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Permit CITY TIGARD PLUMBING PERMIT Al, et, DEVELOPMENT SERVICES PERMIT #: P 21/200 5 -00025 ' � II � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/21/2005 SITE ADDRESS: 12240 SW JAMES ST PARCEL: 2S103CB 01900 SUBDIVISION: WILLAMETTE ZONING: R -4.5 BLOCK: LOT: 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: 55 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: 55' line work for sewer connection. FEES Owner: Description Date Amount BRUNNER, LANE 12240 SW JAMES ST. [PLUMB] Permit Fee 1/21/2005 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 1/21/2005 $5.80 Total $78.30 Phone : 503 - 579 - 4023 Contractor: Q W O C R- REQUIRED INSPECTIONS Phone : Sewer Inspection 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 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: _ Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day ' it AV g Plumbin P 1 PP lication FOR OFFICE:. USE USE ONLY City of T' and tl 1 2005 Received nn Date(B Permit No.: %), 13125 SW Hall Blvd., TigarcOtIl� Y 'a 1 - ©S �J 1 c;2 (JO � ' � 5 Plan Review Other Permit No.. Phone: 503.639.4171 Fax: 503.598.19.Q I A� G„,, iy�., '11 Date/By. St Ai�c�c05 _0629/ 2 24- Hour Inspection Line: / 5 I�j: 1 i t Al 3101 _•_ Date Ready/By: tuns: ® See Page 2 for Internet: www.ci.tigard.o DI '1J TT jj �� � 0 � Notified/Method: / /� Supplemental Information . ��„1 OF WORK • FEE* SCHEDULE . 0 New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION, SFR (1) bath 249.20 E 1- and 2 -family dwelling El Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ' ❑ Multi - family SFR (3) bath 399.00 El Master builder Each additional bath/kitchen 45.00 ❑ O ther: Fire sprinkler ( sq. ft.) Page 2 . JOB SITE INFORMATION , AND LOCATION Site utilities Job site address: / L Z G/v 5(-) y A,.,_... .s $' f Catch basin or area drain 16.60 City /State /ZIP: T; 9 c- r-,-( v fL et 1 2 Z Drywell, leach line, or trench drain 16.60 . ,/ te/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 C )4ss s r et /directions to job site: - Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.. ) / Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK n , I Backflow preventer Page 2 tAk...L . (Qj C.) ,c1 / X., } . - ' Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors sump 16.60 Name: (...-0- .-...e._._ Z,r-,_,..,..�/' Expansion tank 16.60 Address: ( Z. 2.. 4 -1• , S w Ste- s. Fixture /sewer cap 16.60 City /State /ZIP: 7 o„ ok, 25 g- Floor drain/floor sink/hub 16.60 Phone: (c�''�, S *1 et cep'Z3 Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: • Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: OW Water heater 16.60 - Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7a- 5V CCB Lic.: Plumbing Lic._ no.: Plan review (25% of permit fee) `` / State surcharge (8% of permit fee) 5. O U Authorized signature: C-- ws^� -- \ TOTAL PERMIT FEE - 2 sj 2 D Print name: Z. a, Q - 15r e,...e Date: ( / . t I QS This permit application expires if a permit is not obtained within 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: Site Utilities, Qty. Fee (ea) Total . Footage: Permit Fee . Footing drain - 1 100' 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 Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: $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 :Fixture .or Item ' Qty. 'Fee (ea) Total additional $100.00 or fraction thereof, to and 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 * . `Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved Existing Capped 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" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an -Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains 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 Bradley Quantity Total Commercial Isometric or riser diagram is required if fixture quantity 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: i:\ Building \Permits\PLM- PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 1 AM PM BUP Location f a 0 gq /MU Suite _ MEC Contact Person Ph ( ) 1 7®,x' 7 7`S PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation i Access: Ftg Drain ELRV Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors EXPO Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall • Fire Sprinkler '= f � - - ��_— i �— Amor Fire Alarm Susp'd Ceiling Roof Aar �� Other: - ji Final PASS PART FAIL PLUMBING ;;. w :. / 2 ;r l. i L4/ L -- Post &. Beam Under Slab Rough -In Water Service • - ins Catch Basin / Ma ole Storm Drain Shower Pan Other: Fin •, SS • ' T FAIL CHA AL 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 for reinspection RE: Unable to inspect – no access Fire Supply Line �� ADA Approach /Sidewalk Dat 1 �� Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL