Permit CITY TIGARD PLUMBING PERMIT
' I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00365
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/11/2004
SITE ADDRESS: 11880 SW JAMES CT PARCEL: 2S103CA 02300
SUBDIVISION: TRAVPORT PARK ZONING: R -4.5
BLOCK: LOT: 003 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: 95 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 95' line work to connect residence to street. lateral. Septic system to be pumped and filled or removed.
FEES
Owner:
Description Date Amount
SVERID, RICHARD
DARLENE M [PLUMB] Permit Fee 8/11 /2004 $72.50
11880 SW JAMES COURT [TAX] 8% State Surcharl 8/11/2004 $5.80
TIGARD, OR 97223 Total $78.30
Phone:
Contractor:
OWNER
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: 4, / / •�� Permittee Signature: ����
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures RECEIVED
Pllr7iibin2 Permit Application- - - FOR OFFICE USE ONLY
P'1�7 1 1 2 00 EE e ' w l '
City of Tigard 7 Permit �(��Peut No.�13125 SW Hall Blvd., Tigard, OR 97223 CITY OF T ' RD /
Phone: 503.639.4171 Fax: 503.598.1960 PLFN4 teyENC c2'vz'a; ' k Oif Ai Date/By: Other permit 1 x iR.a -�
24- Hour Inspection Line. 503.639.4175 -� Date Ready/By: yd: d Juris: Supplemental e Page 2 or
Information
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❑ New construction ❑ Demolition F or special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
>^.�,,, : "' � „ �„� :^sor. ^�r.��-. a= �:�x'�: r.:::�:��:;_;;�::r y::- :.�zYi; �:. p ,�.,�` < �:ivs: ..ye'�r ,e: _
%.-4-. . y, .. � �, et ,,,,ct C.,, T GORY QF�CONST C ,,T,70 � =3',': 4 :Z- wfA, � .,�A SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
4 96 E F ' ION�AND' CATION y ' , •. Site utilities
Job site address: // gy0 5 _7Ary1Es £7 Catch basin or area drain 16.60
City/State /ZIP: 77 ,51/Z b y d R.. 9 7 3 .Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: '' ,, I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: QS) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no 2S 103 c t\ 0.1300 Absorption valve 16.60
g � . � � � p � S � �' � � i � t i
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`7- ,Igei At y.., - ., �_..1A,t1 � tO7 ;k u '. -� a .� n Backflow preventer Page 2
S f}/%J; /f}/4/ J F/e-_ --, p Backwater valve 16.60
7 e- i ,/ W0/21‹ 14 /.4/�T LL 414/4 j . P %/-' Clothes washer 16.60
hE coin /SSioA/ V Ep7C T97/1‹ Dishwasher 16.60
y ta r ,
:.: :,, ; ;. n, =,� -. Drinking fountain 16.60
. -` PROXETtI' I. r �` TElYANT 16.60
Ejectors /sump
Name: R, eh/4/ D S V E R i b Expansion tank 16.60
Address: /I a eO o ,, ' MFs c7' Fixture /sewer cap 16.60
City/State/ZIP: ,• g 4 , e 2) 0/e. C ' 7 93 Floor drain/floor sink/hub 16.60
Phone: (S03) � I (.� - ati9 Fax: ( ) Garbage disposal 16.60
:.. g i , > ., _ ?.c a Hose bib 16.60
, �` - ' 'APPL g am.. Sc,- 3s4 " :..'E
�� �- (� . �:° �, � ' .� �� ; ��� � . ��;;�V 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
u � a6� z " - ,, ' YCONTIi m , , - : F, Water closet 16.60
Business name: 0 W /VE R • Water heater 16.60
Address: Other:
Subtotal
City/State /ZIP:
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 '7s 50
CCB Lic.: P1 bing Lic. no _ Plan review (25% of permit fee) �/y�
State surcharge (8% of permit fee) �- 0
Authorized signature: 7 C/t
f TOTAL PERMIT FEE
Print name: ik; e.�R S b Date: 8 /: /aD0 / 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.
is\ Building \ Permits \PLMF- 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:
�:� .:fit:, ���`�, -;�� °:�' "�_> n:.�`�:vrex
, 4 :. t : " : r YFee• ea t 'To'tal = ; LL x i
Side Ta il " :ties ` " ' a t tM ° F , 5 , �Qtk . # . ;eft 0
� .,. . . � � ;�, S� q , ua�r�e;F.00tage � �� Perm 4 :;:',"'=-•->.,:','4'., e
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 :;;4 ri°r� =:Ir °.; : _•-- . .,, °. ° ���,. . ' .
Storm & Rain Drain - 1st 100' 55.00 al . uatio u . , .; ° , P rm><t F
$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
0 � Or IIi ' Qty Fie yea). To1al3' inclludingl$10,000.00. 1 r fraction thereof, to and
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 "re .. _ • -and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50000'.00 , $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or t.... (' -( ', each additional $100.00 or fraction thereof, to
and including •
specially requested inspections - per hour 72.50 e fir s t 0'.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 `5 Quantrt (Fixture) workPer ormed , ' ,: t .. A r,, -'
"I7Flft eT pest" r ,?,� plac Re k �.' A ` - ,
=t� 1 U .M F, p ea m
Coments re ardin fixt work:
Baptistry/Font 't . .-\ • \ • ‘,. '
Bath - Tub /Shower
.- Jacuzzi /Whirlpool •
Car Wash -Each Stall ! • \
-Drive Thru - 1 r / .. ,
Cuspidor /Water Aspirator '
Dishwasher - Commercial + , t '
- Domestic •
Drinking Fountain ' ' r i ' �'
Eye Wash
Floor Drain/sink - 2"
3 „
- 4"
Car Wash Drain
Garbage - Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig. Drains • increase of sewer EDUs, a sewer permit will be issued and
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.
Swiinniing Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet y
P lan review'is required if�fixture quantity total is >9.
•
. Urinal '
Other Fixtures: 1 k` l • ' . - , /. , . ; ' r '
•
i \BuildingiPermits\PLM- PermitApp doc 3/03