Permit C ITY OF TIGARD PLUMBING PERMIT
4i6 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00352
c�'II 13125 SW Hall B Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/30/2004
SITE ADDRESS: 08735 SW REILING ST PARCEL: 2S111AD -17600
SUBDIVISION: MLP2000 -00009 (WINTER'S) ZONING: R -4.5
BLOCK: LOT: 003 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: Install new backflow perventer device.
FEES
Owner:
Description Date Amount
CAPSOUTO, LEON
8735 SW REILING ST [PLUMB] Permit Fee 7/30/2004 $36.25
TIGARD, OR 97224 [TAX] 8% State Surchari 7/30/2004 $2.90
Total $39.15
Phone : 503 670 - 7170
Contractor:
REQUIRED INSPECTIONS
Phone : RP /Backflow Preventer
Final Inspection
Reg #:
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.
Issued By: Permittee Signatur e
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received �d Q Permit N
13125 SW Hall Blvd., Tigard, OR 97223 :
Plan Review ern ` �� 1 `` pQ 3�,L,
Plan Re
Phone: 503.639.4171 Fax: 503.598.1960 Oe2,r.tiy , ;w ' / Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 � I J
Internet: www.ci.tigard.or.us ' ---� NotiDate fied/Met ed /Met Ready/By: hod: G Supplemental See Page 2 for
`' Supplemental Information
TYPE OF WORK . ' - -.. -FEE* SCHEDULE •
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY CONSTRUCTION ; , SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
•
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
: • . JOB: SITE INFORMATION AND LOCATION Site utilities
Job site address: 17 3,1 iaJ. iee. f / c ar Catch basin or area drain 16.60
City/State/ZIP: / /YGi.GF. 40 A 9 7 Z-?- Ct Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: } I Project name: e /' -1,„co u f Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
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 - _ Backflow preventer / • 2 .� • '
i ce) Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
a P OPERTY OWNER , I ❑TENANT
/� Ejectors /sump 16.60
Name: 6 el t �N-' .Co C( ra
` Expansion tank 16.60
Address: X 7 3 r ..P. J C.4., /�?./ D 7
1 t ' - £' Fixture/sewer cap 16.60
City/State/ZIP: 44 r 6 R Q 7 2 3. c/ Floor drain/floor sink/hub 16.60
V a 3) / ?A • l 7 fl (f 3 sr Garbage disposal 16.60
Phone: f! f F ax: o ) 9 G� f op
❑ 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 Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan . 16.60
E -mail:
Urinal 16.60
. CONTRACTOR • , ,' . •-, Water closet 16.60
Business name: 0 N I_Id.-' - Water heater 16.60
Address: Other:
City/State/ZIP: /
Subtotal
Minimum permit fee: $72.50 ./ , S
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 Vim"
CCB Lic.: P mbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) A 96
Authorized • •.• , . 9 5
Iv TOTAL PERMIT FEE 7
Print name: -. C p,,,,- ' ; , /So C / d Date r W Q C 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 \Pemtits\PLMF- PemiitApp.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:
Site :Utilities Qty. Fee (ea) Total Square Footage:' Permit Fee:
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: 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
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
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
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 Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
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 Isometric or riser diagram is required if fixture quantity
- Commercial
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 \Petmits\PLM- PertnitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5 6 75
INSPECTION DIVISION _ Business Line: ( MST
BUP
Received Date Reque ted AM ' 7 / 3 PM BUP
Location F 7 3 S Suite MEC
Contact Person h ( )10!)-- 0260y - D o3Sa
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 �v�- - ,
Framing c./'t.
Insulation � „ Q el-5"
Drywall Nailing \
Fire wall „ r l _—
Fire Sprinkler � •
Fire Alarm
Susp'd Ceiling
Roof (7 L cc— .\ c
Other:
Roof ,
Final
PASS ART FAIL
BI
os Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole ` V \.JC
Storm Drain
Shower Pan c - �i A
Other: / r% v
PART `li
M 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 ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA f'2 O ' Approach/Sidewalk Date Inspector V L/' ` Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL