Permit y 9
‘r CITY OF TIGARD PLUMBING PERMIT
�
+� I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00514
c ' JI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/15/2004
SITE ADDRESS: 13769 SW LEAH TERR PARCEL: 2S109BA 08900
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 015 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: Irrigation backflow.
FEES
Owner:
Description Date Amount
GOODLET /MARSHALL [PLUMB] Permit Fee 11/15/2004 $36.25
PORTLANDD, , O R 97291
PO BOX 91551 [TAX] 8% State Surcharl 11/15/2004 $2.90
OR
Total $39.15
Phone : 503 297 - 1881
Contractor:
CATANDELLA IRRIGATION +
BAC KFLOW
5334 SE DEL RIO CT REQUIRED INSPECTIONS
HILLSBORO, OR 97123
Phone : 356 8022 RP /Backflow Preventer
Sprinkler Final
Reg #: MET 5351 '
LIC 11498
PLM 7022
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 =6699:
Issued By i� -�c-w — Permitee Signature: kA.--
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed :next business day
r •
Building Fixtures �)�1f�
P
luj 1 P e m & b1IC�� FOR OFFICE USE ONLY
City of Tigard � 2004 Received / / ./
D ec e ve
, M Permit NZ ��i &57
13125 SW Hall Blvd,, Tigard, OR 97223 D Plan Review
Phone: 503. 639.4171 Pax >�5 98G 960071 11 1I�1°I / t Date/By: Other Permit No.:
24- Hour Inspection Line: 1503y,639..�4`t1�7�5�tifv's'i®N y/�aril >hy� • Ali Date Ready /By: inns: El See Page 2 for
Internet: www.ci.tigard.o ,US5L0 Notified/Method: Supplemental Information
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`••�'x° -,_� -�c � - TYPE OF..WORICe. - °' ,.a, >„
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)flew construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
,. "� I , l �"� .'CATEGORY OF 3 CONSTRUC TI ON3 "€Y+ ` SFR (1) bath 249.20
, .n, r A �r, 'b. &r wi a ".e KeK°vc'3-,. 3, t5.r r ,t'T@u$d rvil `,Bwro .V Fe•,.. - i,.,.4 ; ,i A;
01- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 45.00
['Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
,� ^i'"s.r . •'++'.. ��: �- ::,,.:�!.."!�<: ,,5 •: :k"�a7 " "':�;;: :wAbx �pisx - d`�"C > >e,.n - {s:i): �`- ,ii.��,i°"7"°
1 „°l''3 5 ",, Ot r JOB .S1TE hIN O'WlaTION AND LOCATION1 �r r ,; �,. ; _, Site utilities
Job site address: ` T. GI � �,"�
- ±Q4 \, Catch basin or area drain 16.60
City/State /ZIP: �
1 Drywell, leach line, or trench drain 16.60
�T '
Footing drain (no, linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 4 „„ o , l (, ( 1
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
tt
.-----C----CL � ��,(` b �t- Rain drain connector 16.60
a--AP- v t,�� \ 0_� r Sanitary sewer (no. linear ft.: ) Page 2
,n o R -1 N e,�L- ��- Storm sewer (no. linear ft.: ) Page 2
(� I I Lot no.: Water service (no. linear ft.: ) Page 2
Subdivision:
Fixture or item
Tax map /parcel no.: Absorption valve 16,60
a r At " pN DESCRIPTIONOFaWO ".Hr' j Backflow preventer f Page 2
N"'S I I t tt pc-- A- For � tx .p a - 1,t Backwater valve 16.60
1 Clothes washer 16.60
Dishwasher 16.60
" Drinking fountain 16.60
5 ❑ =PROPER O.W , " fi t. ; I ; ` R TENANT ; "" .`, 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: ( )
° .�,,, �i�t;'at: »� ;g +6t: ,.�; �`''� •�az�" . ,�� � °,;,,, >a;=
r r . V ' APPIfIC _. " * x : " ® CONTACT PER .. , Hose bib 16.60
16.60
; .4d, .., .,,, :1 ,_ . „- -.v , Ice maker
Business name: C0 c,1.,S.0 ,( ` c. t - r 7 n .0 rL d k-�7.0� Interceptor /grease trap 16.60
Contact name: p\e.. ti C c.,"1,c `. 4D Medical gas (value: $ ) Page 2
Address: S 33 L( S E Ze-c 'K. o (, ,-k Primer 16.60
City/State /ZIP: s \n „r cz , 0 R`q l z3 Roof drain (commercial) 16.60
3 < 6 2z, I Sink/basin/lavatory 16.60
Phone: Q Fax::( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
, - - ,,;x -�? : ,a; .it - -_ - 'i� t= :;:T'';i"x a , , •ti;as: «
,�. :�� % �•,t�` �. :: �� ' -t a. " a ,. _ 16.60
,f ,�• h e M' N;TRACTOR.. �, .. r.:' ' ,,^ , ::ag, - r., kV,- W c
%���? ", _�, im!:'f�;n:.. >. >h xi ,;; v "1;�,a " CQ „r5- '�.a ; v ..., a. r^ t. �° u, 2. �:' u .+;i =;3'`��,.;�i�:4�,v, ": .',e�.. e„� -,n�•, .� Aux. � ,�� >.
Business name: n �Qj ✓ Water heater 16.60
J r� � Other:
Address: Subtotal
City/State /ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
- - Pluriibin Lic no : - Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized sty ature: p�,. (J c>,-t.,-ej L TOTAL PERMIT FEE t I S
Print name: i 1,.._, Date: ,, This permit application expires if a permit is not obtained within
_ 180 days after it has been accepted as complete.
IF *Fee methodology set by Tri- County Building Industry Service Board.
i:\Building \Permits \PLMF- PermitApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
,.; N :. `. t ''`
.Ree" ea T,gtal ;'' ;'o• ,.s ;. ._
IS><telVfilities a � ? 3..,E rQy: . f( ? iE s.t as p S=quare Fo -: P
Footing drain - 1s1100' 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 ;. ; s
i
o
=valuatin
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
:, °;;°w� }w:<; -q tr z? , - " . { = a .t, �,, „. = as , + °` a ea ' Total' additional $100.00 or fraction thereof, to and
Y'1I!17rtllre,Or I te�Tljj !t t4Z ' ..a1 ..Qty . 'A ;r ( � u. :tea, 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 * .
` , Quautrty bp (F uture) Work Performed •
Rixtt e J j '' t r � Rep1 c
�* tra Muved aExtsan capped Comments regarding fixture work:
ems_ :�a�., i4!'.t �,�' rag* �'NBtiV� ': ua�, _ «,�33`.4�.r� B;� 2� »o-r ,¢� �-,
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
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refrig. Drains fees assessed for the sewer increase must be paid before the
Oil Separator (Gas Station)
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
total is >9.
- Service
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 \Perntits\PLM- PermitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5(1) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /P 1 ' AM PM BUP
Location (3 7 (p/ rciA-A Suite MEC
Contact Person Ph ( ) 57 PLM a 6 5/./
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain - = ELR
Crawl Drain
Slab Inspection Notes:
--B� - �'��[- 4 SIT
Post & Beam
✓Z��
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: /i'i
Final
P ASS PART FAIL
PLUMBING °..:.
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin / Manhole
Storm Drain
Shower Pan a -
Otr
op: 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
ADA //
Approach/Sidewalk Date 2( > rim Inspector / z Ext
Other:
Final DO NOT REMOVE this inspection cord from the job site.
PASS PART FAIL