Permit .• -
r ITY Y OF TIGARD PLUMBING PERMIT
V 1 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00596
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11117/03
SITE ADDRESS: 12360 SW JAMES ST PARCEL: 2S103CB 01400
SUBDIVISION: WILLAMETTE ZONING: R -4.5
BLOCK: LOT: 039 JURISDICTION: TIG
CLASS OF WORK: OTR 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: ft
WATER CLOSETS: WATER LINE: 74 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 74ft. water line.
FEES
Owner:
Description Date Amount
FITZPATRICK, WESLEY RUTH
12360 SW JAMES ST [PLUMB] Permit Fee 11/17/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 11/17/03 $5.80
Total $78.30
Phone :
Contractor:
HD PLUMBING
PO BOX 61651
VANCOUVER, OR 98666 REQUIRED INSPECTIONS
Phone : 360 Water Line Insp
Final Inspection
Reg #: LIC 151697
PLM 26 -726PB
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: ,‘ 1 .4 a Permittee Signature: _ 7
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
PlumbinifsPermit Application - FOR OFFICE USE ONLY
l 6� Received / I ' Plumbing'''. �� -00314./
Date/B i / / /y Permit No.: a
City of Tigard
Planning • .pro al Sewer
DateB : Permit No.:
13125 SW - Hall Blvd. Plan- Review - Other
Tigard, Oregon 97223 Date /B : Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
//� ' N I� i � t . Date/B : Case No.:
Internet: www.ci.tigard.or.us , a I Contact E See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 --"'" Name /Method: Su lemental Information.
x ;,, S SEE ,SMICOPNOI „ ,,; :,r...... # , FEE *,SCHEDULE°,(f iNfaiii foriiiiii use,chkaiii) alA
❑ New construction ❑ Demolition Description I Qty. I Fee(ea) I Total
III El Addition/alteration/replacement Other: ; _ ; New 1 & 2family dwe1ings �� ,�
�.._.._ i ,, ' , , -. 'i clodes;101): for.�each,utihty •connction) ,, ,,,•,,.
,. a :; RAVATEGORI',OF CONSTRUCTION c_,., :. K SFR (1) bath 249.20
IZI 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
$JOBiSITE=INF a RMATION and;'LOCATION cl Fire sprinkler sq. ft S 1 e Page
X' Job site address: � � a;2. l 0 5 W - /k -Yr)F � � 3 r�: : „ . iie,Uti iii sga A i; t:
Suite #: I 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
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) ' / Page 2
W
Tax map /parcel #. terse (no linear Ftxtnre`,or ° ' '` :,',E a<
Water service r
Page
E , ;, ;, DESCRIPTIONfOF : :CO 'ft " `_ i Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• Drinking fountain 16.60
PROPERTY OWNER . 1❑ T,ENANT , ,,, Ejectors/sump 16.60
Name: / j S OS F/ /� / G/1 Expansion tank 16.60 - .
Address: 42 3 to d 5. j M of _5 Fixture /sewer cap 16.60
City /State /Zip: Tip DX- Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phon - 570 Ztrfr? Z Fax Hose bib • 16.60
APPLICANT r,E ,;ai e „ .; ES CONTA�CTPERS®`N'. £M. . Ice maker
16.60
Name: //0 c i,6 m)g C Interceptor /grease trap 16.60
Address: ,'O A d X - ,-.57 Medical gas - value: $ Page 2
/ Primer 16.60
City /State /Zip: (� /i`/ Gv/ - 78'4. .6 Roof drain (commercial) 16.60
Phone] # ?g7 - 'ZS$ Fax: Sink/basin/lavatory 16.60
E -mail: - Tub /shower /shower, pan 16.60
VIER: ,,.:.k :. - ik ONtfm T R 3;..' .... n,1M, Urinal
16.60
Business Name: Water closet 16.60
Water heater 16.60
Address: _ - Other:
• City /State /Zip: Other:
Phone:\Nd &0^ (0- ` -0(o Fax: /3iAkoo
.. B. ,. • : :':' gtlumbitikI mtt Fees *Cu-; ' :n
Subtotal $
CCB Lic. #: 7 - 7, ( 9 7 Plumb. Lic. #:16 -7.26 Minimum Permit Fee $72.50 $
Author ed - ' , ,_-/-7 Residential Backflow Minimum Fee $36.25
Sir • ,- __ _- - Date: / ' C?' Plan Review (25% of Permit Fee) $
�` W w I `(
_ e 2 State Surcharge (8% of Permit Fee) $
(Please print name)
TOTAL PERMIT FEE $
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:
rt
, = • Site,Utdlttes . 1 Qty Fee (e) oral quare Footage _ .,, ,_ Per.'mit 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 Valjiati T ' „ PerTil ; r
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
WW01: 0Item ' .' _ i t .',. Qty: i wog 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 *.
4
i . *? . Quantttyiby (Fixture) WorkrPerformed Comments regarding fixture work:
F u eT e > `Replace;
� ."- t 7 N „,,Mov Existing „, ,e a Capped
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
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:
•
•
is \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 2- / 1K3 Jj 1ate Requested, 1 /4 P AM PM BUP
Location _„/12-3_67_6 5 &S Suite —
MEC
Contact Person UJ P� (€L/ - patv'i`e Ph ( 5I 6 — 247 PL y ---
Contractor 0 01v v> Ph ( ) SWR
BUILDING Tenant/Owner . ELC
Footing ELC
Foundation Access
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation �'
Drywall Nailing /
Fi reveal I
Fire Sprinkler _ r i
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
"PLUMBING
Post & Beam
Under Slab
Rough -In
-Water Service
Sarn er
Rain Drains
Catch Basin / Manhole
Storm Drain.
Shower Pan
Other:
Fi
__ PART FAIL
ANICAL
Post Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL ° '-
Service
Rough -In
UG /Slab
Low Voltage •
Fire Alarm
Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ' - , ,' Please call for rein pection RE: Unable to inspect – no access
Fire Supply Line r
ADA . ! Xj 2
! �,/
Approach /Sidewalk Date I A. Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL