Permit )
CITY TIGARD PLUMBING PERMIT
lit' DEVELOPMENT SERVICES DATE PERMIT #: ISSUED: 6/25/03 3 -00301
13125 SW Hall B Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13165 SW KATHERINE ST PARCEL: 2S104AB 07200
SUBDIVISION: MORNING HILL NO.4 ZONING: R -4.5
BLOCK: LOT: 101 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 device.
FEES .
Owner:
Description Date Amount
BERGQUIST, KATHLEEN
13165 SW KATHERINE [PLUMB] Permit Fee 6/25/03 $36.25
TIGARD, OR 97223 [TAX] 8% State Tax 6/25/03 $2.90
Total $39.15
Phone : 503 - 579 - 7802
Contractor:
URBAN EDEN LANDSCAPE
4135 NE 18TH AVENUE
PORTLAND, OR 97211 REQUIRED INSPECTIONS
Phone : 503 - 310 - 3791 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7200
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: _ AIM Permittee Signature. f ,�(/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t next busines ay
But Iclilmirlxtures
FOR OFFICE, USE ONLY
Plumbing,)Permit ApplicAtitin ED Received .. 1. .., Plumbing c
1 II 11 '0' ,'-''-.'"'
Date/By /2 ;PO -0.3 ?.. Permit Nol 1,.4/11 D-(9 0 0 ) -0(739 1
Planning Approval Sewer
City • of Ti ': gard a) 11n3
R -,:-.7--. , tJu Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF - t . IGA c ID DateiBy: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1-960 nime i nivirON Post-Review Land Use
DU l 47411101 h\ Date/By: Case No.:
Internet: www.ci.tigard.or.us _41, al 1 Contact Juris.: E] See Page 2 for
24-hour Inspection Request: 503-639-4175 '-'" ' Name/Method: - TO. Supplemental Information.
glitiT n AMPta$011t1t1060081:54
El New construction n Demolition Description - - I Qty. I Fee(ea.) I Total
Addition/alteration/replacement El Other: Zni,:';;V;&:
M41-:;:!:tiIikr jkii koia'66iiiiitositiaaj4liyAgsitel
MnfirlweceMOORtorooNsitouratowatagram
SFR (1) bath 249.20
rE 1 & 2-Family dwelling El Commercial/Industrial SFR (2) bath 350.00 _
['Accessory Building 0 Multi-Family SFR (3) bath 399.00
111 Master Builder El Other: Each additional bath/kitchen 45.00
VIOJI 11410,BiSITYWOWATIONEand§tOrACTIOIrIMP Fire sprinkler - sq. ft.: Page 2
Job site address: / / 6 5 - 5t1) A/471672146. 5 i mrn;egzii:.'mmv:Iotfeoaore3gogig:gwmi
Suite #: 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
/1r ./
= - ..,..44/ Manholes 16.60
Ati4v,i,'.1_ 44‘14 , _ "4",/-:,yZ . ":44,-..- - z_ fy( Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax /parcel #:
Water service (no. linear ft.) Page 2
map
Maggilv -222DEsciarvioNii0FNORKSIVRau AbsOrptiOn valve ' - - - ' - - 16.60 -* ' -
Backflow preventer (1) Page 2
Backwater valve S 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PleOPUMOWNT; ElcaMili II`VCNOTIVUISMALT Ejectors/sump 16.60
Name: Efep k 1 s-i Expansion tank 16.60
Address: -S/A Fixture/sewer cap 16.60
City/State/Zip: a.e 9721 3 Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: 95--444"51--7-02 Fax: Hose bib 16.60
__....,_
e;
APPLICANT ( tZIS'ilM *JR, ,I,- fOONtgeitiR4STOSK Ice maker 16.60
Tame: ...ri 4.-i- 07E1 Interceptor/grease trap 16.60
;7
Address: ii/3 C "ir --- Medical gas - value: $ Page 2
Primer 16.60
City/State/Zip: /4,/ 17.A / i Roof drain (commercial) 16.60
Phone: se-3/p-- 37-/ Fax: iir-7 - 12.7D Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
0,0NTRACTORINC :re ifit%ikeircni Urinal 16.60
usness Name: aRs4„,) 6-0 9 .5. Water closet
Water heater 16.60
16.60
Ad(ress: VA . Other:
City/State/Zip: ') - I -5 - 3 Other:
Phone: Fax: iffigUlle:;,iii-:.:TciiiiiiIIAilii*eisIM]:isztalfataingi
Subtotal $
C.CB Lic. #: 7215'0 Plumb. Lic.#:
Minimum Permit Fee $72.50 $
Authorized , -
Signature: Date: .-,25.--.P3- Residential Backflow Minimum Fee $36.25
Plan Review (25% of Permit Fee) $
3/L(...- 0 Teri 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 TImPermitApp.doc 01 /03
t
Plumbing Permit Application - City of Tigard - _•
•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Stte Tl ,.. Qty T o ial F eF, _ Permit Fee
Footing drain - 1' 100' 55.00 0 to X000 • $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
Valuation: _ . -. Permit, Eee, , a .
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
i,! g .� '1Xtu1'eorIte Open... ;- i ,Qt3':tE F feg *(ea)Tofal
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
and including $50,000.00.
specially requested inspections - per hour 72.50 $5n rn t 0 00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: V
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 *.
' ' Comments regarding fixture work:
Fix Quantity.by (Fixture) WorK Perform ed g g
x � . p
tare�Type �� � - ,� � , � Re lac .
& z „,� ' z_ ,,, Yews ?n: Moved Existing 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"
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 wilily-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 • Bus'tess Line: (503) 639-4171 MST
BUP
Received Date Re•uested -O AM PM BUP
Location 3 - S • • 1—d ' - Suite MEC
Contact Person Ph.( ) PLM 3-0630/
Contractor Ph ( SWR
BUILDING Tenant/Owner k L!1, _ 4 - / ELC
Footing C 79 - aqa d Cm') / 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
Firewall
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling r�
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 Q p -
Othe• J�
S 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 call for reinspection RE: Unable to inspect — no access
Fire Supply Line - Il — —
ADA
11.1"
Approach /Sidewalk Date P — o Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL