Permit CITY TIGARD PLUMBING PERMIT
' DEVELOPMENT SERVICES PERMIT #: PLM2004 -00430
Al l 13125 SW Hall Blvd., Tigard, OR 97 (503) 639 -4171 DATE ISSUED: 9/16/2004
SITE ADDRESS: 13010 SW RAPTOR PL PARCEL: 2S104DA -07500
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 061 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SFA WASHING MACH: BACKFLOW PREVNTRS:
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: 150 ft
Remarks: Building #5. 13010 thru 13078 SW Raptor.
FEES
Owner:
Description Date Amount
O'BRIEN, ERIC & CAROL
13010 SW RAPTOR [PLUMB] Permit Fee 9/16/2004 $101.40
TIGARD, OR 97223 [TAX] 8% State Surcharl 9/16/2004 $8.12
Total $109.52
Phone : 503 - 162 - 3470
Contractor:
R &H RESTORATIONS
1530 SW TAYLOR ST.
PORTLAND, OR 97205 REQUIRED INSPECTIONS
Phone : 503 Storm Drain Insp
Final Inspection
Reg #: PLM 38304
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.
7 6 Issued By: jo„.6,.‹,...-ae/f� Permittee Signature: ,'-
Call (503) 639 -4175 by 7 :00 P.M. for an inspection needed • next business day
B Fixtures RECEIVE D
t
Plumbing Permit Applicatio f EP 1 6 20 -OFFICE OFFICE USE ONLY
City of Tigard CITY OF TIG' R e Received api / Permit No.: L/— / L 2
Date/By: / b , 14 _ ICJ
13125 SW Hall Blvd., Tigard, OR 97223 BUILDING 01 ,/ 10 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / A /so/p"� ' t �i Aix Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 rA j j AI I1 Date Ready/By: Su
H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 774 Supplemental Information
' � , T OF' WORK � E H - - ED - - ,
F E -- SC
-_ '.- „ _z. . ..r� . - .d,' -c �.. .a , ; - .E.o,s ^ >..�:. s'�.w`� - ..„,... _ 434 � wSaay..,_ ��.�."�'���.�v <,,, y v ;� .. ,. ... ..
❑ New construction 111 Demolition For special information use checklist
,� Description Qty. Ea. i Total
❑ Addition/alteration/replacement Other: p row `, w Q, k New 1-2-family dwellings (includes 100 ft. for each utility connection)
rk 4 lint ORrOF fON USTRCTt4N � c SFR (1) bath /249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building IX1 Multi- family 7 0" SFR (3) bath 1 399.00
• Each additional bath/kitchen I 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
,''. JOB STL'F.. OI2MATION"AND LOCAL ION ` - = ya Site utilities
Job site address: / 710 10 _, / 7 i / e.,o �1 Catch basin or area drain 16.60
City/State /ZIP: -•.cik Drywell, leach line, or trench drain 16 -60
Suite/bldg. /apt. no.: J L Project name: � • i l.� t. /, J�,S Footing drain (no. linear ft.: Page 2
t w Manufactured home utilities 110.00
Cross street/directions to job site: G0t.44.atc_ J (+ /3,3 f«--F
�r^ Manholes 16.60
L . r q" ot, get.) 4-<7 V - 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
. >x: '''' � - .
i-,DLS RIPT;ION qF WOT2K ,
�, v� _ :� . � � „ ..,.4���.: �,.,;„:, »,��.•.� �,�, �.. M „ .., . ..,...� Backflow preventer Page t
g , C.. 01J o 1..A_ A_ / - [ e.. � p�y - . �t4. Backwater valve 16.60
DM/ t- t it' � >, rte- P ' :• �! Clothes washer 16.60 • ��� Dishwasher 16.60
z Drinking fountain 16.60
r il PRQPERTY OWNS ' � t 7 E1 AIsi —
.�.A^ .., , .,. :..,, ^ . ,,.- .:4: f , - : r 4, , W Ejectors /sump 16.60
Name: V r , C oL ,..5.. A / �6jr Leo" L, 4 5 1 — 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
z i -; = fr ;' # a':' ;:f: , i M ; " -6Ni lV ;:E3? Hose bib 16.60
^ APPLT T �r ❑ CONTACT ERS'ON
,) 0 .. m .,,„ . 1 » .. _ . .._:.:, . s �,,, ii' 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
$. ;• �_ " h^: ^ e 4 , • :f:. CON.`I�RACTOR -. '.y z '"
' K . -'; ,..1 o-z s, , -. . -;. , ". ,, °'t :r _ „ -, W ater closet 16 60
Business name: R f 1 Pej 'Fov'a-- .ibtit,S Water heater 16.60
Address: iot/lo Other:
City/State /ZIP: P r-4- 16 k ` O r1^ ? Z vs Subtotal
Minimum permit fee: $72.50
Phone: (66 3 7 2 - . Z Fax: (sb 3 Z 2y' 3 63 - Residential backflow minimum permit fee: $36.25 /0 /,, y10
CCB Lic.: 3 7f3 Off. i A_ x..3- Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 2.. /"...._ Authorized signature:
' 4 i /... - • ,,�� TOTAL PERMIT FEE /09, 5;P—
•
Print name: f 37 m;+-, & e I l Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Permits\PLMF- PemutApp.doc 12/03 440- 46I6T(10 /02/COM/WEB)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
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Fee Schedule: Residential Fire Suppression Systems:
S>te�Ut>< ><t es Qty a e$,q -a e k , L er F
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
Storm & Rain Drain - 1st 100' 55.00 - Valuation ' Permlt Fee
c4, $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 eI 6,y $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
FlI tU to or tClll QfY ee (e 'T #ota}a additional uding $100.00 or
000.00.fraction thereof, to and
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 $
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
/0/ L1p 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 * .
Alt i Quantity kY (Ftxtune) WorlPerformeci
01 E T,� C '' '�„ ^' .. ,, y `� riii, x _ iReplace t
xp l Move .4 Ong " s eal3ped 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"
-3"
-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:
i.\ Building \Pemvcs\PLM- PermitApp.doc 3/03
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CITY OF TIGARD 24- Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION,. Business Line: (503) 639 -4171 MST
BUP
Received Date Re • nested
_ a AM PM BUP
Location O 0 : —,• -'.■ i ° 2-- Suite MEC
Contact Person Ph ( ) '3'63 - /.S 3 V PLM Ob z i — Od ei3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: �
Ftg Drain r 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
Under Slab
Rough -In
Water Service
Sa n Sewer
eRar rain
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth
PART FAIL
'MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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 / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL