:
Other:
A
Phone: Fax: F - . ':, a i. Plumbing Permiit k'ees R t i. �. ati .., ?
Subtotal $
CCB Lic,. - • Plumb. Lic. #:
Minimum Permit Fee $72.50 $
Authorized A d-c-44---ze � 'O�� /a 3 Residential Backflow Minimum Fee $36.25 3 (Q . ,-1.5 Signature: r/ �. ate: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ ,., . 0
(Please print name) TOTAL PERMIT FEE $ 39 / 5
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:
ii.FkinSgti:01 -;lpArg aiiqicon gutty j. Permit Fee
Footing drain - 1' 100' 55.00 0 to MOCI•• $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 . ; Permit F
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
EiS,Mr•OitkiteW gMIT FLF0(ea) 11 :Tf4T041 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*.
tit by Comments regarding fixture work:
Fixture Type z:trgA„ Riplace0 !4
airs,TiZE 11*6.4ig
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"
Car Wash Drain
*Note: If the fixture work under this permit results in an
Garbage -Domcstic
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 TImPermitAppPg2.doc 01/03 •
•
CITY OF TIGARD 24 -Hour
BUILDING . • Inspection Line: (503) 639 -4175
MST
INSPECTION DIVISION • Business Line: (503) 639 -4171 .
// BUP
6D
Received Date Requested /D AM PM BUP
Location /6 13S Suite MEC
Contact Person Ph ( ) PLM 3 DO a 70
Contractor Ph ( ) SWR
BUILDING Tenant/Owner % o 3 — I °r 53 ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
- Slab Inspection Notes: SIT
Post
a r Beam
•
S /1/ ��,
Shear Anchors
. Ext Sheath /Shear 12.y_ r izt_t g .e./ 1
-
I Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof -
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
Oth - r: ,
= 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 Please cal for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date / Inspector 7/ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL