Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2003 -00271
ti `�i l DEVELOPMENT Tigard, ) 639 -4171 DATE ISSUED: 9/9/03
SITE ADDRESS: E /D 35o 5IV L/NCOLIl ST — PARCEL: 1S135AB -00100
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 11
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 18
TUB /SHOWERS: SEWER LINE: 450 ft
WATER CLOSETS: WATER LINE: 605 ft
DISHWASHERS: RAIN DRAIN: 900 ft
Remarks: Site utilities to replace existing school building. Other fixtures are: (3) manholes & (15) rain drain connectors.
FEES
Owner:
Description Date Amount
WASHINGTON CLACKAMAS CO
SCHOOL DIST 23J [PLUMB] Permit Fee 8/6/03 $1,435.20
6960 SW SANDBURG STREET [PLMPLN] Plan Review 8/6/03 $358.80
TIGARD, OR 97223 [TAX] 8% State Tax 8/6/03 $114.82
Phone : Total $1,908.82
Contractor:
RAYBORN'S PLUMBING, INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 692 - 4139 Sewer Inspection
Sewer Inspection
Reg #: MET 00001806 Water Service Insp
LIC 87852 Storm Drain Insp
PLM 34 - 166PB Storm Drain Insp
Storm Drain Insp
Storm Drain Insp
Rain Drain Insp
Rain Drain Insp
RP /Backflow Preventer
Final Inspection
•
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
Or
Issued By,SG w . Permittee Signature: ,
�C
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
4
L Site Utilities - 0 ,
Plumbing Permit Application FOR OFFICE USE ONLY
t
Received Plumbing q
Date/Bye 73 Permit No.: I a J --oo 7
Date/By: : Approval Sewer
City Of Tigard Permit No.:S t 7
�� � - � i �% � Date/By: Permi d f, 0 3 - (?f���✓Y
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 //1 I , �7��
�
i � Contact Case No.: ..0 OfGtl7
Internet: www.ci.tigard.or.us ° � =� e .. . j.J l � Contact Juris.: ® See Page 2 for
4\ 24 - hour Inspection Request: 503 - 639.45 i� , .` Name/Method: Supplemental Information. 1
A - TYPE OF WORK '' .FEE* SCHEDULE (for special information use checklist)
M New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings
V CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling KC ommercia1/Industria1 SFR (2) bath 350.00
❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00 .
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
'JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: _ Page 2
Job site address: , Site Utilities _ • .
Suite #: I Bldg. /Apt. #: Catch basin/area drain // 16.60 /RA. (,p
Project Name: M(+Zge,� 6)e.s,? 1a/ S I I? Drywell / leach line/trench drain 0 16
Footing drain (no. linear ft.) 0 Page 2
Cross street/Directions / (/ to job site: / Manufactured home utilities 0 110.00
s-t,, c.0,40 -- S'. (Cr ts s f f- �] Manholes 3 16.60 J/4. BD
J Rain drain connector / 16.60 ?49.00
Sanitary sewer (no. linear ft.) 40 Page 2 ,2 c/p • (c0
Subdivision: I Lot #: Storm sewer (no. linear ft.) goo Page 2 4 o2CP•9.0
Tax map/parcel #: Water service (no. linear ft.) 6o S Page 2 age. 00
Fixture or Item
DESCRIPTION OF WORK • ' - Absorption valve 16.60
Sl /[ i illics Iii r Pp /a 6SM d.ff Backflow preventer Page 2
eL?.„h tI7 Se.4•0 /. (/ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
2<ROPERTY OWNER j ❑ TENANT Ejectors/sump 16.60
Name: 5 1,4)186i / O q Expansion tank 16.60
Address: 61 Q 60 'pI L lir f Fixture/sewer cap 16.60
City /State /Zip: 7 / - • L rd Si 0 2 9 � 7 Z Z 3 Garbb disposal sink/hub 16.60
/ � / Gage e disposal 16.60
Phone: 603 -t 3/: ¢ao 3 Fax: 507- f 3/ - 4041-7 Hose bib 16.60
[]TPPLICANT [CONTACT PERSON Ice maker 16.60
Name: iO 40 heel Interceptor /grease trap 16.60
Address: 54 /o, SI /1g ea ol a pit ,4 541 y rb Medical gas - value: $ Page 2
City /State /Zip: A r �'HA rt 0 /2 9 72 ! 9 Primer 16.60
3 Roof drain (commercial) 16.60
Phone: 503 - 70S -4440 I F lo3 - Lff -alb Sink/basin/lavator 16.60
E -mail: % oI et, @ Co/ $ e ■-516 M rte 4 /�, C Dot Tub /shower /shower pan 16.60
.-..=:' ✓ • • + . V\ONTRACTOR (J, Urinal 16.60
`
Business Name: Rot/ wove: ifZkonSi Water closet 16.60
1 • - Water heater 16.60
Address: /1/990S rc1 C i Pam R•cl . • _ Other:
City /State /Zip: + jq.¢ -ir.v - t's1t- '7706 2- ' Other:
Phone: so3 b$24I35 tax: a69/ Z32e Plumbing Permit Fees*
CCB Lic. #: , A I._ , Plumb. Lic. #: -/ "6P:' Subtotal $
Minimum Permit Fee $72.50 $ /4/3 PO
Signature:
Authorized S 6 ® r � '
Residential Backflow Minimum Fee $36.25
Signature: ��� /�j Date: 0 3 Plan Review (25% of Permit Fee) $ 3 s'g •
JO 1071 IfivEl , State Surcharge (8% of Permit Fee) $ i I . 40'•
(Please print name) TOTAL PERMIT FEE $ ' 0 ' • Os
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\P1mPermitApp.doc 01/03 .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
f BUP
Received Dat qque,�,sted ( AM PM BUP
Location � Suite MEC
Contact Person / 6. - 3.col Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation 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 _ FAIL
PLUMBING
os rseam
U;:ice r S
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Fi
O r PART FAIL
ANICAL
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 LI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line L!i
ADA Approach/Sidewalk Date ( Inspector / Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL