Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00402
' VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/5/03
SITE ADDRESS: 13646 SW LEAH TERR PARCEL: 2S109BA 08100
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 007 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 residential irrigation backflow.
FEES
Owner:
Description Date Amount
HEIGHTS CONSTRUCTION
1 [PLUMB] Permit Fee 8/5/03 $36.25
PO BOX 91249 [TAX] 8% State Tax 8/5/03 $2.90
PORTLAND, OR 97291 Total $39.15
Phone : 503 291 - 2550
Contractor:
THOMAS CONSTRUCTION
P.O. BOX 91283
PORTLAND, OR 97291 REQUIRED INSPECTIONS
Phone : 503 - 690 - 4925 RP /Backflow Preventer
Final Inspection
Reg #: LIC 6361
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
i
Issued By:. .�- •� . �/�' Permittee Signature: ,,.; yfa�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbi Permlt A placation FOR OFFICE USE ONLY
N Received Plumbing-
DateBy: p S -O 3 6a Permit No L \.lpQ 3--o 0 7 1 ® - "
Planning Approval Sewer
City of Tigard n Date/By: PermitNo.:
13125 SW Hall Blvd. ��� Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 / /pnri� Post - Review Land Use
AUG l l t Date/By: Case No.:
Internet: www.ci.tigard.or.us �'u ®1 „11,011 Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 5 ���. ..;. ,a :i . < ,� 03,= ILDo603ING D 9-4�1 F 75 r1G A� Name/Method: T K-7 Supplemental Information.
BU IVIS
ION ^U( �- -,w�.. k : � m atton u . -,� _..�.�� w
RI TYPE OF W. ,ORK`,,, ... -.�. Y : , . � ,,.., �� _ : n� � : EE
E SML).Ul E ,(for spec alflaVii se checkhst)� �
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❑ New construction ❑ Demolition Description I Qty. I Fee(ea) ( Total
❑ Addition/alteration/replacement ❑ Others r a� r � a ew & fa wel nn , �' .,..
i ly a trngs x
�` ,t,; :"�, CATEGORY OF CO NSTRUCTIONt ei. - " r; a `„ ( ty �.
i . a nc i ei *,:if fo , h uiili , ection)
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial _ SFR (2) bath 350.00
DAccessory Building ❑ Multi- Family _ SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
'!t I - IONi'ai d,LOCATION � � a' ' Fire sprinkler sq. ft : Page 2
�„, � � JOB SITEIN�FORIVIAT� �, .
Job site address: /34 y(, ' ., 2e4 IA 7 Site` LIiilrttes , .,_ m
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell /leach line /trench drain 16.60
Project Name: , g A// Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
�'?✓'Q4Vr M.' T•t/ Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: 7 Storm sewer (no. linear ft.) Page 2
Tax map/parcel #: r service (no. linear ft.) 4 2
Wate v� inea ) ag e
�� � I�,� =�h :FtxtnceorItem'i� -�`� `'�g
oa..w . rWt•B RIPNI,ON'OF WORK .... . , F _.ZW
Absorption valve 16.60
Backflow preventer / Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
= .;PROPERTX O.W1OltrA " II ITENANT . I ' . : I ...!: Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
APPLICANT :El : Zg ! C.ON;TACT P ERS ON : 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
. �.., _ ,w Urinal 16.60
t�.� i.��., s�.�'�� �CONTRACT'OR'r. rat .� � ..
Water closet 16.60
Business Name:
✓✓��
,d�dl+rt'.5 �,�"'.l;�re c/�"c°ir Water heater 16.60
Address: Az), /3 j - ,j1 ?3 Other:
City /State /Zip: ,te-fj c /' 97.29/ Other:
Phone: Si'3 65O -g52.T Fax: I.. t.: T, _R,k. , P.tumbtng Pe mtt Fees i ., ..,: �N ; , : a
Subtotal $
CCB Lic. #: 3d;./ Plumb. Lic. #: "202 7 Minimum Permit Fee $72.50 $
Authorized • ' / Residential Backflow Minimum Fee $36.25
Signature: <-aa Date: e/sse Plan Review (25% of Permit Fee) $
¶7'' .ref 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 \PlmPermitApp.doc 01/03
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Uttltttes ' �� e (ea) Toial
_ F �
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
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` F i , ? °, : E„Efee;(e 1 Tota►- including �.�:���c includin $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 *.
M e Quantit y ( F ►hire workiPerformied r Comments regarding fixture work:
txture T e ��' a lteplace�
vi `:.. .�.._ awi41 � iN owed > Existing tis Capped4
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
OF TIGARD 24 -Hour •
N G Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busss Line: (503) 639 -4171 MST
BUP
Received Date Re ested °Z I AM PM BUP
Location / 3 ( .4 Suite MEC
Contact Person Ph ( ) -76-411740 PLM 5-0° ` d - D--
Contractor Ph ( ) SWR
BUILDING Tenant/Owner. ELC
Footing
Foundation ELC
Ftg Drain ACCESS: •
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
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
Ot -: U +�/
PART FAIL
MECHANICAL •
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 ° 0 Please call for reinspection RE: 0 Unable to inspect— no access
Fire Supply Line
ADA g23 \ C)3 Inspector * � Ext
Approach/Sidewalk Date p ��
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL