Permit •
,
A 1 � � CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00601
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/21/03
SITE ADDRESS: 12435 SW KNOLL DR
PARCEL: 2S101 BC -03200
SUBDIVISION: PP1994 -025 MLP93 -00012 ZONING: R -4.5
BLOCK: LOT: 001 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: 1
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 0 ft
DISHWASHERS: RAIN DRAIN: 300 ft
Remarks: Replace rain drains system.
Owner: FEES
Description Date Amount
O.
1243 5 SW KNOL L SW KNOL L [ MB ] PLU Permit Fee 11/21/03 $147.80
12435
TIGARD, OR 97223 [TAX] 8% State Surchar1 11/21/03 $11.82
Total $159.62
Phone : not available
Contractor:
PACIFIC GROUND WORKS
12435 SW KNOLL DR.
VERNONIA, OR 97064 REQUIRED INSPECTIONS
Phone : 503 649 - 8002
Rain Drain Insp
Final Inspection
Reg #: PLM 152746
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: , / .ti - .G`. a c_�� C-i/L, Permittee S ignature: . f r��,,G vt.Y�M � ` yam �-
/ o
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbjn `Permit Application FOR OFFICE USE ONLY .; -
Received . Plumbing N
DateBy: / }/ ' 1 Permit NoL /11. 00b9/
City f ti and Planning Approval Sewer
y g DateBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Internet: www.ci.tigard.or.us j(ii a Date/By: No.:
. W Contact Juris.: ® See Page 2 for
��
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
vow' : 2'� '� a, 5 �. fl�
" 4 ",;'� , , F,." . ,;9 TYRE" OFIW.Oi2K ,. , „ " f #IEEE*SCHEDULE'(foia'special` information :us cl eckl'' `� "� =
tstj k :� `�`,i,
❑ New construction ❑ Demolition , _ . Description I Qty. [ Fee(ea.) J Total
Addition/alteration/replacement '. ,1 ' '-' _. ' �`
Other: '''� #�<�`^_.,`� ��`:�- ",�New1� =` ° &1 familw;ellin s':.�x,.�. ���
a TM 'CATEG RY"OF ❑ " °A;t : t= ,, . d 1 °,,. f° V,:, - i'Qt =
O _:CONSTROUION.,.0 , ��'_•: tt�, (inclu des" 100t ft Pfor,each�utility!conn ecttQU). o 4 •;
"1 SFR 2- Family dwelling ❑ Commercial/Industrial SFR (1) bath 249
SFR (2) bath 350.00
['Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
.,, , Vii. JOB: SITE - ,INFORMATION aiiiil OCATION.. "t ". 't Fire sprinkler - sq. ft.: Page 2
Job site address: i ? &/ i.i, j 3UJ. K Notaa 1wi? , =z:m atestit .s ":wt, °Si'te:Uti►ities{ ,:t, :gty . - - • z
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line /trench drain 16.60
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
Tax map /parcel #: Water _
service (no. linear ft.) Page 2
'. sae.A .r €DESCRIPTION,.`..OFFWORK<" ^ ; :<•. ".i, > ..,,.;,4.,ii�... FturetirItem:.4'= I;"t*,.;_
{� fi
`f '�" Absorption valve 16.60
�
� C C PC • ` IQ •` A N S Backflow preventer Page 2
S it Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
®
PROPERTY :: OWNER i",=LL:5;s I"r` - TEN ANT'" ; > ` ?. a?' Ejectors /sump
16.60
Name: C•l-t A . L1L S - 0 - i b Expansion tank 16.60
Address: l, 3- 935 . S w • i< NJ C •L_ Fixture /sewer cap 16.60
Floor City /State /Zip: •- j o - ' 2-z- Garbage disposal sink/hub 16.60
J Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
® '<APPLICANT` _ #, .;<4- -; :' - ? : ° El i`CON:TACT:'RERSON` :, r,,'5 Ice maker 16.60
Name: AG j Ot ti C G ku [111;.1 k,d Qk'z•lvL.S Interceptor /grease trap 16.60
Address: 1A) C Medical gas - value: $ Page 2
City /State /Zip: Primer 16.60
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin /lavatory 16.60
'O -
I E -mail: Tub /shower /shower pan 16.60
-' , V °i- ; ''`'2 ,- CONTRAC:TOR 7 A- - :''; ,- , N : . '•:i; '"" .';:'_; .;.. Urinal 16.60
m Business Name: ti-Ck KC_ Co t(L ® V 1J '6 A ■k24.‹.:) Water closet 16.60
Address: 5 g ► Si; 2 t
Water heater 16.60
1 / 1 Other:
City /State /Zip : 'fie [ N O0t4 , ()R. -gib ( c(' Other:
Phone:So3 4 9_ o
'&2. Fax :So3 4,yS.. l l u". 3 , : ,,tRac tir "'" mti" Fees *sw"a� _Fa.:: .;, >.,, , . t -•�:
,O . Plain mg Per;' r � " -. •�:� .r'.••__...��
CCB Lic. #: I. '7 it (;) Plumb. Lic. #: Subtotal $
Minimum Permit Fee $72.50 $
Authorized . I -, .-
/ d,o -00a Residential Backflow Minimum Fee $36.25 / t{ • FC(�
Signature:: Plan Review (25% of Permit Fee) $
-- State Surcharge (8% of Permit Fee) $ //. $ .).-
(Please print name) TOTAL PERMIT FEE $ / 5"1. 6.)--
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 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.
is \Dsts \Permit Forms \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Footage: are
S u
q o ge: Permit_Fee:
Footing drain - 1s` 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 Valua'tlOii:., Permit;Fee
Storm & Rain Drain - 1st 100' 55.00 Cf
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' a,. 46.40 9 gV $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
°.•,Gf ;,Qty, °,`" additional $100.00 or fraction thereof, to and
4, °; = r Fixtiireor °Item:; m x F.ee; ea %Total °s
� � )�'� 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 $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 *.
Quantity4by`(Fixture);Work£Performed = . Comments regarding fixture work:
Fixture T e " ' c Replace,
a 4 ,p r � n
4l t YP � ;. 12:1New i. r i s ,. Efistio�r Cappedz1
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 *Note: If the fixture work under this permit results in an
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) 6394175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested l a' — ' AM PM BUP
. Location �' ' 3 S Suite MEC
Contact Person Ph ( ) PLM c � — OO o /
Contractor Ph ( ) 6 (1 go d _ SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:'
Ftg Drain / L 6Y/' ELR
Crawl Drain li
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
Roof /�
Other: v Final
PASS PART FAIL
PLUMBING
& Beam
Under Slab
Rough-In ' / ��
Water Service
Sanit Sewer Warafr r
rai
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
F 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 /�)
ADA Date / Inspector / Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL