Permit C ITY OF TIGARD PLUMBING PERMIT
4i, DEVELOPMENT SERVICES PERMIT #: PLM2004 -00214
' ..��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/25/2004
SITE ADDRESS: 09335 SW SATTLER ST PARCEL: 2S111DB -13300
SUBDIVISION: ZONING: R -4.5 •
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 310 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 182 ft
Remarks: Private site utilities for new 11 lot subdivision.
FEES
Owner:
Description Date Amount
BEACON HOMES
PO BOX 407 [PLMPLN] Plan Review 5/25/2004 $66.45
WILSONVILLE, OR 97070 [TAX] 8% State Surchari 5/25/2004 $21.26
[PLUMB] Permit Fee 5/25/2004 $265.82
Phone : 503 -570 -8828 Total $353.53
Contractor:
GVS CONTRACTING INC
700 N COLLEGE ST
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone : 503 - 538 -2998 Sewer Inspection
Sewer Inspection
Reg #: LIC 54340 Storm Drain Insp
Storm Drain Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -66 .
/,
Issued By: Permittee Signature: /; . dA
all (503) - 9-4175 by 7:00 P.M. for an inspection needed the next b Iss day
i
Site Utilities
op 0161\I Plumbing Permit % 's I ncation FOR OFFICE USE ONLY
Cif oTi and 2004 r N
Received
P ermit No.: �,,/ ,c�
�' g �'� � Date/By: --) , o O _„0 C i� - /PI
13125 SW Hall Blvd., Tigard, OR 9722 . GpBD Plan Review
Phone: 503.639.4171 Fax: 503.598 per/ D� le t l� Date/13y: , 4 / ! D� di Other Permit No.:
(�1� ' l
24- Hour Inspection Line: 503.639.417$ nmG D iSID wi g r.T I � Date Ready/13y: : , ; See Page 2 for
Internet: www.ci.tigard.or.us S Notified/Method: �° f/Cp. ®
Supplemental Information
.TYPE OF WORK FEE* SCHEDULE
I ew 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 OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building 13 Multi-family SFR (3) bath 399.00
,-,.,r Each additional bath/kitchen 45.00
[a
❑ Master builder "6her: I I � - , J/VI ,' y :y ,14 - 1 Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION - Site utilities
Job site address: r 95g,- 5 j : cc Si-. Catch basin or area drain i 16.60 16 .60
City/ State/ZIP: TlLd 6Q. q-12,24 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: ICe ys k- e , , z Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
11� Manholes 16.60
H.') t Stiler Cwc.s'�) t ,., No i'l 5.dc Rain drain connector 16.60
P r ;ar 42 . 7( rte e' , C, ,, J *Yvc. -4- , .,`)t: Sanitary sewer (no. linear ft.:11 ) Page 2 147 80
Storm sewer (no. linear ft.: I SZ.) Page 2 I Zy 1 40
-
Subdivision: k\- ES-L4' et.+.:se. Z 1 Lot no.: Water service (no. linear R.: Page 2
Fixture or item
Tax map /parcel no.: '-T L .* 131ce r 13 3. 0 SEc it ; TZS /l 1'i,
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
P(,,k: Stacy + We: 1 cfS A. : Ly Wa k- 11 Qixf'f Backwater valve 16.60
o f q /.ie 1 1 !O-1 i sAci. : ..i, 6v s •S Clothes washer 16.60
Pic. ROPERTY OWNER I .1 .,iiVebk or For ii s� 3 .0-0 ❑ TENANT Dishwasher 16.60
tom^' r. Drinking fountain 16.60
Ejectors /sump • 16.60
Name: 1,/
tifsi - Zee NGTMes Expansion tank 16.60
Address: P p 0.04 40'7 Fixture /sewer cap 16.60 •
City/State/ZIP: W, I A , y. IL 1 0 � o . Gj ) 70 Floor drain /floor sink/hub 16.60
Phone: ( -43) S D.° 6326 Fax: ( 53 3) ) s � isc� Garbage disposal 16.60
ILICANT �evNTACT PERSON Hose bib 16.60
.Lld
i Ice maker 16.60
Business name: .fie UT i t Interceptor /grease trap 16.60
Contact name: 1- R. tTertk CAN i1/4peer. , Medical gas (value: $ ) Page 2
Address: 115 i 3 .5 iv Sj Primer 16.60
City/State/ZIP: & .,.... Lit. 9 7 3.z- Roof drain (commercial) 16.60
(S ?) 3(3 ``) Z2 7 (5 3) 3 4 -I 2 Sink/basin/lavatory 16.60 •
Phone: � Fax::
l Tub /shower /shower pan 16.60
E-mail: JC be pow I fife, 1a , I S Urinal 1 6.60
CONTRACTOR Water closet 16.60
Business name: a vs (.4,44.,,,4 -•. I c. Water heater 16.60
Address: �• Other:
700 1 J. `.a l lee- 5�. -
City/State/ZIP: /4:,,„,130-, Subtotal
Ci
tY r tos q7 3Z �� I Minimum permit fee: $72.50 e1 i vii
Ni. Phone: (5 ) S Leiq l '372L Fax: Residential backflow minimum permit fee: $36.25 p(D I D
' ic CCB Lic.: 6434-0.6v5 1 Plumbing Lic. no.: ' , 'I ...j Plan review (25% of permit fee) /_ �
�w I. , / / /r } State surcharge (8% of permit fee) at,
Authorized signature O IIIi .�. TOTAL PERMIT FEE �'
Print name: ,Nar , • . S f I Date: i 3 444- This permit application expires if a permit is not obtaina VI i n
`A 1 � / 180 days after it has been accepted as complete.
1_ ._ 1-17Tec I, 1"'3 • *Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permits\PLMU- PcnnitApp.doc 12/03 J 440.4616T(10/02/COM/WBB)
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 5s.03 7,201 and greater $309.00
Sewer -each additional 100' Z 46.40 ci 280
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation:. • Permit Fee:
Storm & RRln Drain - 1st 100' 1 55.00 S4 , $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 4c, AO $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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 391ce 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
.
FixtureType: Re lace 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:
is\ Building \Pemtils\PLM- PermitApp.doe 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested BUP
Location ✓ _ � _ . Suite MEC
itio
Contact Person 'I Ph ( ) PLM 2cx' Al- -((
Contractor J �i� / Ph ( ) SWR
BUILDING Tenant/Ow 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 V •
Drywall
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS RT FAIL
L MBIN
Post & Beam
Under Slab \
Rough -In 1 Water Se _ �/ _ -i �,/ . �� III _ _f
/•
n s
Catch Basin / Manhole
Storm Drain
Shower Pan
0 uer:
40- 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 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 Date Inspector 1 Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL