Permit 1
CITY TI G` kRD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2004 -00273
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/17/2004
SITE ADDRESS: 09685 SW JOHNSON ST 001 PARCEL: 2S102BA 01400
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -12
BLOCK: LOT: 054 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: 600 ft
Remarks: Buildings 1 -2 -3 -4 Approximately 600 rain drain replacement.
FEES
Owner: .
Description Date Amount
WOODARD PARK APARTMENTS, LLC
2083 NW JOHNSON ST #1 [PLUMB] Permit Fee 6/17/2004 $287.00
ATTN: ROBERT D BALL [TAX] 8% State Surchari 6/17/2004 $22.96
PORTLAND, OR 97209 Total $309.96
Phone : 503 620 - 8450
Contractor:
MECHANICAL SERVICES INT. LLC
21185 NW EVERGREEN PKWY
STE. 106 REQUIRED INSPECTIONS
HILLSBORO, OR 970124
Phone : 503 Rain Drain Insp
Rain Drain Insp
Reg #: LIC 126015 Rain Drain Insp
PLM 37 -421PB Rain Drain Insp
Final Inspection
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. l)
Issued By Permittee Signature ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Buile'`
A.. ,,
Plumbing Permit Application t ' FOR .OFFICE USE ONLY
City of Tigard Date/By:17 I7 o 3 Permit No.:pl N „ rn�' -- ODD -7.. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 /�rwNl � \ Other Permit No..
�',' I DatefBy:
24 Hour Inspection Line: 503.639.4175 ? 6_ Date Ready/By: lures: RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
..;re 4,4 : " .,m ; ; z" - 'sr' '^.xix"^,xYo ' ;,; ' va?;s.+7: - - `� ".:: is - :.c. :,,? ,' ", .� .. .x. ..,e .:
r..."�s" x "i .e , e � . ,� " ,�,' e.. °"� "' F es, N ,'...,r '�is _: "-� -�"rz '"t''" "FEE *`` °SCHEDULE
Y�
❑ New construction ❑ Demolition _ For special information use checklist.
Description Qty. I Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
H� �: ,1 4 0. 1 ' C A T GOR Ol? C O N STRC JG TION " h . . b0 6 SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
1=1 Accessory building Multi- family SFR (3) bath 399.00
' Each additional bath/kitchen 45.00
1=1 Master builder ❑ ` Other:
ye a , : . -. r ^,. R :.:a -sad. €rn _;, .. ,.. b Fire sprinkler ( sq. ft.) Page 2
':,, " 4 ,6~ �. 1 9 J6tt TE k il aii i 610 D4 " LOC A O " ' . ' ° , _ Site utilities
3
u site d re.s: �
Job site a ddress: "1 l� � � S(v � s ,, o r N. si.- :BLDG, Catch basin or area drain 16.60
City/State /ZIP: `l g• 7 A,2 3 /--- -i-' Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: (,4 0 v - e t • 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
6 9, , 0 - g1/57) 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
Fixture or item
Tax map /parcel no.:
;;` t', .- ;, .7 ,•., :. ; .:;, , » . ,, ,, Absorption valve 16.60
€ DIe:SCRI ife O WQRK W t u
,, .. % e ,c w ,., ,4u,. .,. , _ - �... i ., t � -.; • F ". ..'at Backflow preventer Page 2
. I ■ (oO L'r - �"""''�' ak61 Backwater valve 16.60
/ - .9. - 3 - Clothes washer 16.60
Dishwasher 16.60
- . - ��-r ; Drinking fountain 16.60
T
t PRairiei , edF;F L � t ILI , 'TENANT , '- t
. ��.. _,. .. ,s . .� t _a. , , r,a, „ d� , . Ejectors /sump 16.60
Name: Expansion tank 16.60
Addr ess: Ql g5 c t d S ' f • Fixture /sewer cap 16.60
City/State /ZIP: - 1'" 1 4•• e 7 3 Floor drain/floor sink/hub 16.60
Phone: VW (o ,2Q ` Fax: ( ) Garbage disposal 16.60
wok, A AYPLICi ' .$ !. "�Q G A T`PERSON ; fir. Hose bib 16.60
w ; , .� -MI: > s : g �. ,Asp, , x,. 4 :� _ .. , MI d... ;� _ . 0" Ice maker 16.60
Business name: C A h.� 14
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: (51)3 .P... O9 - -7 loo 0 I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
- -., *°,•�,.�, a' •`F�;*',. � - �•. �.^ - - ; `.a`3�ai ..gw := >'4`sr�.•,r ``c. , ems.,' -v-�; ;«��`;:;:" _,E.: �3 -
. 1 `� .. 3 , � � tegR RACTOR �, ` i .. °" 1• s `�. Water closet 16.60
iii „ ' ; .,y. ms a ,, a -n_ _; �. �� -ff -. ,
Business name: ., wl' S AS Gu o- Water heater 16.60
Address: . g- s k) to )�^ { p fJvti "'" - P , . 1 b Co - Other:
City/State /ZIP:
- � 1 ` ^n Subtotal
1�
A p
$ Minimum permit fee: $72.50
Phone: (, 3) `P39 - 99 9 I D- Fax: ( ) �l - 3 U • d Residential backflow minimum permit fee: $36.25
CCB Lic..' /A/, B l Plumbing Lie. no.: -7 -4)4'7; Plan review (25% of permit fee)
t State surcharge (8% of permit fee) a.1.9
Authorized signature:
TOTAL PERMIT FEE '� ,CJ
Print name: ��` 1,0001,1-at Datei/ - 6 U 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.
iauildingkPermiis\PLMF- PermitApp.doc 12/03 440- 4616T(10 /02/C0M/WEB) .
•
Plumbing Permit Application - City of Tigard ,-
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
SitgOi if es ' kOplirei plow Ivee (ea) r Sg u are Footage . ; Permit F ee_.,
Footing drain - li 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 ,,
e UE i ,u ?�;r�:.T �'w �,. - `�i� zY`i'` .n.Y,',YF:y..«:+.
�vaIualt on P ermit : , F ee ' •
Storm & Rain Drain - 1st 100' 55.00 _
�� •�� $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
OD
_ . � ) additional $100.00 or fraction thereof, to and
Fi Item �tY ; 1 *ee, Total ,
�- _ ,.���,., , ._� �� �:,;. c;2441 . ., �.� (ett) . � i� 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.
�j $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal:
�O� • ' 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
� r , 0 i Qnanttt (k xtu 'gi*Mk gerl'orin_ed ,
Ft Typ . :` Val l 4R face t
New , MgY a� E ttn , 9: 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"
- 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
Quantity Total
- Bradley
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- PernutApp.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 / 6 - 1 (( AM PM BUP
Location ' . ; r.. -. /,! L Suite MEC
' 1 Ph ( ) `i39- //q7 PLM nn `t' --6na7 3
Contractor PPh (S___74_) .5 3 - -- 2,s - e7 SWR
BUILDING... enant/Owner (,L6 X . ELC
Footing
Foundation ELC
Ftg Drain Access:, ELR
Crawl Drain _ .
Slab Inspection Notes: SIT
Post & Beam el �{ g 0A f�.
Shear Anchors (J (� 1� �
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall % 1 / , . ALi�-�^"' a � Fire Sprinkler
Fire Alarm C i
Susp'd Ceiling
Roof _
Other:
Final 1
PASS PART FAIL _ - ,'
PLUMBING '" ., ��' /
Post & Beam / �
Under Slab ..".APP -`� IZ O .
Rough-In
Water Service IlvAll -t rgr--,' . , _e
Sanita Sewer
—..
Catch Basin / Manhole
Storm Drain
Shower Pan — �o �.!� /`
Oth _
—
PART FAIL
Post & Beam
Rough -In ..././2.------....V
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL ,;,4
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: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / - /r
` fio-r Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL