Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00536
± 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/30/2004
SITE ADDRESS: 10521 SW RIVER DR PARCEL: 2S115AD-07500
SUBDIVISION: DOVER LANDING ZONING: R -4.5
BLOCK: LOT: 058 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.
FEES
Owner:
Description Date Amount
HYDE, HENRY P TRUSTEE
10521 SW RIVER DR [PLUMB] Permit Fee 11/30/2004 $36.25
TIGARD, OR 97224 [TAX] 8% State Surchan 11/30/2004 $2.90
Total $39.15
Phone:
Contractor:
TERRA -SOL LANDSCAPING
21685 SW HEDGES DR
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 692 6389 RP /Backflow Preventer
Final Inspection
Reg #: MET 00001938
LIC 00005019
PLM ALL PHASE & 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 •r if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to folio • rules .dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-009.1- o gh OAR
952 - 0001 -0100. You may obtain copies of these rules or direct restions to 01i NC by calling (503)
246 -6699.
Issued By: f6244_14_, 4_, C r �J Permittee Sign Lure.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi ess day
RECEIVED
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Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard NOV 3 u 2004 Received Permit No
13125 SW Hall Blvd., Tigard n Date/By: I / Received ` I�c%r/' -�rJC
I I VHHO Plan Review /
Phone: 503.639.4171 Fan.. A + . / /yp / / ; y1q Other Permit No.:
t/.� 9'1'I 1 DaDate/By: 24- Hour Inspection Line: r . " s ��lY�S��1d ! ' I1 Date Ready/By: 7 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /jG Supplemental Information
- r,- w,,:..�.�� ^,:.,,. -�. � a,.,: ;•r;.= z;��;;� .s' �-.�:: _ �,�!.s�;,�., „ „�> ;°.,..w,. r:ae:; °xa�tt�, -.w r� ,.��. :z - -n, . - •.°�.:,::� _ . _ ..
... ; TXPE4O WORK r : 1FEE* SCHED.LILE
3 F
?.?3 . � ,: ASs... . . 1.a >8,.,.:�,_ ,, .. s+6'2n m z - r. -«..t ta.,rf`Nwi:. M dmx ;�' . xs�s'.x�+, m { . -,... .., , , t '.a,�. ;�. : t ,A ..w «. .�.�.. ia,. a._ . ... a E .e5a�•sa� k^2E. ,,;.<q.. rz;.s, -,--, . _ -
❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
66 'dition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
A T r. T '� �CA O GO STRUCT t. t . ,,
� a . .� ; V Slit8 ..i ;. 9A F a , ,. w .., T u ` ote r .0 SFR (1) bath - 249.20 dal- 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:
. gk Fire sprinkler ( sq. ft.) Page 2
f ` iSTI'F s fit iiiaf O AND L OCATION ,
.,- , . 1, .�. w. r ca, ; . - .. l z: :,,i u d.::. ..v,.T :ff Site utilities
Job site address: /O 6.2 i S Camu g 1 i (l/L. 0 v2 Catch basin or area drain 16.60
City/State /ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 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: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no
e 3 Abs. . va ve 16.60
4 ; I ,w q DESCRIPTION OF'` WORK+ o
.w *:� .,.- . ,,,W.-,u ,. . , ti: ,,i.. .. ,,s .' = 0P i r em Backflow preventer Pa 2
A (.11- f �. 7-42-,12.4 (, y^ 7/ (0 /( : ac ater valve 16.60
Clothes washer 16.60
Dishwasher 1 6.60
��
Drinking ountain 16.60
t PROPE T�1' • OWNER - 1I : 5. i TEN € g
"I'''''''''''''=""' 1 ._ a-.- .- . ' '''14a4-1''''''''''''''''''""'"' , u; 4;11: Ejectors /sump 16.60
Name: I_ `� -
( tom, Expansion tank 16.60
Address: ( 7 . Fixture /sewer cap 16.60
City/State /ZIP: Floor drain /floor sink/hub 16 :60
Phone: (,?) (pp`Z,.-��g 7 Z Fax: ( ) Garbage disposal 16.60
Qr t „.. .. Hose bib 16.60
r � -1 -' APPL eNL C , CQN`I'AE I E
y
� � �:va P 4 � € : ; . � ` P - ,_ ,5•, 4 . �. t,a: 4 : _ I ..: 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:
-1;, Urinal 16.60
'.� * i y. CON , € x" ' ' � ,' '"� Water closet 16.60
ra »�:. e� ,da u�: m �" �..,�"., v hx� �X,+. , 4F -a.e , k 2sc•, , e ', ro , n , .a_ , . ., _ .
Business name � _ 60( , k � � a wl t ( in
Address: 2t !!! r A 6 (J t � t %.c , _ ` Other:
-
Water heater 16.60 " co Subtotal
City /State/Z]P
Lla et -700 Z Minimum permit fee: $72.50
Phone: az ) , j- C.' D,S'C Fax: ( ) Residential backflow minimum permit fee: $36.25 3h; . . ,95 CCB Lic.: (� C r r Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sign. State surcharge (8% of permit fee) �(�/
/ TOTAL PERMIT FEE */. / ID
Print nam : ' , YYl i 3I fLO ,. 14 Dated 3d - 0 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.
iABuilding\Pertnits \PLM- PermitApp.doc' 12/03 cal ' f 440 - 4616 02 /Cf�M/WE�
Plumbing Permit Application - City of Tigard
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Page 2 - Supplemental Information �►
Fee Schedule: Residential Fire Suppression Systems:
.rte l �
r �k ,, rN "e "R toTiZ '" ": "fit -aaw y : ,Sxi :.' ' 2 i ; ; i "��;,. s`
Site'Utilit1 , „ 4! 0, Q p Square F OOtage F.. P ermi t F ee,
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 sl nation s Perlantt Fee
$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
r' ?'
x Fee (ea) T o al
additional $100.00 or fraction thereof, to - and
I% U>Ce orJ Cnl �.
wow
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 fi rst $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
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 * .
m o t s Qu ntit b (F4x_t per l Woroerfo i l Z •
RrxtureType -; : Replac
A S f a X 0 :04g '419.0ttO 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"
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3"
- 4"
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
- 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\Pemtits\PLM- PertnitApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 639 -4175
INSPECTION DIVISION Business Line: ) 639 -4171 MST
y BUP
Received Date Requested . `'o AM � PM BUP
Location l 0 J •/ // � /,'L}\_. Suite MEC
Contact Person Ph ( ) de
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
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof /`
Other:
Final •
PA RT FAIL
LUMBIN
Post beam
Under Slab
Rough -In`
Water Service
Sanitary Sewer x7
4.
- Rain Drains
Catch Basin / Manhole
Storm Drain '
Shower Pan r
OttfEr: r``
_, "ART FAIL
NICAL-
Post.& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab •
Low Voltage
Fire Alarm
Final Q Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA Date 1 Z / d Inspector 4A A Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL