Permit CITY TIGARD PLUMBING PERMIT
l� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00547
``��" c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/17/03
SITE ADDRESS: 15143 SW KENTON DR PARCEL: 2S112CB-07700
SUBDIVISION: ASHFORD OAKS NO. 2 ZONING: R -7
BLOCK: LOT: 091 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: 76 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 76' of water service.
FEES
Owner:
Description Date Amount
STEBNER, GRANT E /SUSAN K
15143 SW KENTON DR [PLUMB] Permit Fee 10/17/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Tax 10/17/03 $5.80
Total $78.30
Phone :
Contractor:
ROTO ROOTER - WEST OFFICE
25599 SW 95TH B
WILSONVILLE, OR 97223 REQUIRED INSPECTIONS
Phone : 503 Water Line Insp
Final Inspection
Reg #: LIC 13989
PLM 37 -76PB
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:' ' J
� , - - Permittee Signature: i_d f�
Call (503) 639 -4175 by 7:00 P.M. for an inspection nee • ed t e ne i s ss da j
• Bti ling Fixtures
�, FOR OFFICE USE ONLY
�Pl bin Pe i) " i • ` 7 h,. IUII Received ,....„„ Plumbing A
uuu��� Date/By: /�/7 /QJ �JjIY , Permit No.t/Jy200 Sy7
City of Tigard OCT 2003 Planning Approv l Sewer
1 7 Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date/By: Permit No.:
Post - Review Land Use
WI
Phone: 503- 639 -4171 mi.- ILE 9 Wr rl )N / , �� o .� I Date/By: Case No.:
Internet: www.ci.tigard.or.us � Contact C ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: T76- upplemental Information.
. •, . ;" A-- f a rA ':'4 . ' z ° J.. *: DULE fors }ecial` i tormatio itV e`cfiecklist , :;-
.:
, q ...< �:. xs ., � FEE.. �HE
�. ;, ,;. :� - �T�YP,E�OF WORK -,N..� >� .. _ _ .,f ,,.� . : :. � x < ,_::,� . _ _. P . .. _ _
Description Qty Fee(ea)
❑ New construction ❑Demolition p 1 � I Total
it A i n/replacement ❑ Other: n. + , Newel "&2ifamily dwellings
^:(inclu f eachutihty , .
, ; : "" °¢`is 1CATEGOR <Y,OF CONSTRUCTION , i , ;, _ ` .,>
d...a, -'� ° SFR (1) bath 249.20
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
;_ ; n.:kJOB SITE, INFORM 0tO and LOCATIONS - Fire sprinkler - sq. ft.: Page 2
Job site address: /67 S ee, Als /o. 0 /a- ; a ." . .:� . t gego .,W.
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell /leach line /trench drain 16.60
Pro
1 5U �c?/Y)71 6- S T-e I)'- e Footing drain (no. linear ft.) Page 2
Cross streeplirections to job site: !� Manufactured home utilities 110.00
la l._ c4' l 'yt ' J'1 / ) o iat C6 �'f ke r l
5'CJ �j ._ /°>' Manholes 16.60
n . Rain drain connector 16.60
Side- 04 s �ze v</ op_ S -�" ��'� ,z Sanitary sewer (no. linear ft.) _P ge 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) • 2 (p 4 Page 2
w "r � ?:'. IZI _ Zf l T^.c : lid ,�°:R.n "i. �°- �a,�' 4 .c {i, ,
� .: %x . ;��> f,. .,,. v �Fixtur'e �or �Itein� � �� � :,;. ,�
: _: 'litN FA s> DES.CRIPTIONebr.YsORK >„ ,N,:, -:f `..e �s Absorption valve 16.60
lve
-11-'2/1- 4-)t (cam 4--4,, Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
. Dishwasher 16.60
' Drinking fountain 16.60
; TENANT` .�,i.;' °'F � _ ;
- x ROPERTYOWNER �`��x ��� � e � �`��� "". Ejectors /sump 16.60
Name: S a 2 / -A/n/6 - 7 - 8"1 _ Expansion tank 16.60
Address: /5/ y3 /.Clot/% - O // Fixture /sewer cap 16.60
City /State /Zip: 77 /972.4 47L 97 ,V,2 Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: 6 2 y -35 e 2 Fax: Hose bib 16.60
j 'APPI IeWifi w !W t: 1CONTACT:aPEtts7CoNe Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower, pan 16.60
70 : : .- n , '.� f y .° ; Z.r .�� , � Ar Urinal 16.60
- �i'?� Y"•;:. ,�. : CONTRAC'TOR``'� ,.'Y,� ",. �A.f, �:: > > c..s..:3. ��
Business Name: f oTb /2_00 re Water closet 16.60
Water heater 16.60
Address: , t7 5- q,crk / VC Sul t-e- 6 Other:
City /State /Zip: - L st i 0 ;GL . 612- q70 7 o Other:
Phone: 6 HKZ 9"77 4 -/ Fax: Sea - 6.W - c175'/ r i Plumti ng P.ermtt Fees * :' E `�
Subtotal $ S5, ay
CCB Lic. #• /3 ?” Plumb. Lic. #: g 2 -9G P1 3 Minimum Permit Fee $72.50 $ n
Authorized
di Residenti Backflow Minimum Fee $36.25
Si /off, sv
Signature: ,,,r, gn IA., _ Date: �" / Plan Review (25% of Permit Fee) $
I e_ (' , • State Surcharge (8% of Permit Fee) $ S . efT.)
'
7 ase print name)
- - - TOTAL - PERMIT - FEE - - 9 - 31) --
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\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
7 ; , s t Fee ea s Total ° ,e :; " xu:; . Pe mitrFee
, _ � x ��ite �Utiltties a � y ( )
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 SS, 07} Medical Gas Systems:
Water Service - each additional 100' 46.40
V = Pe F � ,,. -
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
"J'Total ' additional $100.00 or fraction thereof, to and
a Future or Item, , �,� 4 :9-0,0 .F. , ,, eet ea (.°-) ;, 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 *.
Comments regarding fixture work:
g g
F►xture�Type �, �t °" #w :* . `Replace . , ' : s
. • e °New Moved,„ e 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"
-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:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
'LDING Inspection Line: (503) 639 -4175
INSPEO'iON DIVISION Business Line: (503) 639 -4171 O MST
-- +y 7 Received / Date Re uested , BUP
Location / S /.J YA Suite MEC
Contact Person ��' Gt- Ph ( 5 6 ? 3) Q 3 S�!1 3 QJ cT 7
Contractor Ltt � c � eTi; - —L Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain 4 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear = -- -
Int Sheath/Shear
Framing �, S
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
:UMBIIW /
Post & Beam
Under Slab
Ro.•1 -.
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
PART FAIL
M CHANICAL •
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final LI Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line - — -
ADA / Approach/Sidewalk D Inspector /IExt
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL •