Permit i► . s_ '
A CITY OF TIGARD
PLUMBING PERMIT
k DEVELOPMENT SERVICES PERMIT #: PLM2004 -00103
.� " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/15/04
SITE ADDRESS: 09490 SW SATTLER ST PARCEL: 2S111CA -00101
SUBDIVISION: ALDERBROOK FARM ZONING: R -7
BLOCK: LOT: 013 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 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: ft
Remarks: (1) clothes washer drain
FEES
Owner:
Description Date Amount
DARL L. SYNOGROUND
PO BOX 529 [PLUMB] Permit Fee 3/15/04 $72.50
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 3/15/04 $5.80
Total $78.30
Phone : 503 652 - 6584
Contractor: •
ADVANTAGE PLUMBING INC
PO BOX 300
GERVAIS, OR 97026 REQUIRED INSPECTIONS
Phone : 503 - 792 - 5907 Rough -in Insp
Final Inspection
Reg #: LIC 149447
PLM 24 -402PB
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
Iss ed By: , i, Vif fA / ; Permittee Signature: yQ'
Call 503 : 9-4175 by 7:00 P.M. for an inspection needed the ext business day
( Y
Buildii hixtures
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard DateBy �? / y p[/ Permit No.: � L+ 1 f .- 7/O 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /�ymu . p'l Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 a�. e` Date Ready/By: ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: f ' Supplemental Information
' • TYPE OF WORK _ ' : FEE* SCHEDULE " . . 7.
❑ New construction El Demolition For special information use checklist.
Description I Qty. I Ea. I Total
' Addi tion/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• CATEGORY OF CONSTRUCTION . + ; . SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
ID Accessory building ❑ 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,. Site utilities
Job site address: 9Y q SL,). 5 j / r Av Catch basin or area drain 16.60
� a / OO ell, leach line, or trench drain 16.60
City/ State/ZIP: c� /fi O. Drywell, ,
Suite/bldg. /apt. no.: / 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: 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 Page 2
Backwater valve 16.60
Clothes washer I 16.60 r6 rbn
Dishwasher 16.60
❑ PROPERTY OWNER I ❑TENANT • Drinking fountain 16.60
Ejectors /sump 16.60
Name: D A. r I Sy / 0, / O K n�c�
/ Expansion tank 16.60
Address: Po (o 7 Fixture /sewer cap 16.60
City/ State/ZIP: L -ci Ee s-,,2y, o f 9 7 Pfd Y Floor drain/floor sink/hub 16.60
Phone: ( So3 ) CS -- 6' S8 (/ Fax: ( NWA) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Ad( i14 e> *Q9.e G ( u. m. k iN, -1NC C.
Interceptor/grease trap 1 6.60
Contact name: J ps Q Co p Z Medical gas (value: $ ) Page 2
Address: (o 6 0 3 O 0 Primer 16.60
City/State/ZIP: 6e rVq,9 s o e 1 7 O a Roof drain (commercial) 16.60
I Sink/basin/lavatory 16.60
Phone: (yo3 ) 75 a -5-50 I Fax: : ( ) SCl/r'te
7 Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60 •
n pp CONTRACTOR . .y' • ' Water closet 16.60
Business name: /�glkikn/'�-gt e P( , A Mbin" X4 , c- , Water heater 16.60
Address: re &'x •C)0 J Other:
Subtotal i ( CD
City/State/ZIP: 6, r✓c S g. 1 7 0 P 6
J V Minimum permit fee: $72.50 �
Phone: ( 7 1"P - 5' 7 �/ / Fax: ( ) 5c� e Residential backflow minimum permit fee: $36.25 7pL . SO
CCB Lic.: f y 1 L(C-n to Xi (osa Plum ing Lic. no.: Plan review (25% of permit fee)
n'[ b State surcharge (8% of permit fee) 5 A O 0
Authorized signature: � r,4.... ( - �J�'�
PT 1 1S ��
p TOTAL PERMIT FEE
Print name: 5 Se_ M C J r Date: 3 -) 5= 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 \ Permits \PLMF- PermitApp.doc 12/03 440- 4616T(I0 /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:
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
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
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"
- 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 \Pemtit&PLM -Pc ntitApp.doe 3/03
CITY OF s IGARD. __ 24 -Hour %
2UILt)ING Inspection Line: (503)639.4175 n �"
INSPECTION DIVISION Busin - ss Li , e: (503) 639 -41.71 MST '
BUP •
Received Date Requested / - o�/ AM PM BUP r t
Location _ 6' d /- `7 cO SI/ mi � - 7 i Suite MEC /
Contact Person . , S ti� S'o - Ph ( 0 3) l A T 2 — (v S T y PLM - r 3
/O
Contractor � s Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain F" 0
Crawl Drain • •
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear /
Int Sheath/Shear -
•
Framing //
•
Insulation / ‘
Drywall Nailing
Fi rewall • _
Fire Sprinkler - - _ !�Ii� '� •
Fire Alarm • /
Susp'd Ceiling Dvt l� e" .9-74 s �� ,,Q el� � M1 i
Roof /// r /
Other: /2 v v .. 0lr A
Final
if - - PAPA FAIL / / /
PLUMBING �(C e. e v O Z . 1� iL -vT.r L 1 �P r�
Under Slab , /
Roug : / ' Watervice , ,- ✓J i• ,
Sanitary Sewer —// � �Q /
Rain Drains �, c �i 1/Y1 (
Catch Basin / Manhole /j- - ��� /nom c\
Storm Drain �`• u • i e-- ( 4 � —�
Shower Pa,
,/y c-e..4 .
;.•
I
PART FAIL
ANICAL
` Post & Beam -
Rough -In
Gas Line
i
Smoke Dampers i
Final /
PASS PART FAIL
ELECTRICAL /
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next I. 'section. Pay a - i Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call r reinsp tion RE: . Agra 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