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Permit
C ITY OF T IGARD PLUMBING PERMIT I4, DEVELOPMENT SERVICES PERMIT #: PLM2004 -00187 '�" ..� I I 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 DATE ISSUED: 4/26/04 SITE ADDRESS: 13283 SW SCOTTS BRIDGE DR PARCEL: 2S104AB -03100 SUBDIVISION: MORNING HILL ZONING: R -4.5 BLOCK: LOT: 064 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: 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: 40 ft Remarks: Rain drain connection. FEES Owner: Description Date Amount KLAS, ROBERT + ROSEMARIE 13283 SW SCOTTS BRIDGE DR [PLUMB] Permit Fee 4/26/04 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 4/26/04 $5.80 Total $78.30 Phone : Contractor: M. LEON CONSTRUCTION 315 NW 107TH AVE PORTLAND, OR 97229 REQUIRED INSPECTIONS Phone : 503 - 643 - 6631 Rain Drain Insp Final Inspection Reg #: PLM 36771 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 Issued By Permittee Signature: ,� i - � 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 Date/By GG��II�� + Permit NNJ•l= 'v0 A 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie Phone: 503.639.4171 Fax: 503.598.1960 /iH 3 f\ Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 �f (I r : Internet: www.ci.tigard.or.us ^ ^ ^� - --� Date Notifieti/Method /Meto d: 'JutJG s /- Supplemental See Page upplement al In 2 for Information TYPE OF WORK . .. - •. FEE* SCHEDULE' - ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total 9 Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) • CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20 N1 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/ldtchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 . JOB SITE INFORMATION AND LOCATION Site utilities Job site address: t 57_ - 5 � ' - meek •>. - Catch basin or area drain 16.60 City/State/ZIP: T4 A e 1 411 223 Drywell, leach line, or trench drain 16.60 tik Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 1 I0.00 Cross street/directions to job site: '1.4 e (Y) mtgp.l EN N I c-1- - Manholes 16.60 c-i e.g./ D EIe •`V..-S Rain drain connector 1 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 Ceti . KE.C'a' •SsIST I _ No. . • „ - Backwater valve 16.60 C' IZ ) a` , # - Clothes washer 16.60 Dishwasher 16.60 ' ❑ PROPERTY OWNER . I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: .) ...A e,, t. Expansion tank 16.60 Address: 1 3 2e3 s\V S • r 1,;- _ • _ D _ Fixture/sewer cap 16.60 City/State/ZIP: I C Q. A 42_ , Cap._ d) - ' re_ 2_ Floor drain/floor sink/hub 16.60 Phone: (I>q') •od© 7l Coo Fax: ( ) Garbage disposal 16.60 -4 APPLICANT • • ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: "-----;,6 M 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 F ax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR ' • • - •• Water closet 16.60 Business name: 01, L__& t 4 t = e . Water heater 16.60 Address: 31'5 t-e � �'Y NY (9TN gE.. Other: City/State/ZIP: f�77�atp d • �'1 2'Zd� Subtotal 7 Minimum permit fee: $72.50 Phone: (6:03) C - 7j - - C� a 5 f Fax: ( ) _ Residential backflow minimum permit fee: $36.25 - �_ CCB Lic.: - 5C.'1 Plumbing Lic. no.: Plan review (25% of permit fee) �is I s �' State surcharge (8% of permit fee) � j ,g�j Authorized signature: i �, / TOTAL PERMIT FEE i g 36) Print name: R Q 1--- � S Date: 4 - /�,( ©¢ 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\Pemuts\PLMF- PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard - - ,i as 4 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' r. 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 Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and Flxtllre or Item 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 increase of sewer EDUs, a sewer permit will be issued and Ice MachiRefrig. Drains p 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 Ouantitv 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: • is\ Building \Pennits\PLM- PermtApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection . i Line: (503) 639 -4175 INSPECTION DIVISION'` .- Business Line: (503) 639 -4171 MST BUP Received Date Requested ! AM PM BUP Location / 3 Z3 Suite MEC Contact Person Ph ( ) PLM o�of - �o / 87 Contractor Ph ( ) SWR BUILDING Tenant/Owner k F7 ' — F oLS Ce ELC Footing � Q -,lam U 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 PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanita wer a n Drain Cott, asin / Manhole Storm Drain Shower Pan Other: Fin - mil+` -- PART FAIL HANICAL 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 Approach/Sidewalk Date q/..)--1 Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL