Permit l
C ITY OF TIGARD PLUMBING PERMIT
I4 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00033
" Ail
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/1/2005
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: 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:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 505 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 505' of water service to service for a total of (4) lots. Some are future MLP lots.
FEES
Owner:
Description Date Amount
STACY SCHLESINGER
10120 SW TIGARD ST [PLUMB] Permit Fee 2/1/2005 $287.00
TIGARD, OR 97223 [PLMPLN] Plan Review 2/1/2005 $71.75
[TAX] 8% State Surcharl 2/1/2005 $22.96
Phone : 503 957 - 0237 Total $381.71
Contractor:
JOE PETRO PLUMBING
PO BOX 98
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Phone : 503 Water service
Plumbing final
Reg #: LIC 91524
PLM 3 -469PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699. ?4Th/vt?4,/64\-ter---
Issued By: rr� � Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1
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Plumbing Permit Application Fol2 oFFIc .: Hsi.: Orl.1
City of Tigard IAN z 2005 Received
13125 SW Hall Blvd., Tigard, OR 97223 RD Date/By 1 AD .0 Permit No: � c.l•9bbp� 33
rr F TIGA
Phone: 503.639.4171 Fax: 503.598.1969' O Plan Review OtherPemlit No.• 3 -a�SoZ
24- Hour Inspection Line: 503.639.417$VILDING DIVIS j', 1 �� �, Date/BY Re 2 l U S -Tv) '_ Date ReadyBy. � ® See Page 2 for
Internet: www.ci.tigard.or.us Notifed/Method / 1(O' 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 Et 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
1:1 Master builder Each additional bath/kitchen 45.00
0 Other Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 Q l a0 S to I G PAD St Catch basin or area drain 16.60
City /State/ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: PA0.T a (Q ti pa Tiff St, Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
/t)g5 t _ / i S Q Rain drain connector 16.60
(9/86 btu) KAiCe.4 V .t„L ' f-- '/ A 5/ - Sanitary sewer (no. linear ft.: Page 2
/Nab & ic �,,,C, be-- /65/ Storm sewer (no. linear ft.: ) Page 2 O0
Po: /0/4640
c
7 / Lot no.: Water service (no. linear ft. Page 2 A $, .
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
P L GE. Vd AT E Q L % N ss. 1 4 Re 094W) [) E AStAntin Backwater valve 16.60
V. 0 t- ti l iT• Ye9.6 Cti t Nt 0 USIS Clothes washer 16.60
�O�'` e# 5b5 Gott q A.014 a LOTS Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER ❑ TENANT
Ejectors/sump 16.60
Name: STAG \ SC1I l. • $$t 5 PAW L. Expansion tank 16.60
Address: I O , tJ 7 \c7'A LI t <R gas Aar Fixture/sewer cap 16.60
City / State/ZIP:' i G A ALL , o.,,, Floor drain/floor sink/hub 16.60
Phone: (S%)) r t5 1 • Qa 31 Fax: (5% ) 16% . 6t4 W Garbage disposal 16.60
❑ APPLICANT jai CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: S Q A h t �,, oist s t tigC. Interceptor /grease trap 16.60
Contact name: S 14N11, .5 SC\\t. F,S % i l O A\ Medical gas (value: $ ) Page 2
Address: 11}55 S StQ`� „ et Primer 16.60
City /State/ZIP: 1 Cr Q OP, ci 1. 4 Q 1 Roof drain (commercial) 16.60
c5 o3) ' 4 % • (050D (5 0 i t b6 t • bi DTI Sink /basin/lavatory 16.60
Phone: Fax:
Tub /shower/shower pan 16.60
E -mail: & rn S & -S T 6 v:%' d e rL . OM Urinal 16.60
CONTRACTOR Water closet 16.60
..-.)( Business name: ri1 / u /.-/ /,(.),, . Water heater 16.60
Address: o fix 69 der:
! `
City / State/ZIP: 1 R f i: 4 i L L 0 4. 1 7a''D Subtotal M o7.
Minimum permit fee: $72.50
Phone: ( j ) c J4 , Residential backflow minimum fee: $36.25
7 J 'l2 Z/ Fax: ( / 7 ) CLS�yoy permit
Lic.: 7/51'4/ / /e5A� Plumbing Lic. no.: 3-4/6 i -)?y Plan review (25% of permit fee) ?/.75
� l� r I p?A . 9lp
Authorized signature _ /r" y ,��, . / C ' 4 74 g "77 tl `0� State surcharge (8% of permit fee) TOTAL PERMIT FEE 4gA 'T(
Print name: J ®5 /P I Date: i LIB / C T his permit 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 \Permib\PLM- PermitApp dot 12/03 4404616T(I 0/02/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
Sewer - 1st 100' / 55.00 pU 3,601 to 7,200 $220.00
55• 7,201 and greater $309.00
Sewer - each additional 100' 5 46.40 a32 OC)
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
Q t y . • Fee (ea) Total additional $100.00 or fraction thereof to and
Fixture 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
and including $50,000.00.
specially requested inspections - per hour 72.50
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.
1 i. ' , t ,
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 • • ` = t••'
Fixture Type: Replace . _ .. ,
New Moved Existing Capped Comments regarding fixture work: ' '
Baptistry/Font •
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall •, • .. '
-Drive Thnr
Cuspidor /Water Aspirator , • • '
Dishwasher -Commercial . 4 - ,
- Domestic -
Drinking Fountain
Eye Wash '
Floor Drain/sink - 2"
-3"
-4" • ;
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work unde permit results in an
- Industrial • ' : increase of sewer EDUs, a sewer permit will.be issued and
Ice Mach./Refiig. Drains t . ,
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\ennits\PLM- PennitApp doc 3/03
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00033
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1 /2005
Phone: (503) 639 -4171 Avof A
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/16/2005 TIME: 7 :11AM PAGE: 29
SITE ADDRESS: 10120 SW TIGARD ST CLASS OF WORK:
SUBDIVISION: SCHLESINGER PART /MLP2002 -00012 LOT #: 001 TYPE OF USE:
PROJECT NAME: SCHLESINGER PARTITION
DESCRIPTION: Installation of 505' of water service to service for a total of (4) lots. Some are future MLP lots.
OWNER: SCHLESINGER, STACY PHONE #: 503- 957 -0237
CONTRACTOR: JOE PETRO PLUMBING PHONE #: 503 - 913 -1221
Inspection Request Scheduled For: Date: 3/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
P pI Art rgg I c 00 503 -968 -6500 Y
Corrections /Comments /Instructions:
c-63 V '
66
i a 4e •
X 1 , 1ZASS ❑. PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ��� Date: Phone #: (503) 718-