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Permit
CITY TIGARD PLUMBING PERMIT r DEVELOPMENT SERVICES PERMIT #: PLM2004 -00019 1 I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/15/04 SITE ADDRESS: 13327 SW SCOTTS BRIDGE DR PARCEL: 2S104A6 -03300 SUBDIVISION: MORNING HILL NO.3 ZONING: R -4.5 BLOCK: LOT: 066 JURISDICTION: TIG CLASS OF WORK: REP 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: 10 ft DISHWASHERS: RAIN DRAIN: ft Remarks: Repair of water service at front of lot. FEES Owner: Description Date Amount GARY DICKERSON 13327 SW SCOTTS BRIDGE DR [PLUMB] Permit Fee 1/15/04 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 1/15/04 $5.80 Total $78.30 Phone : Contractor: POWER PLUMBING CO P BOX 19418 PORTLAND, OR 97280 REQUIRED INSPECTIONS Phone : 503 Water Service Insp Final Inspection Reg #: LIC 52378 PLM 34 -150PB • 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 • sued By: �_� �IIJI[ �' '� Permittee Signature: Call (50 639 -4175 by 7:00 P.M. for an inspection nee. _ = e next business day Buildin .g Fixtures Plumbing Permit Application �D� FOR OFFICE USE ONLY City of Tigard 4' Date/By: / A� . _L /� - tlC/c/ Received 13125 SW Hall Blvd Tigard, OR 97223 g P Review Phone: 503.639.4171 Fax: 503.598.1960 1 // ,i Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 1 .jQ 2 _ ___ t` Date Ready/By: ® See Page 2 for I v Internet: www.ci.tigard.or.us Notilied/Method: / l�� Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New 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 ❑ 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: 400pffp.- ,)J 2 _ 7 , 7 . 1 / at,- p l' Catch basin or area drain 16.60 C _ City/State/ZIP: - J / 7 41 9 /e f 7e Z 3 Drywell, leach line, or trench drain 16.60 Yroject name: --/ Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: (r 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 _ _" Water y/ ! r+' ' Subdivision: 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 iee eiC / r f. TiKy t/Vq J-Fr L/ 17 >_ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 _- - - -- - -- - - Ejectors /sump I 16.60 Name: a � /,kie/�,,7 Expansion tank 16.60 - Mdress' - ! / 3 27 5 t../, S c.arr s B f-mi < is i, Fixture/sewer cap 16.60 P: ----) -City/StateZl-) GyrGr D 9 71 Ls Floor drain/floor sink/hub 16.60 PliOne: (IV j-r,.§ _7 r. 77f 1 ax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 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: Urinal 16.60 \ CO NTRACTOR Water closet 16.60 r Business name: { t P Water heater 16.60 C Address: J P �T f g (,' j g !�, Other: City/ State/ZIP: j � ©/ -i -f1Ji 02 - 9i�!/ Other: p Minimum permit fee: $72.50 (Phone: (5/::: 1t/tf - / / e Fax: ( ) Residential backflow minimum permit fee: $36.25 7Z ' CCBLic.: - < Plumbing - L c. no.: 6 Plan review (25% of permit fee) State surcharge (8% of permit fee) Se $v &uthorized signature; TOTAL PERMIT FEE -7.R , :fit/ Print name: lte: _? 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\PermitaIMF - PennitApp.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: 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' 46.40 100' Water Service - 1st 100 55.00 _ Medical Gas Systems: • Watei Service -each additional 100' 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 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: 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 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: i:\ Building \Penmts\PlM- PennitApp.doe 3/03 Jan -19 -04 01:44P ELI BEAVERTON HUB 5039728465 P -01 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RECEIVED POWER PLUMBING CO JAN 2 U 2004 P 0 BOX 19418 CITY OF TIGARD PORTLAND, OR 97280 Bytom DIVISION Plumbing Signature Form Permit #: PLM2004 -00019 Date Issued: 1/15/04 Parcel: 2S 104AB -03300 Site Address: 13327 SW SCOTTS BRIDGE DR Subdivision: MORNING HILL NO.3 Block: Lot: 066 Jurisdiction: R-4.5 Zoning: TIG Remarks: Repair of water service at front of lot. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: GARY DICKERSON POWER PLUMBING CO 13327 SW SCOTTS BRIDGE DR P O BOX 19418 TIGARD, OR 97223 PORTLAND, OR 97280 Phone #: Phone #: 503 - 244 -1900 Reg #: L1C 52378 • PLM 34 -150PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Aut orized Plumber If you have any questions, please call 503.718.2433. ( lc:)) 4 C/ ° 5C3-598 -1960 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP I Received Date Requested � t ] AM P BUP Location _ 2 �� 4-0 "AAA jle,Suite / , MEC ci Contact Person Ph ( ) PLM y '"DV d f' 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 -G � " ' Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling / 1 Roof Other: Final PAS T FAIL r - • M G Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain 6 Shower Pan Other: Fin- Air 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 Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL