Permit CITY TIGARD PLUMBING PERMIT
u DEVELOPMENT SERVICES PERMIT #: PLM2004-00344
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/22/2004
SITE ADDRESS: 13717 SW LEAH TERR PARCEL: 2S109BA 09100
SUBDIVISION: DAFFODIL HILL ZONING: R -7
BLOCK: LOT: 017 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: Installation of residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
GOO DLET /MARS HALL
PO BOX 91551 [PLUMB] Permit Fee 7/22/2004 $36.25
PORTLAND, OR 97291 [TAX] 8% State Surcharl 7/22/2004 $2.90
Total $39.15
Phone : 503 297 - 1881
Contractor:
CATANDELLA IRRIGATION +
BACKFLOW
5334 SE DEL RIO CT REQUIRED INSPECTIONS
HILLSBORO, OR 97123
Phone : 356 8022 RP /Backflow Preventer
Final Inspection
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 -000 : :: ou may obtain copies of these rules or direct questions to OUNC by calling (503)
246-999. — - --
1
Is ued By: r \ _ Permittee Signature: \
all (503) 639 -4175 by 7:00 P.M. for an inspection needed • next business day
e;13uilding Fixtures
Plumbing Permit Application - . , ::::,.,,,,..,...
- FOR OFFICE USE ONILY' 0
City Of all Blvd., Tigard Date/By: 7 ' / , 7 P ermit No.: r/ jyf 3C� 1�
all Blvd., Tigard, OR 97223 y "V /
13125 SW H
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ii Ni II Date/By:
$1\ D Other Permit No.:
24 Hour Inspection Line: 503.639.4175 eT� l J
ard.or.us �.. Date Ready/13y: S See Page 2 for
Internet: www.ci.ti Notified/Method: fied/Method: ) t�j. Supplemental Information
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%New construction ❑ Demolition For special information use checklist
Description Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
w ; +.±.; :�'F r + �:,, > - F:, ,.r,.'�%� : "s s,a� a ca_- ,.r. - :;a,. : ^;
:� . I VI l i e TEG Y , F G01 3 RLJrCTI <
a aiSC, , 7 ,m ' l SFR (1) bath 249.20
)2(
and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
• Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
...;.s;a..: a ;• ::.., ,..: :. a, Fire sprinkler ( sq. ft.) Page 2
'' " 1 ` JOS gititi )EEO TIOAi •LOCATIQN x <;. •
,.s aI„AMtW ,ate . , rr m 4 r • Aok• k ii ' a >N .�*Z ,• ;41 _ Site utilities
Job site address: 1 3 3 l 5 Lo L P ,�� L . -{ ��r Catch basin or area drain 16.60
City/State /ZIP: 1 -TN G AT Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ( I Project name: d cat G l n . 1 1 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 1 10.00
Cross street/directions to job site:
Manholes 16.60
\■,/e,Cik"- U1e.W 4 •_r Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) • Page 2
Fixture or item
Tax map /parcel no.:
: ,' tip :ir,,: °' -, •;, , tPii: :,.: T•f ; _'. »' -c: `�,:�'t ?et h71.;'r,. #Se ., ,r
Absorption valve 16,60
_ , t t 4, ` DES RIPTI N ,O F WOR l ?. ... �t Backflow preventer 1 Page 2
Backwater valve 16.60
Clothes' washer 16.60
Dishwasher 16.60
,� �� z r � s Dnnking'fountain 16,60
. � .. 7'RUPERTYO WNr •s . . r s + .,- ;:'M'" dTF''lYANT.. .. ,,. : 7
tt� Ejectors /sump 16.60
Name: �i l -- 1L '-L_,
Expansion tank 16.60
Address: D At, tr 9/537 j7 Fixture /sewer cap 16.60
City/State /ZIP: 1-371.77 0/___ 9 7?-9/ Floor drain /floor sink/hub 16.60
Phone: (`r5) 897- / gg/ Fax: ( ) Garbage disposal 16.60
r li ,tm , ' , a, ., . gi v - Liz �, ,," ` , el *i � - ; :..: " ^.m - ttarf :: Hose bib 16.60
A.t ' �t APPLICANT l t ❑ CO A � PERSO . ,,,
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
> - ;: �£.: t. ,. r= M,: ,; ;.gYt.wit r . - iw.a .,< �.s.: ., �::' :` „ as w „' d r t:= ea,:?T, z . ?„ .., § �," .° ..
t 4 ., z A _ . _ rA CONTRAC TOR �r�, � , W ater closet 16.60
Business name: ��, L L' -r 4 %, kC,.'S ko Water heater 16.60
Address: g 3 S ek Q.... o c� Other:
City/State /Z1P: 1 1 1 , 1 y q r0 Or 91-1 2 3 Subtotal
1� Minimum permit fee: $72.50 a , as -
Phone: ( ) 3 S-G 30/7.> Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie :: Plumbin Lie. nor. Plan r eview (25% of permit fee)
b-zz g- t t. 41 6
Authorized signature: -
_ State surcharge (8% of permit fee) 9�
TOTAL PERMIT FEE .,3 /5 '
-7\---;_ / t1fi�. thin
Print name: 1 ' �-k L � Date: �� r / Th is permit application expires if a permit is not obta a within
`1 " ( 180 days after it has been accepted as complete.
*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:
Total, >,.
Site YTtil ties � , _ 3 _. .:� Q C . • 5 °gauare Footage . _i , : Permit' Fee¢ '
Footing drain - li 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
iV;alu�ation „, .; =Permit Fee
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 •
I additional $100.00 or fraction thereof, to and
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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up: , , $742.00 for the first $50,000.00 and $1.20 for
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 * .
_Quitifif b} (POctureJ WoIViiirosmeil i
F'EXtQI'e Type ' ' i35 � - "rai Nri -- t ']2epJaee s -
YVIAVettiAgit4 Moved, Et shn capped Comments regarding fixture work:
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"
- 4"
Car Wash Drain
Garbage - Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
-Industrial
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
- Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
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:
is\ Building \Petmits\PLM- PermitApp.doc 3/03
CITY OF TicARp 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 c;( MST
U BUP
Received Wag- Date Reque ted AM BUP
Location ( � / 7 at) -ch- Suite MEC
Contact Person Ph ( ) 5 51- 39° PL) ,219-0 34'Z
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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
Roof
Other:
Final
P ART FAIL /1"
LUMBIN
am
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole •
Storm Drain •
Shower Pa.
PART 1 - Al
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: 111 Unable to inspect — no access
Fire Supply - Line
ADA
Approach /Sidewalk Date `2 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL