Permit C ITY OF TIGARD PLUMBING PERMIT
l& DEVELOPMENT SERVICES
PERMIT #: PLM2003 -00358
�.� I' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/11/03
SITE ADDRESS: /03,50 L/ S1-- 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: El FLOOR DRAINS; 12 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: Underslab plumbing and setting of (12) 3" floor drains.
FEES
Owner:
Description Date Amount
WASHINGTON CLACKAMAS CO
SCHOOL DIST 23J [PLUMB] Permit Fee 9/11/03 $881.40
6960 SW SANDBURG STREET [PLMPLN] Plan Review 9/11/03 $220.35
, TIGARD, OR 97223 [TAX] 8% State Tax 9/11/03 $70.51
Phone : Total $1,172.26
Contractor:
II S MECHANICAL INC
PO BOX 639
STAYTON, OR 97383 REQUIRED INSPECTIONS
Phone : 503 - 769 - 3738 Sewer Inspection
Water Service Insp
Reg #: LIC 54464 Top -out Insp
PLM 24 -185PB Top -out 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
Iss = • By r1 / ���,� _. /�_���,E, Permittee Signature:
. (50 .39 -4175 by 7:00 P.M. for an inspection needed the next business day
1 07/22/2003 16:13 FAX 5035981960 CITY OF TIGARD 141005
Pe
Building Fixtures
. FOR FOR OFFICE OFFICE t -�sr oNl_�•
Plumbing Permit Application ,
� ® Date/By �o2 /D ? j PartNa: - 0 0 35
City of Tigard RECEIV
Pimming Appel
Dat v ai Senn t No.: /09
d BY• rmi
13125 SW Hall Blvd. Plan Review Other 61.4 1 0113 Ti Oregon 97223 I t } I 1 t> Permit Na:
Phone: 503- 639 -4171 Fax: 503- 598= 3 Po eview e C
i » Case No u -- 00/)e) -- 00/)e)
Internet: www.ci.Dgard.or.us CITY OF TI . � ,, � Contact C ' • ` ® see Page 2 for
24 -hour Inspection Request: 504:6391M 0 r w Name/Method: i CA. 1 Supplemental Information.
,
":�d•. .iY .. 1 r" • v �� -� . V ,, 'k.. tt'•: iO t T om.-, q y��•vy� .1
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t . y�. :/. ':F�: ?[`�'t: Y �� � 1'. .. �• ek�l"' aa• 17vro"." i.. '.'+'���'.Y�eZI�;'�!•! /.l!n!a_4 : L4ty1.
-.� New construction ❑ Demolition Description I Qty. r Pee(es.) Total
teratio la :: -, ?.. Y i ts g fault" u�i;:�._: .
.:: :;.•
• Adtiition/al cement • Other. ': . ,. f: , JE::�> • a e go es .,. "``'•" : `.:
. li:..... ..: •:.- • i1 • t c 157 o - r . r; I .. c:2 ; ;' ■ SFR (l) bath 249.20
■ I & 2 - Family dwelling Commercial/Yndustiial SFR (2) bath 350.00
• Accessory Building DI Multi SFR (3) bath 399.00 '
❑ Master. Builder . ❑ Other. Each additional bath/Idtchen 45.00
61:FiyF '' 'P'itIONiliiml'slt otc,_ ION r" i;:: : ::., Fire ,, err ft_: P • 2
C C L•'
Job site address: . - •- � D � i��riSU�::.'h: >�, .,� , 'Itci ....:....
Suite #: MI ./ ' . t. #: Catch basin/area drain 16.60 •
Drywall /leach line/treoch drain 16.60
Pro act Name: t y W G cad �• • Foot dra (no. linear ft.) Page 2
Cross street/Directi • : to job site: M®ufactured home utilities 110.00
. _ / ` e ge / r si. Manholes 16.60
f"' Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) //)1a7) • , Page 2
Subdivision: 1 Lot #: Storm sewer (no. linear ft.) /D , Page 2 •
ma arcel # Water service (no. linear ft. 4t) _ Page 2
Tax F' ; � ��
-A :;, `� .:':;
A ve
'I{rk 'r. %'� ;5;141 TABU. 16.60
N it J 1/fIA Is F /IA w ' .b Back flow ;swatter • Page 2 _
J Backwater valve 16.60
r A . 1.4.4 Clothes washes • 16.60
" ! /-t h E. 11.0 ' Dishwasher 16.60 :
v c.•-f-4, A0 ` Drinkin fountain 16.60
�;,:;ff- l 1, '
16.60 _
�- :;;ci:ral'1 �;: , , .,f �_ ii i t•_.,d: E Ejectors/sum,
W Expansion tank - 16.60
Address: (9 AA SW lit 60 ,fir Fixture/sewer cap 16.60 .
City/State/Zip: 7,', 4 � D L- 7 Z7 3 Floor drain /floor sink/hub 16.60
y Qarbape disposal • • 16.60
Phone: co - . • 0 3 Fax: 5b - it 3 - , 7 Hose bib . 1610
� �i;i
I {:u,' .-' 7 is ''i ii:: €' r ,.crol� 7.i7''?''2 _ lee maker 16.60
Name: , , It y 2x s . . r Interceptor /grease trap 16.60
4, --- Medical gm - value: $ Page 2
Address: 511 SW Ala( a e t V ee . - Printer 16.60
City /State/Zip: p q p/2.. � 07?-2 3 / T. Roof drain (cormnercial) • 16.60, • •
Phone: , - . - b o P ax: 3D '5 - . ' b Sink/basin/lavatorY 16.60
E -mail: " e G.• d: o✓ nE / _ ;• 111b/showalshowct.pea • . . 16.60 .
: �,, i ,o. gr.+ 16.60
-i"•:.' $� ..i , ::ik7 7. -.7 , : \ i "14 : •.•,! 1L n:1.tt.dJ' .!sL'ilja) Urinal
Business Name: - - • . • ' Water closet 16.60 •
Water heater 16.60 •
Address: Other.
•
Ci /StatelZip: ... . _
1'3( - ,: '..', -. I :;; ;,,,, :! fd;l:: fj " F ,. ,,1, , 1 19
Phone: Fax: . :M: _
CCB Lic. #: Plumb. Lic. #: Subtotal $ ,
Minimum Permit Fee $72.50 $
Authorized ' p• • / VO lt esideatial Basldlow Minimum Fee $36 25 Signature: _ �. Plan Review (25% Of e tit Fee) S
Date: Z - P
A li A 4 G� f' State Surcharge (8% of Permit Fee) S
(Please print name) TOTAL PERMIT FEE • $
Notice: This permit application expires If ■ permit Is net obtained widths MI new moments' bWUdings require 2 sets of plans with hermitic or
180 days after It has been accepted as complete. riser diagram for•piaa review. .
•Fee ,methodology set by id-County Building Industry Service Board.
i:\Dstt\PermIt Po Iin PbfPamitApp.doc 01/03 �r - -
4 Aloft .' 1 PJ{ /i�/s'r/cj SLowi, Er met/ 01 61/40 8 l e-L r ' Y �" .
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21°-
07/22/2003 18:14 FAX 5035981980 CITY OF TIGARD 0008
L.- . . • •
•
,
. • Pkintinigsreadon - City of Tigard
••
Page 2- Supplemental Information .
Fee Schedule: Fire Suppression Systems:
. t. ' '.:01 .3 • -, .,, , ,'-'iii:2 34 ,5 3 F. F7,13 !,7•';‘':' sgiisr-"ifilitlitlii.1T.i' a4iiiiiiei.i.e.:::;:-.:Fy..:',7:;:.i.v.:::j:;;.:.::;;;;:
in ,,,, ...01L . 0 , : , 1 .7' . .. ', -,- r- _..... ! ._! . ' , •■ , le .-' ......_:,
Footing drain • l IOW 55.00 0 to 2,000 5115.00
2,001 to 3.600 Sl60.00
Footing drain - additicmal 100' 46.40
3,601 to 7.200 5220.00
Sewer • in IOW rE117//M 55•Cj° 7,201 and greater 5309.00
Sewer - each additional 100' - • 6t]7 4640
Water Service 7 1st 100' 55.00 Medical Gas Systems:
Water•Service - each additional 100' • 46.40 • Fgii1iiiiitciiii : ',: •' r :. - ! • 1•.; '• ;
Storm & Rain Drain - 1st 100' • • Wili 55-00 31.00 to 55,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' • 46,40 $5,001.00 to 510,000.00 S72.50 for the first $5,000.00 and 51.52 for each
'" diti/VP:21211.1:2(. J ., i.M • additional 5100.00 or fraction theisof, to and
inelmling S10,000.00.
Commercial Back Flow Prevention Device 46:40 -
310,001.00 to 525,000.00 5148.50 for the first $10,000.00 and $1.54 for
Residential Beeldlow Prevention Device each additional $100.00 or fraction thereof, to
minimum - • • • , 27.55 and including 525.000.00. ,
Rain Drain, single Badly dwelling 65.25 525,001.00 to $50,000.00 $37950 for the first 525,000.00 and $1.45 for
• each additional 5100.00 or fraction thereof, to
Inspection of totisdo; plumbing ar and including $50,000.00.
a • iall • uestid i • tions - • - how 72.50 550,001.00 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
accura . - .11 fixtures could result in increased sewer fees*.
Rik7:4344 , • 7 r.P.___TY. , .__`:e , ••:.; t .r.:•_ 7 .--,-; (7,-.:77 Iv Comments regarding fixture work:
■ .. .--,,:/, 1: " 4" 711 , i. JIFIr.: t■t.i • .-,-.).-..7 7 .71
Aril 1
,..... -".2,1=--•- - -, ; ,• :( .t. ., , •,9 .-; J......,• .. ''; Tt i ‘ '....'.
_L •', . ogt
Bath -Tula/Shown .
-Jacuzzi/Wit ••• .1 • .
Car W • -Path Stall
- •Drilm Theo
Dishwasher •Conirmseial
. • -Domestic •
• Drinkin. Fountain
13 Wash ..
Floor Drain/rink -2" • . •
-3"
-4" ignME
o • Wash Dmin *NW: If the fixture work under this permit results In an
Garbage -Domestic • •
Disposal .03TrIntercial , increase of sewer EDUs, a sewer permit will be issued and
-Industrial fees assessed for the sewer increase must bepaid before the
Ice Mach./Refti Dian, • plumbing permit can be Issued-
Oil - . tar Gas Station .
Res. Vehicle ' ' t ,. Station .
Shower -Gang
-Stall • -
Sink -Bar/Lavatory •
-Bradley . •
• -Commis!
Service • .
'
Swi • ••• : Pool Filter
Washer - Clothes . ..
Water &tractor •
Wants Closet - Toikt • • • •
Urinal • . . .
Other Fures:
- . .
• •
BDsts1Permit FornoThnPemtitAppre.dee 01/03
II —S MECHANICAL 6037694374 09/08/03 11:39am P. 003
• .
Plumbing Permit Application I ti I : ().1.1
44 Date received: Permit no.:
City of Tigard
-1.L. Address: 13125 SW Hall Blvd, Tigard, OR 97223 Sewer permit no.: Building permit no.:
Ciry of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: (503) 598 - 1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
O I & 2 family dwelling or accessory Commercial /industrial 0 Multi - family CI Tenant improvement
0 New construction 0 Addition/alteration /replacement O Food service 0 Other:
- JOB .SI I F: 1. \1')12\1.1110.\ FF.1 ." ( "IIF:I11 1.1 . (l,r special hilornlatinn the Checklist)
lob address: /40 Q 90. ' 7 eird OR. Description Qty. Fee(ea.) Total
Bldg. no.: I ( " Suite no.: New 1 -and 2-family dwellfngy Daly;
Tax map /tax lot/account no.: (� 100 ft. for each utility connection)
SFR (1) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Proj name: Id efi. -,v r F"le,-. ea'fet. 7 5 coo SFR (3) bath
_ City/county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
_ Catch basin/area drain
Est. date of completion /inspection: Drywells/leach line /trench drain
l'l.t %MI \G (OVI t.1( I 011 Footing drain (no. tin. ft.)
Business name: Manufactured home utilities
`S /�? �� . hei -n/ �a/ ter. , Manholes
Address: PD Cdr( , 3 Q r .
v Rain drain connector
City: Sta_u I State:. ilk I ZIP:173z? Sanitary sewer (no. lin. ft.) T OO
Phone:soy A? ; 73 8IFax :503 ibg y370-mail :,✓il/i (co& Storm sewer (no. lin. ft.) < /0p
CCB no.: Tip/4,y I Plumb. bus. reg. no: _ p, Water service (no. lin. ft.) <100 ,
City/metro lie. no.: 9.- l5-06 . !,3 _ • Fixture or item: -
Contractor's representative signatu / Absorption valve
!//
Print name: wt; ii - , '» r -ta / Date: 9 -g- 0 Back flow
valve
( ON' %I Pl.ItSO\ Basins/lavatory
Name: ii1A• // 'p ii.-rbooy•t Clothes washer
Address: �O 69( 1 Dishwasher
'�/ Drinkin fountain () s
City: 5 f v I State 7 I ZIP: 973 ,93 Ejectors/sump ()
Phone: SS' Fax:st 3 9 E-mail: wilij wall,
Expansion tank
cap '
Name (print): _ , et e `t O , . f . Floor drain oor sinks/hub F /2,,
Mailing address: -pC osal
Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation /residential maintenance only: The actual installation Primer(s) 6
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) 6
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
'' , F:.\ (: I .\ F:1; R Tubs/shower /shower pan
Name: PA E Urinal
Address: Water closet
Water heater
City: I State: I ZIP: Other:
Phone:5 2240 al 2.1 I Fax: I E -mail: Total
Not all jurisdiCT,°^a accep credit cards, please call Jurisdiction for more information. Minimum fee $
Notice; This
J Visa 0 MasterCard permit ap p li ca ti on
expires it' a permit is not obtained Plan review (at _ %) $
('reds card number: / / State surchar a 8% .
ea ,rea within IRO days after it has been g ( ) $
• Name of cardholder as shown on credit card p accepted as complete. TOTAL $
S
Cardholder signature Amount
440 -4616 (6/00/COMI
CITY OF TIGARD 24 -Hour
BUILDING Inspection tine: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 ' • l MST
/035 o L /NGo Utz BUP
Received Date Requested / D — / 3 AM PM v BUP
Location ' = - Suite MEC .401.
• Contact Person Ph ( ) ?l 3 2 -.ZS 1 PLM 3 -
Contractor � ( ) SWR
BUILDING Tenant/Owner '_�" } , a f" ILi ELC
Footing ((
Foundation Access: ELC
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
PASS PART FAIL
PLUMBING
Post & Beam f
Under Slab
' ou • - 4 1 15111r-'
" "aerSe.'
atc rains
Catch Basin / anh le
orm a rain
Shower Pan � /i ill Ig
PART FAIL ' ' / -
""�T�T� ANICAL
= & Beam
Rough -In
Gas Line 411'
Smoke Dampers ` - !
Final ��•
PASS PART FAIL I �
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: El Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date P 1 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL