Permit . __‘,.
. A CITY OF TIGARD PLUMBING PERMIT
- 111 4 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00342 DATE ISSUED: 7/20/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09860 SW PIHAS CT PARCEL: 1SI35CD -15200
SUBDIVISION: KALAMOIIKA NO.2 ZONING: R -12
BLOCK: LOT: 019 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 install.
FEES
Owner:
Description Date Amount
ECK CONSTRUCTION INC
PO BOX 204 [PLUMB] Permit Fee 7/20/2004 $36.25
SHERWOOD, OR 97140 [TAX] 8% State Surcharl 7/20/2004 $2.90
Total $39.15
Phone : 503 625 - 1305
Contractor:
GROVER'S LANDSCAPE SERVICES
26485 S. MERIDIAN RD.
AURORA, OR 97002 REQUIRED INSPECTIONS
Phone : 503 - 678 - 1796 RP /Backflow Preventer
Final Inspection
Reg #: LIC 11807
PLM ALL PHASES + BA
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 questio . , OU - .y •. ling (503)
246 -6699.
Issued By: Permittee Signature: �`�
�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures RECEIVED
•
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard JUL A2004 Da 0 i �p8 Permit No.:'/jDl4_ Q03
13125 SW Hall Blvd., Tigard, OR 97223 CITY ,, , RD Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 BUI � rHrf,:y„ 1' <h 0 , DateBy: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 1 ] uris:
Internet: www.ci.tigard.or.us ^^'^ ---� Date Ready/By: See Page 2 for
g Notified/Method: Supplemental Information
TYPE OF WORK • ' . . - -FEE* •SCHEDULE -', ':- ,
New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION - p ,: - t ." ;,`,••r SFR (1) bath 249.20
❑ 1- 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:
Fire sprinkler ( sq. ft.) Page 2
• JOB'SITE INFORMATION AND LOCATION _ _ d • . Site�uti 'des
Job site address: 9Y60 5 . w ;dtc1i R1 /AS b. in or area drain 16.60
City/State/ZIP: 4 6 _,0 7eo „ t oreit- _ f' , z ./ •C.c._ (' S- __ DMvell, leach line, or trench drain 16.60
/. Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name:
Manufactured home utilities ■ 110.00
Cross street/directions to job site: 6e-
/ 17- Manholes 16.60
l 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.:
Absorption valve 16.60
DESCRIPTION OF WORK _ . - :. c ow preventer Page 2
_ cs/ S S % .Pir/1 - Backwater valve 16.60
)! ,i,_.., / Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ' ❑ TENANT Drinking fountain 16.60
�
Ejectors /sump 16.60
Name: l�i C t / t Ccj ' s 72(./ - £l
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: (. ) Fax: ( ) Garbage disposal 16.60
• ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
• 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: ( ) I F es:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR . .. :. - Water closet 16.60
Business name: s 4/t¢j1/,1S(�j0.e S-ei,e 0, , , • ater heater 16.60
Address: 5T en ...e.- To / 9 r f Other:
City/ State/ZIP: A 6/tore Q / Subtotal
i Minimum permit fee: $72.50
Phone: (. c (7 ,_ (7 C Fax: (3'0.3 , �R- (7 i' C Residential backflow minimum permit fee: $36.25
CCB Lic.: Plu �•bin Lic. no.:
7( g G g Plan review (25% of permit fee)
Authorized signature: !/ --- • ..-' State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: y�(// t � c - .. ,../eve. Date:'' ' This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
is\ Building \Pemtits\PLMF- PemitApp.doc 12/03 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard r
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities. - • -- . .Qty. - - Fee(ea) Total Square Footage:.
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
Valuation: . , Pertit
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
Fixture or Item Qty. Fee (ea) Total . 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
and including $50,000.00.
specially requested inspections - per hour 72.50
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 * . •
. Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thry
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
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:
i:\ Building \Prnnirs\PL.M- PmnitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 7 •L r Date Requ- - ed 7� � AM PM BUP
Location 0 Q 7 Suite MEC
Contact Person c?j Ph ( rap-w/o PLM 0 /' 0 3 5lia
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 011F Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL I
LUMBI 1
Po eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pa�� it, O er:
al
.'� PART FAIL
HANICAL
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: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date r 1 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL