Permit }
C ITY OF TIGARD PLUMBING PERMIT
CI DEVELOPMENT SERVICES PERMIT #: PLM2003 -00404
I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/6/03
SITE ADDRESS: 07160 SW VENTURA DR PARCEL: 1S125DC -02900
SUBDIVISION: WASHINGTON SQUARE ESTATES ZONING: R -4.5
BLOCK: LOT: 022 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: 1 OTHER FIXTURES: •
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace fiberglas. shower with tile pan and relocate lay.
FEES
Owner:
Description Date Amount
JOHNSTON, MICHAEL R + MARY ELLEN
7160 SW VENTURA DR [TAX] 8% State Tax 8/6/03 $5.80
TIGARD, OR 97223 [PLUMB] Permit Fee 8/6/03 $72.50
Total $78.30
Phone : 503 785 - 8939
Contractor:
DAVID SMITH PLUMBING
9545 SW KILLARNEY LN
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: MET 00003430
LIC 00100030
PLM 34-271pb
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: i i , ,/, � i� ,� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r Building Fixtures
Plum in Permit Application, FOR OFFICE USE ONLY
W Received �" Q - (� Plumbing
�Y�
J '.-=-1 Date/By: �' ty O 3 ) Permit No V JCZS oo�
' li4 `-' � � � � v �� -- Planning Approval Sewer
City of Tigard Planning Permit No.:
13125 SW Hall Blvd. p,,,, Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.•
- i/7.. , ,
Phone: 503 - 639 -4171 Fax: 503 = ` 19 0 ' '° ,,iiru4, (t Post - Review Land Use
� Date/By: Case No.:
- � i y 1
Internet: www.ci.tigard.or.us ' ; , ' �t - � ' . c11 I Contact Juris.. El See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 -"----"-- Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) 1 Total
R Addition/alteration /replacement El Other: New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
® 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: 7 / 4,6 Sz.,) -1)‹ "LAI‘ Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area d ra i n 16.60
Project Name: Drywell/leach line/trench drain 16.60
J Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
1 7 , lJ 4d - 6 V � / U 0 COr er Manholes 16.60
n Rain drain connector 16.60
R Ic IN {' Sanitary sewer (no. linear ft.) Page 2
Subdivision: // � ���� )tp - o, Lot #: Storm sewer (no. linear ft.) Page 2
lJ�`�7 t� ` Water service (no. linear ft.) Page 2
Tax map /parcel #: Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
/lp,, P, ;ex* S €.- W Ti /i Backflow preventer Page 2
P a i a n a t ra /llovG AAv 1. p -ban Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
14 PROPERTY OWNER ❑ TENANT Ejectors/sump 16.60
Name: /{7 / kP� le, p15 Expansion tank 16.60
Address: p d o 5(a Or Fixture/sewer cap 16.60
City/State/Zip: ,� C,/r 1 ' Z.S Floor drain /floor sink/hub 16.60
�' p ! rd / Garbage disposal 16.60
Phone`�3 66 , Fax: Hose bib 16.60
nAPPLICANT 40 CONTACT PERSON Ice maker 16.60
Name: Fj �'� k � C�. T -01 Interceptor /grease trap 16.60
Address: ii.., . (.J ��,, j ,4 Medical gas value: $ Page 2
P 16.60
City /State /Zip: 7 i ' T j �-`5 Roof drain (commercial) 16.60
Phon Fax:;j�°z� rJ Sink/basin/lavatory Ot 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
n,
Business Name: D4 via L 5 m / j Pik �rrhy ,�NG Water closet 16.60
Water heater 16.60
Address: 15q5 5, id), ki //a ► il 1) Other:
City /State /Zip: '7 /h 0 -,7047 Other:
Phone:503 d 9/- Z130 Fax: Plumbing Permit Fees*
�f/ Subtotal $
CCB Lic. #:100031 o Plumb Lic. #: Minimum Permit Fee $72.50 $
Authorized ,n 1� 4. ��
� `/� Residential Backflow Minimum Fee $36.25 -7 _5
Signature: AY Date: h Plan Review (25% of Permit Fee) $
David At S1` , sni State Surcharge (8% of Permit Fee) $ ..
(Please print name) TOTAL PERMIT FEE $ 7 ' . 30
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as n riser diagram for plan review.
/ 6 j ti !r *Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 3 4 _ 27/P$ .7/ /oy
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information t '
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: 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
additional $100 00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or 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 Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower x
- 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 *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPernitAppPg2.doc 01/03
C F TIGARD 24 -Hour . .
LDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION r Business Line: (503) 639 -4171
• BUP
Received Date Reque ted v AM PM BUP
Location 7/b ,IS,Q0 2241 S 7 Suite MEC
Contact Person / /�2 Ph (� ) - 3/ D S / � PLM 3 re '7
Contractor �J Ph ( ) SWR
BUILDING Tenant/Owner '� `G �� 1 3d^ ELC
Footing ELC Ink
Foundation Access: NM •
Ftg Drain ELR
Crawl Drain MUN
Slab Inspection Notes: / SIT ►'U_
Post & Beam
e�,
Ext Shear Sheath/Shear
S
ea Anchors
th /Sh
Ext eah/hear
Int Sheath/Shear U�u � — re ✓� ✓k _ r�� t � �
Framing �� e �
Insulation 65* e f�
Drywall Nailing 9
Firewall
Fire Sprinkler (? �
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
MB
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other
- AS PART FAIL
MECHANICAL
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' y T I o 3 Inspector Est
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL