Permit 1� ,w
f. ^' CITY OF TIGARD PLUMBING PERMIT
Ik DEVELOPMENT SERVICES PERMIT #: PLM2004 -00192
.. �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/28/04
SITE ADDRESS: 11310 SW TIGARD ST PARCEL: 1S134DC -02800
SUBDIVISION: CHERRY HILL ACRE TRACTS ZONING: R -4.5
BLOCK: LOT: 010 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: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Addition of (1) water closet and (1) lay.
FEES
Owner:
Description Date Amount
ANDREW WEAVER
KATHERINE [PLUMB] Permit Fee 4/28/04 $72.50
11310 SW TIGARD ST [TAX] 8% State Surchan 4/28/04 $5.80
TIGARD, OR 97223 Total $78.30
Phone :
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Rough -in Insp
Final Inspection
Reg #:
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
Issu d By: ` ,!4, Si" v: A Permittee Signature: J( 6 ( \d --
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
\_
`` Plumbing Permit Application FoR d r�i Ic I •
., u :u ONLY
City of Tigard Received
/y IiR I 17 1 I _...� +00 ...,,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4 m = 'lid , Date /By Other Permit No :
24- Hour Inspection Line: 503.639.4175 - ■ - _ y Date Ready/13y Ready/13y luri' 0 See Page 2 for
Internet: www.ct.tigard.or.us Notified/Method. ,c 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 (I) bath 249.20
® 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/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11310 SW Tigard St. Catch basin or area drain j 16.60
City/State/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Weaver re -plumb & 1/2 bath addition Footing drain (no. linear ft.: ) Page 2
Cross street /directions to job site: Tigard St. and Gallo Ave. Proceed West on Tigard Manufactured home utilities 110.00
11 Manholes 16.60
- fro', d ostersi oW v\ r a, d . Co n i', n N SS r A, 9 Rain drain connector 16.60
0 - q H W '4 5-\e, P G\ T P OIP.rt1 wr. Gr1 U 1:01 o cet✓A Sanitary sewer (no. linear ft.: ) Page 2
II L t-r%'‘,-P fi O G 0 4 . \ \ 0 e . _ 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 BackOow preventer Page 2
Disconnect all installed galvanized pipe, install natural gas fueled tankless hot water Backwater valve 16.60
heater, re-plumb with copper pipe and add a 1/2 bath by converting a storage area Clothes washer 16.60
to a bathroom Dishwasher 16.60
* PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Andrew & Katherine Weaver Expansion tank 16.60
Address: 11310 SW Tigard St Fixture /sewer cap 16.60
City/State /ZIP: Tigard, OR 97223 Floor drain/floor sink/hub 16.60
Phone: (503)684 -0692 Fax: (503)684-0692 call before faxing 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: ( ) Fax:: ( )
Sink/basin/lavatory 16.60 I �_ (p(3
E -mail: Tub/shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 1 16.60 1 /p . (p 3
Business name: 6 to o e/2__ Water heater 16.60
Address: Other:
City/State/ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backfow minimum permit fee: $36.25 72,..
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6.80
Authorized signature: C A u ` CO ! TOTAL PERMIT FEE 70,40 70,40 Print name: Anc \re�nl \ij oil,f I Date: Li \La\O`i This permit application expires if a permit Is not obtained within
180 days after it has been accepted as complete.
*Fee mt thodoloav set by Tn - County Building Industry Service Board
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested f° - Z— AM PM BUP
Location 6 .--"�„ Suite MEC
Contact Person 0_/Vle!?e. Ph ( ) �D g � ( -� 9 Z PLM 2 o�-t- Co /
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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING Ara
Post & Beam � P
Under Slab r
Rough -In 1 /
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
le PART FAIL
ANICAL
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 L
Approach/Sidewalk Date �v /� Inspector Ext
Other: l
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL