Permit CITY TIGARD PLUMBING PERMIT
�� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00010
AA .,� II 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/13/2005
SITE ADDRESS: 10120 SW TIGARD ST PARCEL: 1S135CC -03400
SUBDIVISION: SCHLESINGER PART /MLP2002 -00012 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 450 ft
Remarks: Installation of 450' of private storm drain in easement.
FEES
Owner:
Description Date Amount
STACY SCHLESINGER
22455 SW SHOPE CT [PLUMB] Permit Fee 1/13/2005 $240.60
TIGARD, OR 97223 [PLMPLN] Plan Review 1/13/2005 $60.15
[TAX] 8% State Surcharl 1/13/2005 $19.25
[PLUMB] Investigation 1 1/13/2005 $240.60
Phone : 503- 968 -6500
Total $560.60
Contractor:
SM BUILDERS INC
11455 SW SHROPE CT
TIGARD, OR 97223 -4071 REQUIRED INSPECTIONS
Phone : 503 Storm Drain Insp
Storm Drain Insp
Reg #: LIC 86533 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 C 952 - 00 10 . You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 699.
Issu B y: J Permittee Signature:
• Call (503) 639 -4175 by 7:00 P.M. for an inspection neede the next business day
,. .. � 1ti�o2G) 'odd
Plumbing Permit A 11 IV .
City of Tigard Received
131 SW Hall Blvd., Tigard, OR 97223 bJNIV 1 L 2U�5 a D BY /' // .5 // v , Pe""it No 1 421 5 - ,/d ( 5/ 6
Plan Review. 1 Other Permit No..
- ,
Phone: 503.639.4171 Fax: 503.598.196 , y,; �,;i\ D ) / /3 /ps�w
24- Hour Inspection Line: 503.639.4175 T .
� s L - I 1 1 Date Ready/By: J9 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF i IG Noufied/Method $ � Cr ®
Supplemental information
BSI KDIVISION FEE* SCHEDULE
'a New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
Commercial /industrial and 2- family dwelling ❑ Comercial /industrial SFR (2) bath 350.00
-
-" Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 (4,b \ KT ) Catch basin or area drain 16.60
City /State/ZIP: ‘ (C-. Ii-V tU (IF.... Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: p pt.f� IT ) ) il L r )1 tG AV..,D Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: ST Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: /,97) Page 2 .
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
i(1(1�,,
'-\\Z-t\ DESCRIPTION OF WORK n I -, gackpow preventer Page 2
P - CA Cr \ Al S�Z \4‘1 l 'IV � , Backwater valve 16.60
\ \ '' `\ r 6 � k ry\ r� y U N Clothes washer 16.60
�� V �tuvv Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
((�� Ejectors/sump 16.60
Name: Z-7 , S, 1, -1`t -. k r ri.-'' ,1� Expansion tank 16.60
Address: 1 \ \:\-r S \V ` ___N Fixture/sewer cap 16.60
City /State/ZIP:1` l< I'J 4 7 '4 t^`7) Floor drain/floor sink/hub 16.60
Phone: 6K-1:-,) l,'..l V.-.1X) 0 Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
APPLICANT `[CONTACT PERSON
r Ice maker 16.60
Business name: "N S \� - _ • TAS
Interceptor /grease trap 16.60
< l
Contact name: \ r \ � J �/\ \rte.$ ( \ly Z, tP Medical gas (value: $ ) Page 2
Address: \ \ C - �/ S \_t Primer 16.60
City/State/ZIP: �` i Roof drain (commercial) 16.60
y `�-, C � - �ti�� a'l Ko'l,
Phone: ( 6% » „ Co `bt) I Fax:: , 2,) 6 - b tk (7 ubs asin/lavatory 16.60
Tub/shower/shower Tub /shower/shower pan 16.60
S \ `\ S V', P V\ 1 t, i
E -mail: `\1 4 Cy t , Urinal 16.60
CONTRACTOR - Water closet 16.60
Business name: S INN 9 V` (!,,,\O �S Water heater 16.60
Address: Other:
City/State/ZIP: Subtot nn''//vv
AJ STi Mi p fee: $72.50 O�`T�' 4"c Phone: ( ) Fax: ( ) a y !�
CCB Lic.: y.. V. S b` 1`0tit Plumbing Lic. no.: Plan review (25% of permit fee) , C 3 /
6J
Authorized signature: --41iW ir1- --( �. State surcharge (8% of permit fee) / 9, R 7
I l TOTAL PERMIT FEE 6" .40
Print name: S p)� 1 L t5 S 6 V \ ` �5 1 w a s , Date: P uC Thi perm application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
i• \Building\Pennits\PLM- PennnApp doe 12/03 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard r .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • Qty. l Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 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 ValuatlOD • 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 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
- 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\Permib\PLM- PermitApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING . Inspection Line: (503) 639 -4175
I ECTION IVISION Business Line: (503) 639 -4171 MST
!I l BUP
R ived t 5 Date Requested / l AM PM BUP
Location rO / '}mod' ST- Suite MEC
Contact Person Ph ( ) ) 62.4 a ) ;005 606 10
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing
r
Insulation
Drywall Nailing
g 6 i 30 /�
Fire Sprinkler / -
Fire Alarm
Susp'd Ceiling
Roof -
Other:
'- Final
PASS PART FAIL
` t UMB�IG
Post & b eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
orm i r -I -
• ,, er -Pan
Other:
e- 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 Q Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA �L,�^1
Approach/Sidewalk Date Inspector pry
Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL