Permit ✓
CITY OF TIGARD
PLUMBING PERMIT
I4 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00472
{�' 13125 SW H a l l Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/8/03
SITE ADDRESS: 13480 SW SANDRIDGE DR PARCEL: 2S105DD -04100
SUBDIVISION: PACIFIC CREST ZONING: R -7
BLOCK: LOT: 017 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: Installation of residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
MICHELLE HARROLD
13480 SW SANDRIDGE [PLUMB] Permit Fee 9/8/03 $36.25
TIGARD, OR 97223 [TAX] 8% State Tax 9/8/03 $2.90
Total $39.15
Phone : 503 - 524 - 9291
Contractor:
ESEQUIEL ROBLES LANDSCAPING
7076 RIDGEMONT DR N
KEIZER, OR 97303 REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 503 - 390 - 4353
Final Inspection
Reg #: PLM 7784
•
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
AO
I ued By: ah, - I ,, e / + � Permittee Signature: j / s ;��— ,ijQa , /NIP.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing r fixtures
,plumbing Permit Application FOR OFFICE USE ONLY
., Received 2 Plumbing
1 i_ Date/By: Permit No.: y: 9 / tT / Z,9 c Z
City of Tigard ' Planning Approval Sewer
`J g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Post - Review Land Use
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 / / , �i(' °\ Date/By: Case No.:
Internet: www.ci.tigard.or.us ' :iIi I Contact : El See Page 2 for
24 -hour Inspection Request: 503- 6394175 -- ' Name/Method: / A.O _ Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description - • I Qty. ( Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft for each utility connection)
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR ( bath 249.20
SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: I ZLOS 5l0 S Q K4. y 1 d p Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK Fixture or Item
Absorption valve 16.60
Backflow preventer J Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
ID PROPERTY OWNER I ❑ TENANT Drinking u ouptain 16.60
� Ejectors/sump 16.60
Name: M l at e;)1e 14 il Y bid Expansion tank 16.60
Address: i 3!f'o Sw San a i E9 Fixture/sewer cap 16.60
City/State /Zip: 'r k p Q v d 0 R a ` � Floor drain/floor sink/hub 16.60 ,
Garbage disposal 16.60
Phone: 56$ ,t{ 9 41 Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: S s9Qu l e L Rea to 5/ Interceptor /grease trap 16.60
Address: 7076 R; e P tb,t f DIZ Medical gas - value: $ Page 2
• 5 Primer 16.60
City /State /Zip: K 1 ze. d g Q7 � 3 Roof drain (commercial) 16.60
Phone:56" 3.. 99? -7z cf I Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower. pan 16.60
CONTRACTOR Urinal 16.60
Water closet 16.60
Business Name: eseTo gr,bltS icksasca pA Water heater 16.60
Address: 20? 6 R z o, e p V R Other:
City /State /Zip: e . a R 9-j3 t , 3 Other:
� _n" - c
Phone: (� pt Fax: Plumbing Permit Fees*
CCB Lic. #: Plumb. Lic. #: t(' Subtotal $
Authorized �� 1 Minimum Permit Fee $72.50 $ e 56 .,,:2 p Residential Backflow Minimum Fee $36.25
Signature: Date: / k•O 3 Plan Review (25% of Permit Fee) $
Cs e4iG ?c C gt . b r State Surcharge (8% of Permit Fee) $ Z • Y6
(Please print name) TOTAL PERMIT FEE $ 5.9 . / 5
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i :'Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard • 4
Page 2 - Supplemental Information n
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities - Qty." Fee (ea) Total Square Footage: Permit Fee: '
Footing drain - 1' 100' 55.00 0 to X000 $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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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
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 *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
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 *Note: If the fixture work under this ermit results in an
Garbage - Domestic p
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station -
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i :\Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
q BUP
Received "� ?la Date Requested 7 /� —. AM PM BUP
Location / 3 V8 -.2 Suite MEC
Contact Person Ph ( ) / '2-4/ PLM 3 — e 240e ,
Contractor 9/� Ph ( ) g' 7 '9 9 7V SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: 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
t .-7-2---
PLUMB! G
Post & Beam
Under Slab
Rough -In
Water Service
. Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P n
Other:
44 ?
PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for rein pection RE: El Unable to inspect — no access
Fire Supply Line 7
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL